Bending the Value Curve

In health care policy circles, “bending the cost curve down” may qualify as the phrase of the decade. More than 1 million web search references are testament to its widespread use, intended to express a focus on reducing health care costs. Yet it should not surprise anyone familiar with technocratic vocabulary that there is no clear agreement on what the phrase means.1 Nonetheless, with health care spending nearing one-fifth of the nation’s gross domestic product,2 the nationwide clamor to “bend the cost curve down” is understandable. In this commentary, however, we discuss the shortfalls of focusing on costs alone and instead propose a national commitment to “bending the value curve up.” Although finding ways to control health care spending is certainly important, focusing on cost alone is neither sufficient nor appropriate. Calling out costs in isolation may be disconcerting to many stakeholders, including those whose health care services or livelihoods rely on this important sector of the economy. For example, patients might associate cutting costs with decreased access or hastily provided care, and clinicians may fear lower salaries or undue administrative pressures. Moreover, slicing away at high-quality and lifesaving programs for the poor, the young, the disabled, or the elderly or increasing the financial burden for disadvantaged populations is short-sighted and unfair.3,4 Beyond this, focusing on cost alone ignores the benefits to life and well-being that result from high-quality health care spending, even if it is associated with a high price tag. Rather than simply asking whether we are spending too much, we should also ask whether we are achieving the kind of care experiences and outcomes we would expect for the price we are paying. Value is the quality …