As part of our efforts to evaluate the Value for Money offered by the Better2Know tests, we recognise that it is vitally important to fully understand the concept of Value for Money, and note that this concept has been widely and rigorously explored in the context of Healthcare.
Peter C. Smith is Professor of Health Policy, and is co-director of the Centre for Health Policy in the Institute of Global Health Innovation. He is a mathematics graduate from the University of Oxford, and started his academic career in the public health department at the University of Cambridge. He has worked and published in a number of disciplinary settings, including statistics, operational research and accountancy. However, his main work has been in the economics of health and the broader public services, most recently as the Director of the Centre for Health Economics at the University of York. Peter has acted in numerous governmental advisory capacities, has been a board member of the Audit Commission, and is currently a member of the NHS Cooperation and Competition Panel. He has also advised many overseas governments and international agencies, including the World Health Organization, the International Monetary Fund, the World Bank, the European Commission and the Organization for Economic Cooperation and Development. http://www3.imperial.ac.uk/people/peter.smith
Whilst this paper examines primarily the concept of Value for Money in the context of national healthcare systems such as the NHS, it nonetheless contains some highly relevant considerations applicable to Better2Know’s STD testing service.
In his paper, Peter Smith says:
“Although there is room for debate about what is valued, in the NHS they can be grouped according to four broad categories: health gains, the patient experience, inequalities, and the broader social and economic benefits of health services.”
This statement provides us with a basic framework for considering the value for money provided by Better2Know. We need to consider the Health Gains it might provide; consider the Patient Experience, any inequalities which may arise and finally broader benefits that might accrue to the patient for having purchased our STD tests.
It is also worth noting the following from Peter Smith’s paper:
“There is a growing acknowledgement that patients and their families place considerable value on the experience of their interactions with the health services, independent of health outcome. WHO grouped these patient experience concerns in the category of ‘responsiveness’, which includes concepts such as choice, communication, confidentiality, quality of amenities and prompt attention. Surveys of the patient experience have become commonplace, and the challenge is to develop adequate summary measures of provider performance.”
The above is important in our considerations as his statement cuts to the heart of the Better2Know service offering. He states that the WHO study found “considerable value” in the overall healthcare experience made up of the Choice available to the patient, the Communication experience, the Confidentiality of the interaction, the perceived Quality of the space where the service is delivered and the Waiting times suffered.
Another very important consideration which he points to is that:
“Health services yield benefits beyond the immediate heath gain to patients, such as increased worker productivity, increased personal independence and reduced burden on carers and social care agencies. Depending on the context, there may be a case for integrating these considerations into any VfM analysis, although measurement issues are often challenging.”
He goes on to say:
“Quite apart from health gain, patients are becoming increasingly vocal in demanding that healthcare should be responsive to patient concerns beyond the health effects of treatments. This concern with the patient experience covers issues as diverse as promptness, autonomy, empowerment, privacy and choice. Many argue that these concepts should be incorporated into all VfM analyses when they make a clear contribution to patient well-being. In the UK, one of the biggest concerns in this area has been various aspects of patient waiting time. However, there is evidence that the UK also scores poorly on other elements of responsiveness, such as communication between doctor and patient (Blendon, Schoen et al, 2003).”
So the measure of Benefit or Value cannot be limited simply to the health outcome, and must also include less tangible but no less important matters such as productivity, independence (in our case freedom from worry) and the benefits which might accrue to others thanks to the improved condition (physical or mental) of the patient, and factors such as empowerment to make health decisions, having a range of services from which to choose and being able to enjoy privacy in the healthcare experience.
Finally, the paper concludes the following:
“The naive VfM assumes that contemporary inputs give rise to contemporary outcomes. Yet in most healthcare there is a need to adopt a longer time perspective. Some of today’s outcomes arise from health service endeavours, such as disease prevention, in previous periods. And some of today’s endeavours affect outcomes only at some time in the future. Therefore, when analysing the VfM of some services, it will be necessary to adopt a longer time horizon.”
This conclusion is categorical in establishing that the benefit or Value of any health intervention must be measured over a longer time horizon than that simply associated with the health outcome of the particular intervention in our case STD tests.