How Do We Define Value in Health? Well, That Depends

OBJECTIVES: Defining value in health can be challenging as it depends on who the stakeholder is – if we map out a generic care pathway, we can see that there are multiple stakeholders. The central stakeholder is the patient followed by healthcare providers, payers, drug and technology manufacturers.

METHODS: A targeted gray literature search was conducted to explore how various stakeholders define value. Patient advocacy websites, industry magazines, and payer websites were reviewed to evaluate the variation between patients, providers, payers, and industry.

RESULTS: The literature search highlighted that, in healthcare, having a shared definition for the term ‘value’ is challenging as each stakeholder looks at this through their own individual lens.

For payers, value is defined as clinical effectiveness (efficacy and safety) and cost‑effectiveness (such as the QALY). For the pharmaceutical industry, value comes in the form of drug efficacy, safety, market access, reimbursement, and clinical outcomes. For providers, value ultimately means providing the best most appropriate quality of care; however, efficiency and resource are key considerations. Patients (who are arguably the key stakeholder) value having a relationship with their provider or HCP, a move from paternalism to partnership. They define value as shared decision-making and place a high emphasis on quality of life.

CONCLUSIONS: All stakeholders have a varied definition of value and often have conflicting goals. For policymakers, the definition of value has broadly remained the same for decades. Health is extremely complex and how we evaluate individual and population health has evolved over time. Our needs and priorities have changed, so is it time policymakers re-visited how value is measured?