In the global struggle to manage the cost of health care, both clinicians and policy makers are increasing their focus on value. Health systems around the world are starting to document variations in health outcomes and, at times, remarkable differences in clinical practice. Making the data available allows clinicians to identify best practices and helps steer resources toward the clinical centers and specific clinical interventions that achieve the best results. Such efforts are facilitated by the proliferation of new systems and capabilities in health care informatics that make it possible to collect outcome data and share the information broadly with clinicians and the public. We call such efforts to improve health outcomes—while also maintaining or lowering costs—value-based health care. (See Exhibit 1.)
Value-based health care is becoming the focus of many health-care-reform efforts around the world because it promises to be a more effective and more sustainable approach for limiting the increase in health care costs than traditional approaches such as utilization reviews or cost controls. The Boston Consulting Group has recently developed a methodology—a maturity assessment framework—for assessing the progress of a country’s health system in adopting and institutionalizing value-based health care. In 2011, we used this framework to evaluate the health systems of 12 countries: Australia, Austria, Canada, Germany, Hungary, Japan, the Netherlands, New Zealand, Singapore, Sweden, the U.K., and the U.S. (In the course of 2012, we will be adding other countries to the list.)
Our research shows that a number of countries have begun to build the infrastructure and processes to support a value-based approach, but some countries are significantly farther along the learning curve than others. Despite this differential in development and major differences in the structure and organization of national health-care systems, however, there is much to learn from each country.
In this report, we describe our approach for assessing a country’s progress toward value-based health care; identify some best practices that are emerging, as well as some common issues that countries face; and discuss what governments, in particular, need to do to support value-based health care.