Intended for healthcare professionals


Value based healthcare

BMJ 2017; 356 doi: (Published 27 January 2017) Cite this as: BMJ 2017;356:j437
  1. Muir Gray, visiting professor1
  1. 1Nuffield Department of Primary Care Health Sciences, Oxford, UK
  1. muir.gray{at}

Reducing unwarranted variation to maximise the value of healthcare for populations

How can the gap between need and demand on the one hand and resources on the other be closed or even narrowed? Since the global financial collapse most countries have reduced or reversed annual increases in the resources invested in health services, creating a big problem for those who pay for or manage health services, many of whom are also clinicians.

The techniques that have been developed over the past 20 years include evidence based decision making (to ensure that only interventions with strong evidence of cost effectiveness are used), quality improvement (to improve outcomes), and cost reduction. These are all necessary but not sufficient. A new approach is emerging called value based healthcare, which aims to increase the value that is derived from the resources available for a population.

The Choosing Wisely campaign, led in the United Kingdom by the Academy of Medical Royal Colleges, has identified many interventions that could be substantially reduced without adverse effects on the population.1The BMJ’s leadership on overdiagnosis and “too much medicine” focuses more on the trend to overuse interventions that …

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