The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., affordability.

You can increase value by raising quality, improving accessibility and by lowering the cost of care. The "cost of care," however, is the elephant in the room.  

The unrelenting rise in medical expenditures has nearly broken the back of so many consumers, "outstripping any growth in worker's wages" and net buying power.  (See "Health Insurers Push Premiums Sharply Higher," NY Times pub. Sept. 27, 2011. http://www.nytimes.com/2011/09/28/business/28insure.html?_r=1&emc=tnt&tntemail1=y, esp. the graph, http://kff.org/ehbs/); It is this increasing disparity that has made the U.S. less competitive in the world market.  

Why has it been so difficult to improve the value of care?  The short answer is that the incentives are not well aligned in health care to affect quality, cost and access, simultaneously.

These factors are critically linked in both theory and in reality.  The Value Equation shows how they relate to each other and to you.

For instance, if doctors are paid fee for service, we're paying for piecework and the economic incentive in piecework is to generate pieces.  If doctors are paid prospectively (e.g., capitation or for a defined episocde of care), they may discourage services that, so to speak, they perceive comes out of their pocket.  If patients have to pay out of their pocket and they have limited cash flow, they may make compromises - delay care, get the cheaper drug or not get that drug at all.

Make patients informed consumers? It doesn't work even for doctors who are patients.  In one's hour of need, will you be sifting through comparative statistics to decide which test, doctor or emergency room to use?

The Dearth of Meaningful information

Even the health care manager is disadvantaged by not having good information, especially at the point of contact with the patient.  Who has access to specific outcomes data when they need it?  Even if they had it, are those data acuity-adjusted? Controlled for socio-economic differences?  Who really knows what works and what does not, which doctor or team gets the best outcomes, which insurer provides the best coverage with the least hassle?  

And, what do I mean by "disadvantaged"? Everyone is familiar with the balloon analogy--When you squeeze the healthcare balloon in one area of interest, it pops out elsewhere.

Cost-shifting and cost-sharing?  Hardly the answer here.

I'm worried.  What is the cost of care doing our fragile economy--Health care as an industry is propering and we are getting less from it. (Compare our mortality statistics to any other industrialized country.)

It's not "good news when you look into what type of health jobs propelled this strong growth. Most of it, the study authors conclude, came from an increase in administrative positions, jobs like billing specialists and office support staff. It’s quite likely that more people with health insurance mean more resources necessary to bill insurance companies and administer the business of health care.

An increase in those kind of jobs is great for employment. But it’s not so great for health care costs. It’s part of the reason that American doctors have administrative costs four times higher than their Canadian counterparts. It likely contributes to growing health care costs that have eaten up nearly a decade worth of increased earnings. And it’s why, at the same time that health care jobs increase, we also have graphs like this:

Sarah Kliff, writing at Ezra Klein’s blog