Monday, 28 April 2014

How the health value can be measured?

At first, talking of health value seemed as if it was initiating a debate in the area of epistemology. Instead, in the hands of Michael Porter, this issue becomes very practical: “What results in terms of health have been achieved and what were the costs?”. Put this way, it seems fairly clear, but then it’s logical to ask ourselves: What is an outcome in terms of health?

As the renowned Harvard professor sees us, the ones dedicated to this, as a bit stuck, he gives us a clue in the following table, proposing three levels of results (tiers) and two subgroups within each.

Now, with the previous table on the retina, let's get into the skin of a Integrated Practice Unit who needs to present their clinical results, beyond the usual indicators of suitability and efficiency. If, for example, we think of a functional unit responsible for an oncologic process, a very important fact should be the survival of patients treated in a given period, say five years. And while admitting that this would be very useful information, we have, however no knowledge at this point as to what are the survival factors attributable to the different oncologic units.

However, despite this inexplicable lack, let’s assume that we manage to know the survival factors attributable to the results of work of specific cancer units (dreaming is free). So it would be nice to associate this data with a cost denominator, thus obtaining the health value of Porterian inspiration.

                                                             Survival at 5 years
Health Value =  -------------------------------------------------------------------------------
                                            Process costs (in the perspective of 5 years)

Imagine how interesting it would be to know the result of the previous section for all units of thyroid cancer, for example. If we’d be unlucky enough to be diagnosed with this disease and we’d lived in a system where we could choose freely and also having to pay for the process out of our own pocket.

This thyroid case may seem a little dramatic (although is based on reality), but if you analyze the other levels (tiers) of the Porterian table, we could now propose to do the same exercise for different health outcomes, less forceful than of life or death, but probably very important to determine the value that certain clinical processes bring to the health of people.

But before offering an explanatory example of each tier, I would like to recap their meaning:

And now look at an example of each tier, except the first box of the first tier, as with the supposed case of thyroid cancer I consider it already exemplified:


We have to value Michael Porter’s work because it’s the first time we've seen a proposal that leads to the development of indicators to measure the health value, although no one would dismiss the difficulties arisen in giving consistency and statistical robustness to these new indices, especially the complexities related to the estimation process of the overall cost.

But I'm not pessimistic, because I remember that before the DRG nobody believed it was possible to catalogue the hospital casuistic but it was done. Although it was related to the successful development of the new system, the support from the U.S. federal government and the Medicare's decision to adopt it as a basis for prospective payment in hospitals.


Porter ME. What is value in health care? NEJM 2010 363; 26:2477-81

Jordi Varela


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