Much progress has been made in healthcare over the last 40 years, most of which has been achieved through technological advances in treatments, complemented by other approaches to increasing effectiveness:
There are, however, three outstanding problems in every health service irrespective of structure or funding mechanism.
1. Unwarranted variation, in access, quality, safety, cost and outcomes.
In turn, the presence of unwarranted variation reveals the other two problems.
2. Underuse of high-value interventions
In addition, health services will have to cope with rising need and demand in a context where resources are unlikely to increase at the same rate as need and demand. To ensure the sustainability of healthcare we need to achieve greater value from the resources available.
In the USA, the meaning of the term ‘value’ is different: it is conceived as the relationship between outcomes for the patient treated and costs. In countries committed to universal health coverage this relationship would be termed ‘efficiency’ and it relates to technical value.