The Confusion of Shifting Value

Our medical care system is missing a framework for understanding the value that patients seek in a medical care encounter. The act of seeking medical counsel is itself a defining characteristic of a patient. Understanding how one comes to seek medical care in the first place is essential to framing a patient's concerns in the right context.

As good business theory goes a transaction is the exchange of tangibles or intangibles that a party values less for other tangibles or intangibles the same party values more. Simple enough.

If quality is a desired outcome of our care system then it might be useful to analyze it in the context of creating value for patients and physicians. For a customary attempt at consistency in what I hope to be an exploration in this matter I will propose a few term definitions. I anticipate these will need refinement to more easily and accurately describe the variables here.

Quality - as in the degree to which something is excellent - can be thought of as an effect of competitive forces acting on the players of each side of transactions occurring in any market.

Value is the relative worth - measured in currency, time, et cetera - of those items being exchanged. The value of what is being exchanged is determined by the participants freely making a transaction.

Lastly, the greater the value that each transacting party places on what it receives relative to what it gives the greater the likelihood for quality to emerge from the exchange. Not exactly groundbreaking.

What seems to elude so many who say they are concerned with fixing health care is that health care is quite different than medical care. More importantly, the quality of medical care has a relative value to each participant of the transaction - the patient and the physician.

The value that a 30-year-old man with asymptomatic and undiagnosed hypertension would place on medical advice for the disease is very low. That, of course, is the reasonable and intelligent value he should place on such advice if he neither senses the effects (asymptomatic) of hypertension nor has had the deadly disease factually identified (undiagnosed). The same man whose untreated hypertension intensifies to the degree that he develops symptoms troubling to him will place greater value on the very same medical advice. All obvious.

However, underlying the observable relationship between quality and value in medical care are the mechanisms that differentially determine value for patients and for physicians. These shift variably but predictably when viewed through the lenses of mechanisms to help reveal their root causes.

Perhaps it would be fruitful to discuss those putative mechanisms here.