The traditional assumption has been that more health care is better. All too frequently, decisions on health care management have been made without an explicit probing of the value systems of patients. Because physicians have not traditionally considered cost when making medical decisions, the issue of whether the value of a given medical intervention is worth the cost rarely came up. Patient preferences are an essential component of value-based medical care. Rather than simply trying to reduce health care costs, physicians should be seeking ways to increase the value of health care.
Input is defined in terms of dollars spent, output in terms of improved health status of patients.
Therefore, in order to understand value, one must first understand quality. In the first context, physicians must understand what is important to their patients in order to provide high quality care. In the second context, physicians must be attuned to the costs of health care interventions in order to provide high quality care. Owing to the competitive nature of today's health care environment, anesthesiologists themselves are also beneficiaries of value-based anesthesia care, because job security is increasingly dependent on anesthesiologists' assuring that the value of anesthesia services is consistent not only with the needs of patients but also with the expectations of hospitals and managed care organizations. Therefore, Chapter 4 focuses on how to analyze costs.