Connecting Value and Costs: Whom Do We Ask, and What Do We Ask Them?
Eddy, David M.
JAMA. 1990 Oct 3; 264(13): 1737-1739.
Eddy recognizes the conflict in American health care between the desire for the best care possible and an unwillingness to pay the cost. Resolution of the conflict requires connecting the value of a health activity to its cost, and this in turn requires incorporating costs in practice policies. Using the example of a new drug to treat myocardial infarction, Eddy argues that the determination of whether the value of a health intervention is worth its cost should be made by the patient, who experiences the benefits and the harms of treatment, and who ultimately will pay the bill. Eddy identifies eight steps incorporating patient decision making that he contends will implement the connection of value to cost at the practice level. This process will require information about health and economic outcomes, actual comparisons by patients of health and economic outcomes, and a conviction by patients and physicians to live with their decisions. (KIE abstract)
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