is the most famous name in value-based healthcare with his succinct definition of value as “the patient health outcomes relative to the costs of care” often cited by policy-makers. Of his numerous publications we found What Is Value in Health Care?
(NEJM, 2010) to be the most thoughtful and comprehensive. It includes supplementary material on his approach to measuring the “outcomes that matter to patients”.
At the core of Porter’s contention is that value should only be understood from the perspective of the individual patient. In contrast, the Institute for Healthcare Improvement takes a population perspective. Their paper The Triple Aim: Care, Health, And Cost (Health Affairs, 2008) says high value healthcare is not possible unless improvement initiatives pursue three interdependent goals:
- Improving the individual experience of care (including quality and satisfaction)
- Improving the health of populations
- Reducing the per capita costs of care for populations
Muir Gray’s article Value based healthcare (BMJ, 2017) reflects the UK’s universal health system focus on equitably managing scarce resources by increasing the ‘value’ derived from the resources available for a population and reducing unwarranted variation in health outcomes.
The European Commission’s 2019 paper Defining Value in “Value-based Healthcare” has the broadest definition of any we’ve found. It rejects the Porter view of value as individual outcomes per dollar spent and proposes that value-based healthcare to be a comprehensive concept built on four value-pillars:
- Appropriate care to achieve patients’ personal goals (personal value)
- Achievement of best possible outcomes with available resources (technical value)
- Equitable resource distribution across all patient groups (allocative value)
- Contribution of healthcare to social participation and connectedness (societal value)
The World Economic Forum’s Laying the Foundation for Health System Transformation (2017) provides a global perspective and very clearly describes, in broad terms, the prerequisites for value-based healthcare.
For an Australian perspective, Kylie Woolcock’s 2019 Deeble Institute paper Value Based Health Care: Setting the scene for Australia does an excellent job of distilling the above material and more for the Australian context.