Individualized cost-effectiveness analysis of patient-centered care: a case series of hospitalized patient preferences departing from practice-based guidelines

Abstract Health literacy and palliative care have been receiving more attention within health care organizations and systems in recent years. Both can offer a pathway to care that is better for patients and has the potential to be of high value. A health literate approach to palliative care provides patient-centered care that is better aligned with patient preferences and needs.

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The challenge of determining appropriate care in the era of patient-centered care and rising health care costs

Journal of Health Services Research & Policy ◽

10.1177/1355819618815521 ◽

2018 ◽

Vol 24 (3) ◽

pp. 201-206 ◽

Cited By ~ 7

Author(s):

Ian Coulter ◽

Patricia Herman ◽

Gery Ryan ◽

Lara Hilton ◽

Ron D. Hays ◽

...

Keyword(s):

Patient Preferences ◽

The United States ◽

Patient Centered Care ◽

Cost Of Care ◽

Patient Centered ◽

Inappropriate Care ◽

Appropriateness Of Care ◽

Centered Care ◽

The Cost ◽

Care Costs

Appropriateness of care is typically determined in the United States by evidence on efficacy and safety, combined with the judgments of experts in research and clinical practice, but without consideration of the cost of care or patient preferences. The shift in focus towards patient-centered care calls for consideration of outcomes that are important to patients, accommodation of patient preferences, and incorporation of the costs of care in patient-provider shared clinical decisions. The RAND/UCLA Appropriateness method was designed to determine rates of appropriate or inappropriate care, but the method did not include patient preferences or costs. This essay examines how methods of studying appropriateness can be made more patient-centered by describing a modification of the RAND/UCLA method by including patient outcomes, preferences, and costs.

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Priority Setting, Cost-Effectiveness, and the Affordable Care Act

American Journal of Law & Medicine ◽

10.1177/0098858815591511 ◽

2015 ◽

Vol 41 (1) ◽

pp. 119-166 ◽

Cited By ~ 2

Author(s):

Govind Persad

Keyword(s):

Cost Effectiveness ◽

Affordable Care Act ◽

Priority Setting ◽

Cost Effectiveness Analysis ◽

Patient Centered ◽

Effectiveness Analysis ◽

Practical Concern ◽

Standard Cost ◽

Important Health ◽

The Affordable Care Act

The Affordable Care Act (ACA) may be the most important health law statute in American history, yet much of the most prominent legal scholarship examining it has focused on the merits of the court challenges it has faced rather than delving into the details of its priority-setting provisions. In addition to providing an overview of the ACA's provisions concerning priority setting and their developing interpretations, this Article attempts to defend three substantive propositions.First, I argue that the ACA is neither uniformly hostile nor uniformly friendly to efforts to set priorities in ways that promote cost and quality.Second, I argue that the ACA does not take a single, unified approach to priority setting; rather, its guidance varies depending on the aspect of the healthcare system at issue (Patient Centered Outcomes Research Institute, Medicare, essential health benefits) and the factors being excluded from priority setting (age, disability, life expectancy).Third, I argue that cost-effectiveness can be achieved within the ACA's constraints, but that doing so will require adopting new approaches to cost-effectiveness and priority setting. By limiting the use of standard cost-effectiveness analysis, the ACA makes the need for workable rivals to cost-effectiveness analysis a pressing practical concern rather than a mere theoretical worry.

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