Mold James
Family and Preventive Medicine, University of Oklahoma HSC.
Cureus. 2017 Feb 21;9(2):e1043. doi: 10.7759/cureus.1043.
Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost). It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Reframing health in terms of health-related goals and directing the health care system to help people achieve them, could both improve quality and reduce costs. In the process, it could also make health care less mechanical and more humane.
医疗保健改革举措越来越强调奖励价值（质量/成本）的支付模式。因此，审视我们在医疗保健中所重视的东西似乎是恰当的，而这将要求我们审视健康的定义。尽管世界卫生组织及其他方面发出了告诫，但我们当前的医疗保健系统是在健康意味着没有健康问题这一假设下运作的。虽然这种观点推动了医学科学取得惊人进展，但现在它可能对价值产生不利影响。以问题为导向的医疗显然是成本上升的驱动因素之一，而且根据质量的定义方式，它可能对医疗质量产生不利影响。如果我们根据以患者为中心的目标重新定义健康，医疗保健就能更直接地聚焦于有意义的结果，减少无关检查和治疗的数量。将更多重点放在预防、有意义的活动、预先指示以及个人成长与发展上。患者在医患关系中的角色将得到提升，从而加强治疗关系。从与健康相关的目标角度重新构建健康，并引导医疗保健系统帮助人们实现这些目标，既能提高质量又能降低成本。在此过程中，它还能使医疗保健不那么机械，更加人性化。
