The laparoscopic surgical value package and how surgeons can influence costs.

"Quality first and costs second" should be our motto. As surgeons we need to get involved with our procedures, but with the knowledge of the strengths and weaknesses of both outcome and cost analysis-that is, value assessment. The key to evaluating a procedure is to determine its value. This can be done only by physicians cognizant of the disease process and value assessment. The value is determined by assessing a procedure's utilization, outcomes, and costs. Utilization allows early treatment and avoids neglected disease. Therefore, the appropriateness of the utilization can be determined only by an outcome study. An outcome study is another term for quality assessment. Outcomes deal with morbidity, mortality, and the long- and short-term effects of the procedure. Overall, an increase of quality in a global perspective decreases the costs of the procedure to the health care community. Costs must remain secondary to outcomes. A cost analysis of LC has shown that surgeons can influence the majority of OR costs, and these are the direct variable type. Costs are usually not comparable between hospitals. Within each hospital, costs can be successfully used to assess efficiency and demand elasticity. An attempt to decrease costs directly is a maneuver that, when applied solely by nonmedical individuals, will most likely decrease quality. When the quality can be maintained (as assessed only by a practitioner), then a decrease in global costs increases value. The concept of increasing value by increasing quality without an attempt to decrease costs is a very important principle that the health care system must learn in our ever-challenging medical environment. Business administrators have decreased costs without consideration of quality assessment. Consider the additional impact of taking these cost savings and paying dividends to investors rather than reinvesting the monies into medical research or new technology. Quality declines first in patient choice, then referring physician choice, and finally short- and long-term results. When will this decline be apparent if quality assessments are not completed concurrently with cost analysis?