《2016-1_Porter_What-is-value-in-health-care_Appendix-1》.pdf

This framework paper is Supplementary Appendix 1 to Porter ME. What is value in health care? N Engl J Med 2010; 363:2477-81 (10.1056/NEJMp1011024). VALUE IN HEALTH CARE Michael E. Porter, Ph.D. In any field, improving performance and accountability depends on having a shared goal that unites the interests and activities of all stakeholders. In most fields, the preeminent goal is value. The concept of value refers to the output achieved relative to the cost incurred. Defining and measuring value is essential to understanding the performance of any organization and driving continuous improvement. In health care, value is defined as the patient health outcomes achieved per dollar spent. Value should be the preeminent goal in the health care system, because it is what ultimately matters for customers (patients) and unites the interests of all system actors.1 If value improves, patients, payers, providers, and suppliers can all benefit while the economic sustainability of the health care system improves. Value encompasses many of the other goals already embraced in health care, such as quality, safety, patient centeredness, and cost containment, and integrates them. It is also fundamental to achieving other important goals such as improving equity and expanding access at reasonable cost. Despite the overarching significance of value in health care, however, it has not been the central focus. Indeed, value remains largely unmeasured not only in the United States but around the world, perpetuating health care delivery as an art and not a science amenable to continuous improvement. (Value must be measured directly in health care because profitability, the proxy for value in most industries, is not a reliable indicator of value in health care because of flawed reimbursement and lack of competition based on actual results.) Instead of value, health care stakeholders have myriad, often conflicting goals,