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The value proposition of health care for the patient 
  1. Rishi Gupta
  1. Correspondence to Dr Rishi Gupta, Wellstar Medical Group, Neurosurgery 61 Whitcher Street, Suite 3110 Marietta, GA 30060, USA; rishi.gupta{at}

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The ability to deliver value along with sustainable high-quality healthcare often appears to be at odds in the minds of physicians and patients. Much has been written about the drivers of healthcare costs, with fingers pointing towards regulators, insurance companies, trial lawyers and hospitals. Unfortunately, the costs of healthcare continue to rise and there is a lack of transparency that does not allow patients to make a truly informed decision about their care. A recent study showed that the cost per capita of delivering healthcare is twofold higher in Massachusetts and Alaska than in Utah and Georgia.1 There are many plausible explanations for the differences, but physician choices are not often discussed. The selection of implantable devices, frequency of follow-up imaging or treatment, and medication regimen are typically driven by the physician.

The field of neuroendovascular surgery is a mere fraction of healthcare costs in the USA that currently comprises of 17.7% of the gross …

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  • Competing interests Consultant/Scientific Advisory Board: Stryker Neurovascular, Covidien, Rapid Medical. Steering Committee: THERAPY Trial sponsored by Penumbra. Associate Editor Journal of Neurointerventional Surgery, Journal of Neuroimaging. Royalties from UpToDate.

  • Provenance and peer review Commissioned; internally peer reviewed.