Improving value is a unanimous goal for health systems worldwide. This imperative emerges from a reality where healthcare budgeting faces escalating pressures—not just from competing funding priorities, but also from the demographic shifts of ageing populations and the pandemic’s lasting impacts.

The intrigue lies in the insufficient attention paid to the true definition of value in healthcare. Despite intense interest, one would expect a standard definition, but instead, we find ambiguity. What does ‘value’ signify, and to whom does it apply? There seems to be no collective agreement on this.

For health systems reliant on financial metrics, ‘value’ implies doing more with less. Operational efficiency is paramount, as is the reduction of waste and redundancy. Operational efficiency is crucial, as is minimizing waste and redundancy. This principle is not confined to any particular system; it is a universal goal in the global health landscape.

Universal coverage health systems present a more complex scenario. Whether it’s the Bismarck model, which blends employer and government funding, or the Beveridge model, characterized by national, budget-capped funding, these systems demand a broader definition of value that includes social care aspects and costs.
The conundrum deepens when considering the recipient of care—the individual patients. Are their perceptions of value identical to that defined by the health systems? Invariably, disparities arise, with individual and systemic perceptions of value not always aligning.

Recent developments in both Beveridge and Bismarck systems have promoted the notion of personalised care, tailored to the patient’s aspirations within the inevitable financial constraints. However, individual and systemic goals still frequently clash.
Consider the allocation of new treatments. In budget-limited systems, prioritisation is often necessary to extend resources. Yet, individuals invariably seek the best possible care regardless of cost, leading to complex systems designed to ration care equitably. The ethical framework for such decisions remains a topic needing further deliberation, as a consensus on the best approach is elusive.

Some health systems have experimented with allocating a fixed budget directly to patients, allowing them to decide on its use. This has resulted in individuals making choices that veer from traditional healthcare spending, illustrating the diversity of personal values and priorities.

It’s clear that a singular approach to these ethical quandaries is yet to emerge. The ongoing debate is essential and must be more transparent and inclusive. It’s crucial to ensure that care—however it is defined—is delivered efficiently and that caregivers operate in a system where they are adequately supported by those they serve. This nuanced conversation about the meaning and management of value in healthcare is not only necessary for advancing the field but also for ensuring that all parties, from policymakers to patients, are part of a dialogue that shapes the future of health services.

– Dr. Charles Alessi,
Chief Clinical Officer of éditohealth and Steering Committee member of Radical Health Festival