Assessing value in health care programs

摘要

MANY HEALTH CARE SERVICES PROVIDED IN THE United States are of low value, meaning that the cost of providing those services is high relative to the health care benefit they confer. In some cases, the care provided may have no value or even, on average, may be harmful. Examples of low- or negative-value services include unnecessary surgery or diagnostic imaging that will not change management. Given estimates that 30% of the dollar2.5 trillion the United States spends on health care services each year may provide little benefit,1 there is a widespread eagerness to enhance the ratio of benefits to costs.Because value matters in health care, when new health care programs are proposed it has become common to ask, "What is the return on investment from implementing this new program?" Implicit in this question is that programs should be supported if they save money but not otherwise. Positive return on investment, meaning that more money is saved than is spent, has become the standard by which new initiatives are evaluated. This standard has been used to evaluate new programs such as the primary care medical home, disease management, and the projects submitted for the new Center for Medicare & Medicaid Services Innovation Challenge.