Great progress has been made in all health services over the last forty years but these problems remain. One is unwarranted variation in investment, cost and outcome which reveals the other two:

Underuse of high value interventions. This results in

  • failure to prevent death and disability which may aggravate.
  • Inequity

Overuse of lower value interventions. This results in

  • waste – activity that consumes resources which could give greater value if used for another group of patients, which may also result in
  • patient harm

In addition, need and demand are increasing faster than resources, both financial and human. It is therefore essential to focus on value which is broader than, but encompasses, quality, cost effectiveness and efficiency. The concept of value now has four meanings, adopted by the European Union and the G20:

  • Personalised Value – how well do the outcome relates to the problem that was bothering them most
  • Allocative Value – how well are resources allocated to different populations and sub groups
  • Technical Value – how well are resources used for all the people in need in a population.
  • Social value – how well does the health service add value to its population

Value based healthcare embraces the paradigms of quality improvement and evidence-based decision-making. The aim is better value both for individuals and populations.

This book summarises the key concepts and skills to reduce waste and increase value for people who page for or manage healthcare resources, including clinicians and patients’ organisations.


For decades clinicians and health services have focused on providing high quality care for patients and public health has focused on populations with the aim of preventing disease. However, these two perspectives need to become one if we are to provide high value care to individuals and populations, and reduce inequity which persists even in countries committed to universal healthcare. The new paradigm is called population healthcare or population health management to use another term. Everyone paying for or providing healthcare needs to think about the whole population served as well as about those people who reach that services and are treated by it. Only by taking this perspective can we ensure the optimal use of the resources available, and the time of healthcare staff rather than money is the key finite resource , and indeed the sustainability of universal healthcare.