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Researching the Value in Health Care

Introduction

Value in health care involves interplay of various important factors including cost, quality, safety, outcomes, and innovation. However, health care stakeholders are faced with challenges in striking a balance between these factors. In this light, this paper is based on the 2009 IOM’s report on Value in Health Care, and particularly on the relationship to prevention and cost effectiveness. Health care providers perceive prevention to play a major role in sustaining cost-effective health care. According to the 2009 IMO report, there are four key points in relation to prevention and cost-effectiveness (The National Academies Press, 2010, p. 69). The proceeding paragraphs evaluate these arguments based on the analysis of health care researchers’ viewpoints and findings.

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Prevention should not be limited by cost

The cost of prevention intervention should not be the reason for sidestepping the intervention since the long run cost that can be incurred on health event often outweighs the cost of prevention. However; Cohen, Cowley, Dorros, Faxon, Holmes, Jacobs, and Kelsey (2008) argue that the majority of preventive health care interventions involve monetary expenditures (p.1234). The cost of prevention is usually less than the cost of cure. Often, preventive healthcare programs are extremely cost-effective. Instead of focusing on the cost savings of the preventive healthcare intervention, the relevant bodies should implement an extensive approach that begins with the extent of its benefits as opposed to the extent of the reduction in downstream healthcare expenditures (The National Academies Press, 2010, p.70). The opinion that preventive health care saves money is rather a shallow view on the benefits, and subsequently priorities, for prevention. The IMO report purports that this point needs a consistent reinforcement. This conception is an indication of the problem in regulating health care cost by other means.

Prevention in terms of improvement of quality versus the length of life

When prevention translates into extension of life, it may often lead to future costs in terms of both medical and nonmedical costs. This case can have considerable impact on the cost effectiveness of the program. Incorporating these costs can significantly alter the cost-effectiveness ratio, thereby improving the cost effectiveness of interventions that lengthens life (Carman & Kooreman, 2007, p.26). This implies that when one wants to reinforce the economic case for prevention, concentrating on the programs that primarily enhance quality of life might be prioritised over those that lengthen life.

The aforementioned ideology is less practical with regard to youthful population constituting the workforce and even less practical for older population if working lives increase with increased longevity, although the trend in retirement ages in the U.S. in the previous years has been the opposite (Porter, 2010, p.16). This serves to shift the goal of prevention from that of saving money to that of accounting for future costs for its tendency to make programs that enhance quality of life probable to be more cost-effective relative to those that lengthen life.

The basis of the value of prevention

A wide range of preventive programs exist that vary in their cost-effectiveness based on the circumstance of their use. Policy consideration demands a fine distinction of the specific approaches to proposed prevention and the target population and the context in which they will be applied (Ginsberg, Fisher, Shahar, & Bornstein, 2007, p. 231). The Pap smear study helps to validate the importance of context; even though it is highly cost effective when received once at intervals of three years, it has no more or less incremental benefits if performed more often. Although eliminating more frequent Pap smears that are not cost-effective could improve the overall healthcare system, Raffle, Alden, Quinn, Babb, and Brett (2003) warn that, one must take caution regarding eliminating inefficient use because efficient use may be compromised also (p.903). In addition, non-selective application can transform a potentially cost-effective intervention into non-cost-effective. The Institute of Medicine (2006) argues that, the concept has been demonstrated drastically in studies of intensive treatment of diabetes in which “a remarkable heterogeneity in patient preferences is evident” (p.39). This discrepancy is based on the patient’s viewpoint on the quality of life attached to the therapy.

Value of prevention in terms of technology

The notion that the value of prevention is based on one’s use of it implies that people need to carefully consider how to use cost-effectiveness analysis in policymaking (Vijgen, Hoogendoorn, de Wit, Limburg, & Feenstra, 2006, p.425). The judgements of policymakers is important in situations where a cost-effective analysis indicate that an intervention could be cost-effective when used in a particular way (Porter & Teisberg, 2006, p.372), but not used that way practically given a range of policy options to choose from that may alter the cost-effectiveness of the program. Conception that the value of prevention interventions should be analysed in the context of use leads to consideration of approaches that can alter the application of technologies. A wide range of possibilities ranging from patient-focused methods to provider-focused methods, are available to impact on people’s behaviour.

Conclusion

Prevention is considered a significant component of health care because of its potential to impact health and control specific aspects of health care costs. Nevertheless, the value of prevention differs greatly based on the approach selected and the way and the target population.

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Reference list

Carman, K. G., & Kooreman, P. (2007). Flu Shots, Mammograms, and the Value of a Statistical Life. Tilburg University and Netspar; Department of Economics.

Cohen, H., Cowley, M., Dorros, G., Faxon, D., Holmes, D. R., Jacobs, A., & Kelsey. (2008). Percutaneous coronary intervention in the current era compared to with 1985-1986: the national heart, lung and blood institute registries. Circulation, 102 (24), 2945-2951.

Ginsberg, G., Fisher, M., Shahar, I. B., & Bornstein, J. (2007). Cost–utility analysis of vaccination against HPV in Israel. Vaccine, 9, 229–236.

Institute of Medicine. (2006). Performance measurement accelerating improvement. Washington D.C: National Academies Press.

National Academies Press. (2010).The value of health care:Accounting for cost, quality, safety, outcomes and innovation- workshop summary. Four Key Points About Prevention and Cost-Effectiveness Analysis. Washington D.C; National Academies of science.

Porter, M. E. (2010). Health policy and reform. The new england journal of medicine, 12(2), 14-19.

Porter, M. E., & Teisberg, E. O. (2006). Redefining Health care: creating value-based competition on results. Boston: Harvard Business School Press.

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Raffle, E., Alden, B., Quinn, M., Babb, J., Brett, T. (2003). Outcomes of screening to Prevent cancer: analysis of cumulative incidence of cervical abnormality and modeling of cases and deaths prevented. British Medical Journal, 326(26), 901-906.

Vijgen, S. M., Hoogendoorn M., B. C., de Wit, G. A., Limburg, W., & Feenstra, T. L. (2006). Cost effectiveness of preventive interventions in type 2 diabetes mellitus: a systematic literature review. Pharmacoeconomics, 24(5), 420-31.

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