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The value based health care system you describe above I first introduced through a series of about a dozen articles, monographs and book chapters between 1987 and 1991. I also spent the first three of these years on the lecture circuit in this country trying to alert all types of stakeholders that this eventually would take hold here. As it turns out, I found a more receptive audience in the land, whose best known Prime Minister, Winston Churchill, you paraphrase concerning Americans always being counted on to do the right thing, after they’ve exhausted all other options. One of Prime Minister Churchill’s well known successors, Margaret Thatcher, had begun a “Value fo Money” initiative in the U.K. in her final two years in office in the late 1980’s/early 1990s. My “medical care value purchasing” initiative (as I called it) was the perfect model by which to operationalize Prime Minister Thatcher’s initiative. I was privileged to present my model to both the National Health Service and Oxford University while over there in both 1990 and 1991. Although I have no way of knowing this, I like to think that what I started over there back then has led today to the U.K. being by far the furthest along in value driven health care (or Pay for Performance as it is often also called) of any OECD nation (about 95% penetration). I am also pleased that if you “Google” medical care value purchasing”, today, you will find one of my early articles on this (from 1988) appearing as the first of over 5 million references. Go ahead and try it!

It is interesting to see Dr. Couch celebrate the achievements of the last 15 years of change in the UK health system, because few UK residents would. A recent report from the Karolinska Institute highlighted one of the reasons - 5 year survival rates in cancer are 53% for women and 43% for men compared with 71% and 53% respectively in France - a statistic which the authors link with the low level of use of newer (and more expensive) therapies. In theory the “value driven health care” which has resulted in this low level of care for cancer sufferers should be more than counter-balanced by better care in other areas, but it just doesn’t look that way.

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