LESSON 1 ESSAY
At some point you or a loved one will need healthcare services. Write a 1 - 2 page paper on what delivering value in healthcare means to you as both a professional and consumer. Be sure to incorporate several key points you learned from the lessonreading.
You must use APA format. Your essay should be double-spacedwith 1" margins on all sides. You should use a 12 point font that is legible.
© 2017 Marzorati and Pravettoni. This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms. php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License (http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms (https://www.dovepress.com/terms.php). Journal of Multidisciplinary Healthcare 2017:10 101–106 Journal of Multidisciplinary Healthcare Dovepress submit your manuscript | www.dovepress.com Dovepress 101 P E R S P E C T I V E S open access to scientific and medical research Open Access Full Text Article http://dx.doi.org/10.2147/JMDH.S122383 Value as the key concept in the health care system: how it has influenced medical practice and clinical decision-making processes Chiara Marzorati1,2 Gabriella Pravettoni2,3 1Foundations of the Life Sciences, Bioethics and Cognitive Science, European School of Molecular Medicine (SEMM), 2Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, 3Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy Abstract: In the last 10 years, value has played a key role in the health care system. In this concept, innovations in medical practice and the increasing importance of patient centeredness have contributed to draw the attention of the medical community. Nonetheless, a large consensus on the meaning of “value” is still lacking: patients, physicians, policy makers, and other health care professionals have different ideas on which component of value may play a prominent role. Yet, shared clinical decision-making and patient empowerment have been recognized as fundamental features of the concept of value. Different paradigms of health care system embrace different meanings of value, and the absence of common and widely accepted definition does not help to identify a unique model of care in health care system. Our aim is to provide an overview of those paradigms that have considered value as a key theoretical concept and to investigate how the presence of value can influence the medical practice. This article may contribute to draw attention toward patients and propose a possible link between health care system based on “value” and new paradigms such as patient-centered system (PCS), patient empowerment, and P5 medicine, in order to create a predictive, personalized, preventive, participatory, and psycho-cognitive model to treat patients. Indeed, patient empowerment, value-based system, and P5 medicine seem to shed light on different aspects of a PCS, and this allows a better understanding of people under care. Keywords: health care system, value, value-based medicine, patient empowerment, clinical decision-making, patient centeredness Introduction Nowadays, the concept of value is a prominent topical issue in health care. Individual needs, wishes, preferences, and ethics influence the meaning of value which, in turn, is influenced by different cultures or historical periods.1 The necessity of finding better ways of redirecting the incentives away from volume and toward value pushes patients, physicians, policy makers, and other stakeholders to turn their attention toward what value means and what are the main features of this concept.2 Even if there is still no unanimous agreement on value’s definition, it is commonly accepted that values in health care may be defined as normative guidelines helping us to evaluate actions or situations and influencing the decision-making process.3–5 Different studies point out how the definition of value changes according to the reference sample: doctors’ values, most of the time, do not match the values of the patients, and vice versa.3,6,7 The presence of different opinions encourages some reputable organizations and associations to base their definitions of value on expert judgment or on empirical studies Correspondence: Chiara Marzorati Foundations of Life Sciences, Bioethics and Cognitive Sciences, European School of Molecular Medicine, Via Adamello 16, 20139 Milan, Italy Email chiara.marzorati@ieo.eu Journal name: Journal of Multidisciplinary Healthcare Article Designation: PERSPECTIVES Year: 2017 Volume: 10 Running head verso: Marzorati and Pravettoni Running head recto: Value as the key concept in the health care system DOI: http://dx.doi.org/10.2147/JMDH.S122383 http://www.dovepress.com/permissions.php www.dovepress.com www.dovepress.com www.dovepress.com https://www.facebook.com/DoveMedicalPress/ https://www.linkedin.com/company/dove-medical-press https://twitter.com/dovepress https://www.youtube.com/user/dovepress Journal of Multidisciplinary Healthcare 2017:10submit your manuscript | www.dovepress.com Dovepress Dovepress 102 Marzorati and Pravettoni that correlate attributes of value with a measurable outcome. According to this, the American Heart Association (AHA) underlines that, even though clinical efficacy and outcomes constitute the primary basis of good medical practice, value plays – together with costs – an important role, and it includes positive results in patient’s outcome, safety, and satisfaction at a total cost that is reasonable and affordable.6 However, in 2008, the Institute of Medicine7 (IOM) held a 2-day workshop to explore key stakeholders’ perspectives on value in health care, seeking to understand the meaning of value. Finding a mutually acceptable agreement among the different points of view, as expressed by patients, providers, economists, payers, and employers, is understandably complex. In fact, providers considered value on the basis of appropriateness of care and effective, evidence-based interventions; economic representatives defined value as the clinical benefit achieved for the money spent. Patients, however, place their attention on the ability of health care to satisfy their goals: a valuable intervention is a way of treating that also fulfills their needs.8 Indeed, from a patient’s perspective, the burden of illness is not limited to disease status, but it is also important to consider quality of life (QoL) factors and, more precisely, health-related QoL, referring to its clinical dimension. Patient’s needs are frequently measured taking into account different aspects of QoL, such as pain, emotional and cog- nitive functioning, or functional impairment.9,10 Moreover, a recent review11 on patient’s perceptions of quality of care emphasizes how communication, health care access, and shared decision-making (SDM) are the key elements in a valuable health care environment. Nowadays, even if we narrow our attention to the medi- cal context, we are not able to identify the core features of a health care system based on value because every paradigm adopts different definitions of value. The absence of common and widely accepted meaning allows each movement in health care practice to take into account different components of value identifying different model, of care. The aim of this article is to provide an overview of the main approaches of the last 10 years that have considered value as the key theoretical concept. As we shall see, each movement adopts a particular definition of value leading to a different application of these paradigms in the health care system. From evidence-based medicine (EBM) toward value-based medicine (VBM) Two decades ago, the EBM was the first movement in health care that disregarded the paternalistic approach and revolutionized the idea of doing science. The EBM intro- duced a new way to make good clinical decisions: health care decisions should be based on the best available evidence mixed with the clinical expertise.12 External evidence and clinical expertise must be integrated with patients’ preferences in making medical decisions about their care; only in this way, doctors will be able to identify the best interventions to maxi- mize QoL of patients and minimize the cost of their care.13 Despite its success throughout the scientific world, some researchers have started asking whether this paradigm has been facing a crisis. Among different reasons, Greenhalgh et al14 suggested that, during the course of the years, EBM has forgotten the importance of individualism. Evidence should be understandable by all patients, practitioners, and other stakeholders, and they should share discoveries and fears to take reasonable decisions.14 At the same time, preferences, wishes, thoughts, and all individual aspects of patients were included in the conceptual label of value, becoming like a constellation of principles with an important role in life. Fol- lowing the definition of Sackett et al15 with “patient values we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient.” In the last 10 years, to re-emphasize the importance of patients’ preferences and QoL, new paradigms were born, turning their attention toward individual aspects and focus- ing on patient’s value. Consequently, health care paradigms faced a shift from EBM to VBM. The term “value-based” was first introduced by Brown et al who defines this new paradigm as “the practice of medicine incorporating the highest level of evidence-based data with the patient per- ceived value conferred by health care interventions for the resources expended.”16 EBM focuses its attention on clinical trial results and uses these data to provide the best care and, in the meanwhile, it usually ignores the importance of QoL improvement. Instead, the VBM leads to a higher level the discoveries of EBM cal- culating the value of operations in medical practice, based on pharmacoeconomic principles.1 The value is measured objectively by calculating the improvement in QoL and life expectancy after surgery: the result is the benefit derived from an intervention for the costs expended.17,18 In other words, VBM takes EBM to a higher level, including the QoL in the data analysis and interpreted the data in relation to the value and costs of an intervention. In so doing, VBM utilizes a health care economic cost–utility analysis where results could be interpreted in terms of $/QALY (quality-adjusted life year), considering the dollars spent for the improvement in length of life and/or QoL on a continuum from 0.0 (death) to 1.0 (perfect health).19 QALY is the arithmetic product of life www.dovepress.com www.dovepress.com www.dovepress.com Journal of Multidisciplinary Healthcare 2017:10 submit your manuscript | www.dovepress.com Dovepress Dovepress 103 Value as the key concept in the health care system expectancy combined with the measurement of the quality of remaining life years.20 The choice of the “right methodol- ogy” had been controversial, and they finally opted for a time trade-off cost–utility analysis since it would be applicable in any specialty of medicine, allowing a comparison across dif- ferent interventions.18