Have We Been Misled about Determining Medical Value?

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Have We Been Misled about Determining Medical Value?

How many times have we been lectured on our need to focus on and deliver value when it comes to healthcare? Whenever I see this subject appear, invariably the equation “value equals outcome divided by cost” is cited. I’ve never seen this relationship among these three variables questioned - it has just been accepted as fact. To me, this formula looks eerily similar to that for measuring productivity. Should medical value be viewed/calculated similarly to productivity? I think not - we’re not making widgets!

This often-cited formula places far more emphasis on cost compared to outcome, since dividing by cost could yield a theoretic result for value approaching infinity (if cost can be sufficiently reduced), whereas outcome is inherently limited. Perhaps infinite productivity is theoretically possible in some settings, such as power from nuclear fusion. But, does the concept of infinite value for medical care make any sense? “Value equals outcome minus cost” would place more equal weight on the variables on the right side of the equation, and avoid the theoretical possibility of approaching infinity. However, that equation is similar to the one for profit, so it may not also be the correct one to determine medical value.

I’m not claiming to know the right equation to use to determine medical value, but I have serious reservations regarding the one that’s been apparently accepted by many leading physicians working on healthcare economic issues. It’s my hope that organized medicine, especially orthopaedic societies, emphatically question the Pied Piper tune of “value equals outcome divided by cost.” I raised this hope at the 2019 AAOS NOLC, and heard a few months later at the Fall AAOS meeting in Nashville that there might be some movement towards questioning this formula for medical value.

Years ago, resistance by such organizations against the dangers of prescribing sustained-release opioids (such as OxyContin), and also against the “pain is the fifth vital sign” campaign, were woefully anemic. Hopefully, our societies will become increasingly bolder and more resolute. I’m thankful that the WOA gives platforms to perhaps contrarian views, such as what I’ve expressed here.

Omer A. Ilahi, MD
[email protected]

Further reading:
Quinn RH, Murray J. Academy Defines Quality and Value in Musculoskeletal Health Care. AAOS Now. January 1, 2020.


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