At a recent panel on the movement to value in health care, the panelists were asked to reflect on what metrics to measure success in value-based care, and someone suggested mortality as a long-term outcome. The Chief of Medicine countered in disagreement, "If you wanted to improve mortality, you wouldn't invest in health care. You would invest in the economy, eradication of poverty, education, high school graduation rates." The Chief proposed that the goal our health care system should be to reduce the burden of health on its people. These ideas reflect several truths about medicine: most of what we do lacks clear evidence of benefit especially in terms of mortality; mortality may or may not be the most important or measurable outcome; and social determinants can be more prominent than organic processes in determining health.
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A Medscape 2017 Survey of <14,000 physicians reveals that:
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