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In my last article for eyeforpharma, I highlighted the very high current industry activity around the demonstration of the value of pharmas products, and made the point that value is rather like beauty - very much in the eye of the beholder. And so here, I want to begin to explore the concept of value.

Certainly talk on value is everywhere at the moment and all the terms being bandied about can be very confusing: value for money, value-based pricing, added value, value assessments, economic value, value dossiers, value proposition, full value package, value determination, value messages, etc, etc. Market access is another key industry focus at the moment and for sure, how to continue to build and demonstrate the value of treatments in the eyes of the payer will be critical in the future, particularly as the effects of a healthcare recession begin to bite.

The payer beholder is now certainly king, so a very clear definition of value and a full value story and narrative would now seem to be key. And yet it is more than the clinical value demonstrated by clinical trials. It is now even more than just health economics and outcomes research. Companies will, in the future, need to produce more compelling evidence of the value and benefits that their products deliver across the healthcare economy and at a much more strategic and population-based level.

For example, how will a products use be helpful in preventing hospital admissions in an area like COPD? What impact might its have on the use of social care funding in an area like Alzheimers disease? The value proposition here will need to be stronger, albeit in silo-based healthcare systems economic arguments can often fall on fallow ground.  But as the movement for more integrated care accelerates - in the UK health and social care are now coming much closer together - these opportunities must be maximized.

Last time too, we explored the whole area of value sets and we cannot proceed without reference to the furious debate now going on within the US over healthcare reform, as this nicely demonstrates these value sets in operation. Various factions in the US have demonized the UK National Health Services as Stalinist and yet this is a system where most care is available free at the point of need, while US healthcare continues to move towards bankruptcy and some 50m US citizens are currently uninsured.

The result on this side of the Atlantic has been that both Tweet Street and Fleet Street have rallied to the NHS defence as a government-run healthcare system. Whilst the UK NHS certainly has its faults, of course the current American system also has its problems. Indeed, management consultants AT Kearney say that the US will perhaps need to learn from European healthcare systems, though many US stakeholders may not fancy this idea. In their report, they note that President Obamas proposed reforms have ignited furious debate one characterized by often wild, irrational and politically motivated assertions. It adds that the UKs NHS has been cast by conservative Republicans as the bogeyman of socialized medicine, noting that it was described by ex-vice-presidential candidate Sarah Palin as evil..

The Canadian healthcare system also has come in for some criticism. AT Kerney argues, however, that the current debate risks trivializing a far more fundamental crisis in healthcare funding. Growth in US health spending is unsustainable, and its relative performance is declining. The report notes that the NHS is far from the only model from which the US might learn, and there are other European insurance-based systems that deliver far better outcomes than the US system at a much lower cost.

AT Kearney goes on to say that US health reform is a critical issue for the entire world, because, despite having 5% of the global population, it accounts for 45% of total healthcare spend, and its system increasingly underperforms those of other developed countries. Any reforms will have significant impact on many sectors, most notably the pharmaceutical industry, it adds..

Inclusion of $1.1bn in the Obama Stimulus Plan to support comparative effectiveness research of drugs, medical devices, surgical procedures and other treatments is a clear indication of the US government's priority to obtain value in healthcare dollar spending. As it gains traction among policymakers, and as the Federal Government continues to increase its role as the largest direct payer for drugs, biologics, devices and diagnostics, one would expect regulators to demand extra data for new products demonstrating greater benefits over existing products.

Europe too has its problems, and AT Kearney predicts that a common healthcare model will emerge that all will gravitate towards. So many of the cost control mechanisms in common use in European socialized medicine systems will inevitably need to be adopted across the Atlantic, says the report. Fundamentally, the European Union, a market about the same size as the US, has a different value set around solidarity and the care due its citizens.

Although most European systems are insurance-based, individual member states do accept that heath care coverage is an essential right, but that funding is finite and that difficult decisions will have to be made. So the bottom line on all this does seem to be a clash of values around cost containment and priority setting -  in other words for the judicious rationing of scarce healthcare resources...

The same clashes are now also occurring over value, and we will return to value per se next time.

Read more Tribal territories:Of values and value- part 1

Fatima Moncrieff is a UK-based independent healthcare policy analyst and adviser. Her consultancy specializes in healthcare policy issues for both the pharmaceutical industry and the National Health Services and aims to support organizations in steering the right strategic course through a rapidly changing and turbulent healthcare environment.