Value Based Healthcare

The last 20 years has seen dramatic improvements on the quality of healthcare provided, stimulated by reports both in the United States and the United Kingdom on the need to improve quality and safety published at the start of the century.  Improving quality and safety continues to be of vital importance and must continue, as does the need to increase the efficiency of health services, namely the outcomes achieved related to the resources invested.

However it is important to remember Peter Drucker’s principle that there is nothing more foolish to do something more efficiently than should not be done at all and it is vitally important to focus on value and the four perspectives on value identified by the EU in their 2020 report are set out below  these are set out below:

“the Expert Panel proposes to define “value-based healthcare (VBHC)” as a comprehensive concept built on four value-pillars:

  • personal value – appropriate care to achieve patients’ personal goals
  • technical value – achievement of best possible outcomes with available resources
  • allocative value – equitable resource distribution across all patient groups
  • societal value – contribution of healthcare to social participation and connectedness”

A simple example of the challenge facing us is proposed by consideration of variations and the rate of investment in musculoskeletal services and variation of the rate in hip replacement when the population is used in the denominator and not the number of patients treated.

Variation in spend








Variation in hip replacement











And we should be asking:

  • Is the rate of over 200/10,000 the right rate for this population or is it operating on people who really are not in the highest category of need and
  • is the rate of under100 the right rate for those populations or is there under provision complicated by inequity

What is also of great importance is an understanding that personalised value and population value are two sides of the one coin and that it is vitally important to look at ways in which we can ensure that every individual considering the hip replacement, or any other significant treatment, making what is sometimes called the fateful decision, fully understands the probabilities of benefit and harm and relates these to the problem that is bothering them most as well as the diagnoses.

Our mission is to promote and support value based healthcare.