The core purpose of a health system should be to maximize the health of the population. When the main challenge is managing long-term conditions, maintaining health rather than delivering health care per se should be the goal.
In a comprehensive, publicly funded system like the United Kingdom's National Health Service (NHS) there is an overriding imperative to deliver maximum health benefit per pound spent. Quality, effectiveness, and efficiency are the goals. Traditionally, physicians and other health care professionals have regarded financial efficiency as outside the scope of their professionalism (indeed, often at odds with it). The concept of value—useful health outputs divided by the resources needed to achieve them—as advocated by Porter and Teisberg1 and others is relatively new and unfamiliar to many clinicians. However, the need to achieve more with less puts the need to strive for value into sharp focus. Following a decade of above-inflation increases in NHS funding, the urgent need to reduce the United Kingdom's national debt means the NHS is entering a sustained period of flat or declining funding, while demand for services continues to increase (from technological progress, an aging population, increasing expectations, and population growth). Striving for value therefore becomes an ethical imperative.2
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