Seeking value in pharmaceutical care: balancing quality, access and efficiency

Healthcare remains a dominant issue for Canadians. Central to the debate is the dynamic tension among the value, accessibility and affordability of drugs. Simply put, innovative drugs improve health and economic outcomes for individuals and populations. As a result, providers and patients increasingly demand, and expect, these benefits; utilization and expenditures increase. The management challenge is finding the best balance of quality, access and costs. Supply-side strategies, such as restricting access with the intention of controlling isolated costs of drug budgets, are not optimal from a population health view because they have the adverse impact of limiting the system benefits of innovative drugs. Management strategies emphasizing the demand side of the market are more empowering to providers and patients and, given the increasing knowledge and accountability of these stakeholders, are increasingly feasible. Population health outcomes and efficient resource use may be better served by a combination of strategies. The partnership-measurement model of disease management is a practical example of this approach at the community level; timely and repeated feedback of real-world practices, as well as provider and patient education, drive accountable, cost-efficient and continuously improved outcomes. As we seek the optimal societal strategy for innovative drug therapy, resource allocation decisions have to be made. Widening the debate and informing the debaters will enhance the chances of making choices that achieve the best health for the most people at the best cost.