Finally, well-matched treatments are treatments that patients would have chosen to have if they were well informed.
Even an effective, high-quality knee replacement surgery provides no benefit if the patient, given complete
information about the recovery from surgery and the effectiveness of her non-surgical treatment options, would have
chosen to avoid surgery. If the patient would rather have avoided a surgery altogether, it’s not reasonable to count
that treatment as providing a benefit to the patient – or providing any value for the money spent on it.
Useful measures of health care value must therefore account for the effectiveness, quality, and match of the
treatments provided to patients. But throughput measures, such as the number of bypass surgeries that can be
performed over a given period of time, fail to capture whether services are provided in a manner that is high or low
quality, well matched, or even effective. A metric that only captures the number of patients seen per day could easily
portray a physician who does shoddy work quickly as being very productive (even if another physician has to go back
and repair the damage later), while a slower but safer and more effective physician would appear relatively
unproductive.
The medical community is hardly unaware of the concerns about measuring throughput, and measuring quality of
care has been increasingly important in medicine over the last few years. However, only six metrics in the papers
Hussey and his coauthors reviewed made any effort to judge productivity on what actually matters for patients: five
included the health outcomes achieved through medical care (although they tended to use relatively narrow
measures of health),10 and one other measure accounted for the quality of services provided. When only six measures
of 265 have even a weak connection to patient welfare (and none account for match quality), we are falling far short
of even beginning to gauge the true value of health care.