Survey: Disconnect in Perceptions of Healthcare Experience Among Stakeholders

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Commissioned by the University of Utah Health and conducted by Leavitt Partners, the Value in Health Care Survey identified how 3 key stake holder groups (patients, physicians, and employers) define value and prioritize 3 components of the concept (quality, service, and cost).

A survey has found a siginificant disconnect exists between patients, physicians, and employers in their perceived values and priorities in healthcare.

With the increasing popularity of the idea of value-based care, there comes a challenge of what constitutes high value. The idea of “value” and its interpretation varies amongst stakeholders.

“For many years, major stakeholders in the US healthcare system have been discussing how to ensure that patients consistently receive full value for the nation’s steadily growing investment in the healthcare delivery system,” wrote the authors from the University of Utah Health. They added, “While few would disagree that high-quality, patient-centered care at an affordable cost is the desired outcome for our nations, progress toward achieving that goal has been slow.”

The delay in progress can be attributed to the meaning of “value” being unclear, according to the authors. In order to make a break through, it’s important to have an understanding of how 3 key stakeholder groups (patients, physicians, and employers) define value and prioritize 3 components of the concept (quality, service, and cost).


Researchers at the University of Utah Health commissioned Leavitt Partners to conduct the Value in Health Care Survey. Between May 25, 2017, and July 14, 2017, 5031 patients, 687 physicians, and 538 employers completed the online survey. In addition to answering questions on a plethora of issues related to overall quality, level of service, and cost, participants were asked to choose from a list of statements that may reflect value in healthcare delivery.

Although patients, physicians, and employers all agreed that, as a country, too much money is being spent on healthcare, results highlighted large differences in prioritized components of value. While a majority of patients and employers said they were somewhat or extremely satisfied with what they personally paid for healthcare, only 37% of physicians answered the same way.

The majority of patients (62%) and physicians (88%) responded that quality was the most important aspect when receiving or delivering care; 26% of patients said cost was the most important, compared with only 5% of physicians.

When looking at the value statements, employers emphasized cost-oriented statements; physicians had a clear top 5 representing quality and service-oriented statements; and patients had a mixture of quality, cost, and service-oriented statements. The only clear top value statement for patients was “my out-of-pocket cost is affordable.”

One-third of patients said they were responsible for keeping out-of-pocket costs low, while another third said the responsibility was on insurers/brokers. In contrast, physicians typically held insurers/brokers most responsible and patients the least. Two-thirds of employers said insurers and health systems should be most responsible, while one-third of employers claimed responsibility themselves.

“A better understanding of how value in healthcare is perceived differently across groups is imperative to achieving a value-focused healthcare delivery system,” concluded the authors. “The Value in Health Care Survey starts a dialogue on those varying perceptions of value and, we believe, helps to advance healthcare transformation in a meaningful way.”

Just as there are multiple perspectives on what value means in healthcare, there are multiple value frameworks. At this year’s American Society of Clinical Oncology conference, Scott Ramsey, MD, PhD, Fred Hutchinson Cancer Research Center, told The American Journal of Managed Care® (AJMC®) that value frameworks aren’t at an ideal point in their development yet, but it is important to keep in mind that these different frameworks represent different perspectives.

Some have even argued that it is impossible to implement a one-size-fits-all approach to value. During The International Society for Pharmacoeconomics and Outcomes Research conference in August, Ilene Hollin, PhD, MPH, the National Pharmaceutical Council and University of Southern California Schaeffer Center’s Postdoctoral Health Policy Fellow, discussed a tailored approach to value assessment. Hollin told AJMC® that we need to tailor our approach to each stakeholder because this is what will help drive innovation and make sure future therapies are developed with what patients want in mind.