The role of patients within clinician-patient relationships would be elevated, strengthening therapeutic relationships. Greater emphasis would be placed on prevention, meaningful activities, advance directives and personal growth and development. If we redefined health in terms of patient-centered goals, health care could be focused more directly on meaningful outcomes, reducing the number of irrelevant tests and treatments. Problem-oriented care is clearly one of the drivers of rising costs and it could be adversely affecting the quality of care, depending upon how quality is defined. While that perspective has led to incredible advances in medical science, it now may be adversely affecting value. In spite of admonitions from the World Health Organization and others, our current health care system operates under the assumption that health represents the absence of health problems. It seems appropriate, therefore, to examine what we value in health care, and that will require that we examine our definition of health. Health care reform efforts have increasingly emphasized payment models that reward value (quality/cost).
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