Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.
Ann Intern Med. 2011 Feb 1;154(3):174-80. doi: 10.7326/0003-4819-154-3-201102010-00007.
Health care costs in the United States are increasing unsustainably, and further efforts to control costs are inevitable and essential. Efforts to control expenditures should focus on the value, in addition to the costs, of health care interventions. Whether an intervention provides high value depends on assessing whether its health benefits justify its costs. High-cost interventions may provide good value because they are highly beneficial; conversely, low-cost interventions may have little or no value if they provide little benefit. Thus, the challenge becomes determining how to slow the rate of increase in costs while preserving high-value, high-quality care. A first step is to decrease or eliminate care that provides no benefit and may even be harmful. A second step is to provide medical interventions that provide good value: medical benefits that are commensurate with their costs. This article discusses 3 key concepts for understanding how to assess the value of health care interventions. First, assessing the benefits, harms, and costs of an intervention is essential to understand whether it provides good value. Second, assessing the cost of an intervention should include not only the cost of the intervention itself but also any downstream costs that occur because the intervention was performed. Third, the incremental cost-effectiveness ratio estimates the additional cost required to obtain additional health benefits and provides a key measure of the value of a health care intervention.
美国的医疗保健成本正在不可持续地增长,因此进一步控制成本是不可避免且至关重要的。控制支出的努力应侧重于医疗保健干预措施的价值,而不仅仅是成本。一项干预措施是否具有高价值取决于评估其健康效益是否能证明其成本合理。高成本干预措施可能具有良好的价值,因为它们具有高度的益处;相反,如果低成本干预措施提供的益处很少或没有,则可能几乎没有或没有价值。因此,挑战在于如何在保持高价值、高质量护理的同时,减缓成本增长的速度。第一步是减少或消除没有益处甚至可能有害的护理。第二步是提供提供良好价值的医疗干预措施:与成本相称的医疗效益。本文讨论了理解如何评估医疗保健干预措施价值的 3 个关键概念。首先,评估干预措施的效益、危害和成本对于了解其是否具有良好的价值至关重要。其次,评估干预措施的成本不仅应包括干预措施本身的成本,还应包括因干预措施而产生的任何下游成本。第三,增量成本效益比估计获得额外健康效益所需的额外成本,并提供医疗保健干预措施价值的关键衡量标准。
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