The real cost of care: focus on value for money, rather than price-tags

The likely basis of our natural aversion to cost-saving initiatives stems from fears that costs will override considerations for effectiveness and that costs are an unfair, biased, and distasteful frame of reference for guiding clinical decisions where life and limb are at stake. Yet, blanket prohibition of cost considerations in clinical decision-making is a ticket to disaster and is based on naı̈ve assumptions that healthcare resources are unlimited. In fact, ignoring costs will result in more loss of life and limb than a reasoned approach to considering value for dollar, since a ‘‘free-for-all’’ approach to decision-making results in less value extracted from our given resources. Resources in healthcare are limited, and as a result, choices must be made about what to use and what to forgo in providing medical services. Even if we could eliminate all wasteful practices and limit ourselves only to the interventions in healthcare that ‘‘work’’, we would still face the quandary that resources are insufficient to meet all needs. Again, this requires making choices about what to include and what to leave out. Ideally, these decisions will be made based on the best available scientific data about what ‘‘works’’ (i.e., evidence-based medicine) and what range of options will offer the most value for patients from within our set of available resources.