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. 2021 Nov 12;33(4):mzab140.
doi: 10.1093/intqhc/mzab140.

Defining value in health care: a scoping review of the literature

Susan N Landon  1 , Jane Padikkala  1 , Leora I Horwitz  1   2   3
Affiliations

Defining value in health care: a scoping review of the literature

Susan N Landon et al. Int J Qual Health Care. .

Abstract

Background: As health-care spending rises internationally, policymakers have increasingly begun to look to improve health-care value. However, the precise definition of health-care value remains ambiguous.

Methods: We conducted a scoping review of the literature to understand how value has been defined in the context of health care. We searched PubMed, Embase, Google Scholar, PolicyFile and Scopus between February and March 2020 to identify articles eligible for inclusion. Publications that defined value (including high or low value) using an element of cost and an element of outcomes were included in this review. No restrictions were placed on the date of publication. Articles were limited to those published in English.

Results: Out of 1750 publications screened, 46 met inclusion criteria. Among the 46 included articles, 22 focused on overall value, 19 on low value and 5 on high value. We developed a framework to categorize definitions based on three core domains: components, perspective and scope. Differences across these three domains contributed to significant variations in definitions of value.

Conclusions: How value is defined has the potential to influence measurement and intervention strategies in meaningful ways. To effectively improve value in health-care systems, we must understand what is meant by value and the merits of different definitions.

Keywords: costs; high-value care; low-value care; outcomes; quality; value.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare no competing interests with regard to the submitted work.

Figures

Figure 1.
Figure 1.
PRISMA Flow Chart of Study Selection Process[13]
Figure 2.
Figure 2.
Framework for Categorizing Definitions of Value
Figure 3.
Figure 3.
Summary of Value Definition Categorizations by Framework Element. A) Distribution into low value, value, and high value. B) Distribution of components included. C) Distribution of perspectives. D) Distribution of scope. Note: framework categories are not mutually exclusive, so totals may exceed the number of included publications in the given value category.
Figure 3.
Figure 3.
Summary of Value Definition Categorizations by Framework Element. A) Distribution into low value, value, and high value. B) Distribution of components included. C) Distribution of perspectives. D) Distribution of scope. Note: framework categories are not mutually exclusive, so totals may exceed the number of included publications in the given value category.
See this image and copyright information in PMC

References

    1. Domestic general government health expenditure per capita (current US$) | Data. https://data.worldbank.org/indicator/SH.XPD.GHED.PC.CD (accessed 13 Oct 2020).
    1. NHE Fact Sheet | CMS. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Tren... (accessed 25 Jun 2020).
    1. Sisko AM, Keehan SP, Poisal JA, et al. National Health Expenditure Projections, 2018–27: Economic And Demographic Trends Drive Spending And Enrollment Growth. Health Aff (Millwood) 2019;38:491–501. doi:10.1377/hlthaff.2018.05499 - DOI - PubMed
    1. CMS’ Value-Based Programs | CMS. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Inst... (accessed 22 Jul 2020).
    1. Our Mission. https://www.choosingwisely.org/our-mission/ (accessed 22 Jul 2020).

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