The quality/cost/value relationship

Abstract

The cost of healthcare in the United States is growing at a rate that is non-sustainable given its percentage of the gross domestic product. This is in the setting of poor quality as defi ned by preventable mortality, access to care and equitable and effi cient care delivery measured relative to other nations. Given the potential signifi cant growth in individuals requiring healthcare, emphasis must be placed on the improvement in the value of care delivery. In order to improve the value, quality must be improved, or cost/or volume must be reduced in order to effect the value = quality/cost equation. The cost of quality theoretical model will be reviewed to understand how this has evolved as we move through the quality improvement era. Mechanisms to improve quality and cost including value stream analysis, value on investment and the use of interdisciplinary teams to improve the value of healthcare delivery will be examined.