The value
of health

Porter investigated the economic processes in the American health care system; based on an analysis of their weak points, he developed "Value-based health care". The model devised by Porter works in a fundamentally different way than existing models. This is because the focus is no longer on the doctor, his or her instructions, findings and decisions: instead, the value that the treatment gives the patient is now the central factor. Porter's book on this subject was published in 2006: "Redefining Health Care".

"Quality comes at a price" is the usual justification given for the costs of existing health care systems. Porter adopts a radically different approach: a health care system has to achieve the best possible result for the patient – and it must do so at low cost. His call to restore the patient's status as the central focus of health care is in line with economic principles. Porter's analysis: amid competition between health insurers, hospitals and doctors, the patient's wellbeing is relegated to the background.

A key issue in the entire process is the value of treatment – measured in the currency of the patient's long-term quality of life. This should be ascertained with the help of surveys before and after treatment, including questions such as: What is life like two years after a hip replacement implant? How quickly can the patient return to work? How many follow-up treatments were needed?

‍Consistent tracking of the entire patient pathway is the only way to arrive at a qualitative analysis. Digitalization makes it easier to collect, record and evaluate all the personal data for this purpose. Patients themselves move from being passive participants to active players – just as Hippocrates advocated – and they have to take on personal responsibility.

Health reformers have seized upon Porter's idea and continued to develop it; modern data processing systems make analysis easier. "Value-based health care works!" – that was the verdict of Gregory Katz at the annual congress of the European Institute of Innovation and Technology (EIT). Katz, who comes from France, is the Director of the EIT Health Trends Report. He is working on the publication of a report titled "Implementing Value-Based Health Care in Europe: Handbook for Pioneers".
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Beatrice finally reached breaking point during an outing with her family, when even a gentle uphill slope left her out of breath and she could no longer manage without help from others: "I knew that the time had come for something to happen," says Beatrice (who is now 72). Back then, she weighed in at 96 kilograms – distributed over a body height of 1.50 meters. The consequences of being overweight were making her life difficult: joint pains, shortness of breath and type 2 diabetes. Beatrice K. numbered among the eleven percent of obese individuals in Switzerland.

"Obesity is a chronic condition," according to Professor Ralph Peterli. For many years, this surgeon has undertaken research on obesity and its consequences at the Obesity Center of Clarunis (the University Center for Gastrointestinal and Liver Diseases) on the Claraspital site in Basel. "The idea that obese individuals eat too much simply because they lack discipline and willpower is wrong," the specialist points out. In his day-to-day work, he sees that many factors are conducive to obesity: they include genetic and psychological factors as well as an unhealthy lifestyle or a metabolic disease. "Individuals with this condition can take as many slimming cures as they like – but through their own efforts, they rarely shed enough weight to restore them to normal levels."

Beatrice K. also had this experience. "I went on diets for decades," she says, "but they never lasted – I always put on weight again afterwards and became even heavier." And then the secondary conditions began to appear. A normal, active life was out of the question without medicines and therapies. The psychological strain kept on increasing. "You feel so ashamed," she recalls. "When you take your seat in a plane, you have to ask for an extension for the safety belt because it won't fit round your belly."

At breakneck speed, the cursor flits across the screen where little pink balls are turning red and something resembling a snake is prancing about. This is the computerized graphic view of a catheter during an intervention in the atrium of a patient's heart. A closer look reveals an outline that resembles a gray stone. "This", Charlotte Vivet explains, "is the 3D view of the inside of the heart." This 25-year-old engineer, a graduate of the École Polytechnique Fédérale de Lausanne (EPFL), has been working at Johnson & Johnson as a Clinical Support Specialist for well over a year. She is one of a team of 15 highly specialized staff in Switzerland who act as partners to doctors when they perform high-tech cardiac surgeries. This morning, she is working in tandem with Professor Etienne Delacrétaz at the Hirslanden, Clinique Cecil in Lausanne.

Behind Charlotte's screen, separated by a pane of glass, is the operating theater. On the table lies a young man, fast asleep. In front of him at waist level sits the doctor, whose quiet comments and instructions are relayed from the loudspeaker set up in front of Charlotte. Professor Etienne Delacrétaz is at work. This specialist in cardiology and electrophysiology is performing a catheter ablation of the patient's heart. This is a minimally invasive procedure that involves scarring of the heart tissue with the help of a catheter. It is an exceptionally efficient method of eliminating dangerous cardiac arrhythmias.

As well as putting life at risk, cardiac arrhythmias are extremely frightening for the sufferer. That was the case for 56-year-old Christian G, so he underwent catheter ablation performed by Professor Delacrétaz. This was after his heart suddenly started beating irregularly from one day to the next. "It happened while I was sitting in front of the TV after dinner – my heart suddenly started beating like crazy." Christian, a heating fitter, went to consult his cardiologist. "We tried to calm my heart down with medications, but that didn't really help," he explains. Although he is normally quite athletic, Christian felt listless, constantly tired and somewhat depressed due to his condition. He was afraid that he would have to give up his hobby of riding. "But the worst thing of all was the fear," he recalls. He knew that his father and uncle had suffered from high blood pressure, and both of them had died before their 60th birthdays. He too had been taking antihypertensive drugs for years.

After well over an hour, the operation is over as far as the patient is concerned. He is wheeled out of the operating theater. With latest-generation catheters, the procedure takes no more than one and a half hours. Delacrétaz recalls that it wasn't always like this: "It used to take up to four hours." About five percent of all heart patients are currently treated with cardiac catheter ablations. As well as elderly patients, they include children and young people – who are often competitive athletes. After the procedure, the patient has to take a few medicines that drastically reduce the risk of cardiac insufficiency or a stroke, which could lead to irreparable damage. There is a spectacular improvement in the patient's quality of life, accompanied by a reduction of the subsequent costs that would be incurred without the intervention. Long-term chances of a successful outcome decrease with age, so patients should not be older than 70. It is now six months since Christian G. had his catheter ablation. The surgery passed off without any complications whatsoever. Christian's entire face is radiant: "I hardly felt any pain – but I could already feel the positive consequences on the second day after the operation." He was even able to resume work immediately. The atrial fibrillation has disappeared and although his blood pressure is still slightly high, he has it under control thanks to medications. He feels fit and vigorous, and he is taking part in equestrian competitions once more. "It's as if I was young again," he says.

Slim and athletic, Adrian Tschannen was in his mid-50s when – all of a sudden – he felt a pain in his right hip. A stabbing sensation that was quite overpowering. "At first, I thought I'd pulled a muscle," Adrian Tschannen recalls. He isn't someone who pays heed to every little ache and twinge, so he ignored the pain. He also brushed aside his constant need to take several steps before he became able to carry on more or less normally. But then he reached the point where he couldn't manage any longer. A visit to the orthopedist shed light on the problem: the X-ray image clearly showed that he was suffering from arthritis of the hip. 
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This came as something of a shock to Adrian, who is a business IT specialist. Most patients with this condition are not expecting such a diagnosis, even though about half of all people in Switzerland aged above 60 suffer from degenerative hip and knee disease. And it also raises a question: what should I do now? This is usually the starting point for a journey into unknown territory, because it is no longer possible to reverse arthritis caused by progressive breakdown of the joint cartilage. "We start out by trying to help the patient with conventional treatment," says Daniel de Menezes, a senior physician and consultant in orthopedic surgery and traumatology of the musculoskeletal system who specializes in knee and hip surgery. Conservative treatment methods include the administration of painkillers with anti-inflammatory properties, cortisone preparations and hyaluronic acid as well as physiotherapy. 

"It's entirely up to the patient to decide the appropriate time for a hip replacement", Daniel de Menezes notes. Nowadays, this hip surgery is a routine operation for this experienced orthopedist – thanks to improved materials, state-of-the-art minimally invasive operating techniques, and increased safety during the surgery with digital support from a modern navigation system. All these factors have helped to raise the safety of these interventions to an exceptionally high level in recent years. And by no means least, the materials used today are superior to their predecessors, as de Menezes explains: "The main factor that leads to good results is highly crosslinked polyethylene with minimal wear and tear, which we now use as standard in conjunction with a shaft prosthesis."