Health and Value in Psychiatry: What’s It Worth to You?

By Wesley Sowers, M.D.

We commonly think about value when considering a purchase, even if not consciously. How we decide what to buy is typically related to the accessibility and desirability of an object. Things that are most difficult to get and are much coveted are typically considered to be valuable, whereas things that are plentiful and readily available are not highly valued—even when they are quite necessary.

Value can also refer to attributes or ideals we strive for, and in many ways, those we choose, define who we are and give our lives meaning. However, unlike physical valuables, these kinds of values are not universal nor consistently applied. For example, many who profess to subscribe to certain religious beliefs and the values associated with them do not always act accordingly.

The above constructs are both relevant in considering the value of medical and psychiatric services.

On a basic level, one would like to have some objective way to measure the value of the services we provide. A simple equation for doing so is Value = Quality/Cost. While there are ways to quantify quality (numeric representations of attaining a desired outcome) and cost (resources needed to obtain those outcomes), stakeholders cannot always agree on what those outcomes should be or on what percentage of limited resources should be made available to achieve them.

For example, some stakeholders may value personal comfort over communal well-being. In a fragmented and profit-driven system such as the one in the United States, these differences in values often cause significant conflict in the pursuit of value in health care. In a recent book produced by the Committee on Mental Health Services at the Group for Advancement of Psychiatry, Seeking Value: Balancing Cost and Quality in Psychiatric Care, these conflicts and how they are reflected in the US healthcare system are considered in detail.

Perhaps the most egregious contribution to the US healthcare crisis is the system’s focus on illness rather than health. Millions of dollars are spent on treating preventable conditions that were not detected early enough to avoid the onset of acute symptoms or the progression of chronic conditions.

Why? Easy access to care is not available to many populations: rural residents, minority groups, and indigent populations. In addition, the supply of healthcare professionals, particularly physicians, is inadequate. This shortage, in combination with the growing demand for services in recent times, adversely affects the quality of care being delivered.

In this scenario, systems (such as the one the US has) that rely on market forces to determine the degree of product excellence, health businesses have little reason to be concerned about competition or quality. There is little incentive for clinicians to engage in preventive activities since there are very limited resources allocated by insurers—both private and public—to reimburse them.

The US healthcare system is at least twice as expensive as those of other developed countries and yet health outcomes are much inferior. Shifting existing resources to prevention and health promotion, rather than continuing an almost exclusive focus on illness in medical coverage and medical education, will go a long way toward correcting the low value of care currently delivered by the US systems of care.

Wesley Sowers, M.D., is a member of the Committee on Systems Innovation and Transformation at the Group for the Advancement of Psychiatry