How to Get Better Value Cancer Care

As Don Berwick emphasises: ‘In a zero-sum budget time, when what healthcare
gets, other worthy social and private purposes lose, the pursuit of “value” has
become critically important. How can cancer care systems be redesigned to
better meet the social need for better care, better health, and lower cost?
The crystal clear discussions in this book raise many tough questions. Knowing
how cancer care could change does not automatically tell us how it should
change. It uncomfortably faces us with questions of value, choices about
the relative importance of different outcomes, and what we want in terms
of distributional equity.’

The need for cancer care will increase by at least 1% per year, principally due to
population ageing though in some countries also due to an epidemic of smoking.
Need, however, is not only determined by the number of new cases. When
an effective new intervention is developed, a new need is created, and these
innovations will continue to create an additional increase in need of at least 1%
per year in the next decade.

The logic of this is that over the next decade the need for cancer care will
increase by about 20% – equally true for countries that have well-developed
services but stagnant economies as for those which have growing economies but
a huge legacy of unmet need, especially among their poorest citizens. Whether
rich or poor, every country therefore faces a widening gap between need on the
one hand and resources on the other. The only realistic solution is to get more
value from the resources that are available.