Value-based healthcare

April 12, 2018

What do we mean by Value-based healthcare
Louise Hurst and Muir Gray

Whilst the resources – time, carbon and money – to invest in healthcare may be limited, the potential to spend resources on health never is. New technology , changing population demographics and increased patient demand have limitless potential to drive spending on keeping people alive, and well, for as long as possible. It is therefore not surprising that our attention is increasingly focussed on the value of healthcare.

Value-based healthcare has, therefore, emerged as a field of its own [1]. Feet firmly founded in Evidence-based medicine, it forces us to ensure that the interventions offered have strong evidence of cost-effectiveness and confront essential questions about where we spend money, and why, and to consider if, and how, we might spend resources better.

Value-based healthcare has been described as  “the health outcomes achieved per dollar spent”[2] but in settings that have to meet the needs of a whole population from a finite budget this is not enough. In order to achieve the best value for a population, we need to ask if the resources available have been allocated fairly and optimally and to ensure that the people being treated are those who would benefit most and not just those people who have managed to be referred to the health service.

For value-based healthcare that is focused on equity as well as efficiency, people making decisions about the use of resources need to weigh up the opportunity costs of moving resources from one area to another.

Our definition, therefore, has expanded to incorporate and define different aspects of value:

  1. Allocative value
    Are we allocating resources to different conditions or illnesses in a way that represents good value for the population?
  1. Technical value
    Are we spending resources on the treatments (including prevention) in the places and on the people that offer the best value for the population?
  1. Personal Value
    As with evidence-based medicine [3], value-based healthcare must take into account the preferences of the patient. How does the individual patient value the outcomes (good and bad) of their treatment?

The Value-Based Healthcare programme, which is interlinked with the Centre for Evidence-Based Medicine is running its second Master’s level module on Value at the Department of Continuing Education in Oxford between the 9th and the 13th July this year. It is designed for people who want to get more value for individuals and the population from the resources available

Louise Hurst is a Public Health Specialist and Senior Associate Tutor and Research Fellow in Public Health, Nuffield Department of Primary Care Health Sciences. She coordinates the Healthcare Value Postgraduate short course.

Professor Sir Muir Gray is the Director of Better Value Healthcare and an Honorary Clinical Researcher, Nuffield Department of Primary Care Health Sciences. He leads the Healthcare Value Postgraduate short course.

  1. Gray J.A.M (1983) Four Box Healthcare; Planning in a time of zero growth

Lancet 2; 1185-1186

  1. Porter ME, Teisberg EO. Redefining health care: creating value-based competition on results. Boston: Harvard Business School Press, 2006.
  2. Sackett, D. L., Rosenberg, W.M.C., Gray, J.A.M., Haynes, R.B., Richardson, W.S. Evidence based medicine: what it is and what it isn’t. (1996) BMJ 312 (p.71).


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