Health, Biomedical Science and Society Initiative

Value and quality in care are paramount

Value and quality in care are paramount. For any solution to have lasting impact, it must drive dramatic improvements in health care and health outcomes while increasing efficiency. The point is not to reduce costs at the expense of health. We need to enable innovations that drive up value to have the best health outcomes for our investment, and that should be our primary measure of value. We must reduce overuse and inappropriate care and deepen investments that truly make a difference to health. The United States already spends more per capita than any other nation ? more than we need to ? on health care. With proper redesign, we can have better health outcomes, better health for the population as a whole and improved efficiency at the same time. Fundamental improvements in value will be accelerated when doctors, nurses, insurers, researchers, communities and individuals ? in a word, everyone ? works toward these aims. The goal of improving value aligns everyone’s interests.

The goal of health care reform must be to improve health care value for individuals. This means enabling health and driving dramatic and sustained improvement in health care results. Contrary to popular impression, quality need not drive up costs. The goal of our health care system is not to provide more care, but to provide better health. And better health is often less expensive. There are myriad examples of improvements that would both enhance health and reduce spending.¹ In general, preventing the progression of a disease is less costly than the acute treatment of compounding complications. Doing things right the first time avoids the pain and expense of repeat procedures. Avoiding infections speeds recovery and reduces costs. Improving coordination avoids repeated tests and potentially harmful delays in care.

A significant amount of research examining quality has documented the economic and health hazards of poor quality. Indeed, several studies have found increased spending correlated with a lower quality of care.² Injuries, unnecessary care and ineffective treatments raise costs without improving health. About 1 million patients per year are injured, but not killed, by medical errors.³ In addition to the medical expenses, these injuries lead to lost wages and productivity. Almost 30 percent of health care spending (or $40 billion over four years) for Medicare-recipients with chronic conditions may be unnecessary.⁴ And only 40 percent of prescription drugs deliver their expected outcome; worse, adverse drug reactions from the ineffective drugs lead to many harmful results.⁵ Incorrect diagnoses raise costs and reduce quality by leading to inappropriate or ineffective care. While the incidence of these errors is difficult to track overall, errors of negligence in diagnosis account for 30 to 40 percent of malpractice costs.

Recognizing health care value as paramount aligns the interests of all stakeholders. Achieving better health outcomes is better for patients, less expensive for payers, improves productivity for employers, takes stress off families, and supports the goals of physicians and other health care professionals. Thus, not only can we afford the pursuit of better health, we can’t afford not to pursue improvements in health care value.