Expert Panel on effective ways of investing in Health (EXPH), Defining value in “value-based healthcare”
Link to Report, click here.
Link to Factsheet, click here.
“Health is considered to be an intrinsic value: a precondition for pursuing a “good life”, for obtaining other (vital) goals what people wish to pursue in life. Since universal healthcare intends to provide health to the population (patient populations as much as the whole population) the “equitable” achievement of health for all is the aim as precondition for social cohesive European societies.
Currently, “value” in the context of healthcare is often discussed as “health outcomes relative to monetized inputs”, aiming at increasing cost-effectiveness. This interpretation of “value” is perceived by the EXPH as too narrow and the notion of “values-based healthcare“ seems more suitable in conveying the guiding principles underlying solidarity-based healthcare systems.
The EXPH therefore proposes to define “value-based healthcare (VBHC)” as 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) and contribution of healthcare to social participation and connectedness (societal value).”
The EU has made clear that the definition of value created for a market-based health system (outcomes relative to costs) is too narrow for universal health systems such as those found in the EU. Instead they believe the definition needs to adopt the four goals of personal, technical, allocative and societal value.
Implications for value
All health systems face resource constraints; workforce, time, money or carbon. Health systems that provide universal healthcare have an additional obligation to ensure that they use those resources for the good of the whole population. For this reason, the EU expert committee on value-based healthcare has adopted an approach to value that considers whole populations with a common need, individuals with that need and broader societal benefits.
The panel recognised that there are values underpinning health systems across the EU. Indeed, the Charter of Fundamental Rights of the European Union and the European Pillar of Social Rights secure universal access to affordable, preventive, curative and good quality healthcare in the EU.
At the Oxford Centre for Triple Value Healthcare (3V) we were delighted that our Founding Director, Professor Muir Gray, was appointed as the expert advisor to the committee. He was appointed in recognition of his distinguished work on value and population health, stretching back to his seminal Lancet paper in 1983. Hence, the position paper reflects Muir’s truly original thinking, his approach towards sustainable universal healthcare, referencing his work over the years.
The paper recognises that at the heart of value based healthcare is the notion that to find resources to fund true innovations it becomes essential to switch resources from lower value to higher value healthcare. Specifically, the EU Expert Committee describes four pillars of value-based healthcare:
The paper offers a sustainable and fairer future for healthcare. Implementing the recommendations will be challenging, it calls for nothing less than a change in culture, but the alternative is having to make difficult rationing decisions, cuts to services and worsening health inequities.
The report includes six recommendations, with culture featuring heavily. They are summarised below:
Recommendation 1: Creating greater awareness of health as essential in an equal and fair European society. This needs to provide a clear narrative setting out how the financial sustainability of existing progress towards universal health coverage is endangered by waste and low value care.
Recommendation 2: Develop a long-term strategy for a step-by step value-based approach towards change of culture.
Recommendation 3: Support Research & Development on/of methodologies on appropriateness and unwarranted variation
Recommendation 4: Support the creation of Learning Communities
Recommendation 5: Encourage health professionals to take responsibility and feel accountable Health professionals hold a key role in advocating a change of culture.
Recommendation 6: Support patients´ initiatives for engagement in shared decision-making.
 Muir Gray, J. A. (1983). Four box health care: development in a time of zero growth. The Lancet, 322(8360), 1185–1186