Value-based healthcare

Abstract

In the last decades, paternalistic medicine based on the principles of “science and conscience”, has been definitively replaced by evidence-based medicine, in order to ensure that only interventions with strong evidence of clinical efficacy/utility will be used. Evidence-based medicine, however, has two main limitations. The first one is that it fits with difficulty to the individual patient. To overcome this limitation, precision medicine has been founded. The second and main limitation is that evidence-based medicine and the related concept of clinical appropriateness do not consider the costs of health services. Clinical appropriateness should therefore be closely associated with organizing appropriateness, to give absolute relevance to both the concepts of risk/effectiveness and cost/effectiveness of the healthcare. Accordingly, every intervention aimed at improving individual and public health should include evidence-based decision making, quality improvement and cost reduction. These features are all necessary but not sufficient. A new approach is emerging, called value-based healthcare, which aims to privilege activities capable of generating value, in a new model of healtcare in which interventions are reimbursed on the base of the results obtained on the whole community health.

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