The values debate in health care.(GUEST EDITORIAL)

Most developed countries face similar challenges in attempting to stem rising health care costs. The common forces driving utilization and costs include medical technology advancement, demanding consumers, and an aging population. The most elusive factor, however, is the role that social values play in shaping health care systems.

Health economists often fail to recognize that health care systems reflect social values, not just science and economics. Social values help explain the variation among health care systems with respect to government and private sectors roles; payer, provider, and consumer relationships; access to care; and definitions of health and illness.

In this country, stakeholders are often caught in the gap between what experts define as policy goals and options, and what the public will accept. The loosening of managed care over the past decade is a profound example of the power of social values to circumvent policy and reshape the health care system. Consumers and the media rejected the concept of gatekeeper health maintenance organizations, despite an ability to constrain costs, because they value freedom of choice in all markets, including health care.

American definitions of health and illness influence what constitutes an insurable event. As Americans live longer with chronic illnesses, the definition of good health that can be financed through insurance has been dramatically expanded.

Coverage for drugs to treat erectile dysfunction illustrates how our perceptions of health translate into market expectations that insurance should pay for costly drugs that aren't life-essential but can improve quality of life. Wellpoint was the first company to ...