We love our pets. Seventy percent of Americans are pet owners, who collectively spend $123 billion a year on them. Over $34 billion of that spending is on veterinary care.
Because of their shorter life spans relative to humans, companion animals force us to confront quality-of-life issues and the costs of ever-advancing treatments and therapies. The costs are especially acute, since insurance covering costs of veterinary care is not the norm in the United States (although the pet insurance industry is growing).
Those costs have been increasing, outpacing the rate of inflation for 20 years. At the same time, veterinary pay has been stagnant when adjusted for inflation. As a result, many animals go without veterinary care. In fact, while more of Americans have brought companion animals into our homes, especially during the early, cooped-up weeks of the COVID pandemic, veterinary visits have decreased. In underserved US communities, 88% of pets are not spayed or castrated, compounding the problem in terms of financial burden and animal quality of life.
Although many veterinarians offer low-cost and sliding-scale pricing to make quality care affordable, the veterinary profession is increasingly turning to quality-of-life and value-based care concepts used to address inefficiencies in non-human healthcare contexts.
Defining the Spectrum of Care
The spectrum of veterinary care ranges between less costly, less advanced treatment options to technologically advanced, expensive therapies. Choosing the appropriate options depends on the pet owner’s values, goals, and resources and the availability of and accessibility to veterinarians with advanced expertise.
Veterinary advances, like those in human medicine, are developing rapidly, and with them, the associated costs and ethical issues, including:
- Dythanasia, the flip side of euthanasia, referring to death associated with overtreatment relative to the patient’s clinical condition and expected prognosis
- Conflict of interest due to the veterinarian’s financial interests and opportunities to pursue professional development
- Experimentation with innovative techniques, which is less regulated than in human medicine
- Weighing quality of life vs likely survival time
With this in mind, veterinarians are tasked with empowering owners with the information to make the most appropriate decision for their pet. This might include:
- Advantages and disadvantages of treatment
- Likely outcomes
- Associated costs and long-term follow-up
- Evidence base for available treatments
Adapting Value-Based Care for Non-human Patients
Patient-reported outcome measures have been repeatedly been shown to lead to improved outcomes and quality of life and lower healthcare costs. Can these benefits translate to veterinary healthcare settings, where the patients can’t directly communicate their outcomes?
Observer-reported outcomes, used for patients unable to self-report, such as young children and infants, may allow clinicians to measure outcomes. As with communicating the spectrum of care, eliciting observer-reported outcomes require veterinarians to hone soft skills like listening and asking open-ended questions about the goals of care and financial resources.
Veterinary organizations have organized initiatives to further value-based care for their patients. The Initiative for Accessible Veterinary Healthcare has set the following priorities to advance this goal:
- Develop, evaluate, and refine clinical guidelines based on best evidence
- Promote effective, evidence-based practices
- Establish a network to report relevant clinical veterinary outcomes research
Our animal companions trust us to provide them with the best possible quality of life, including providing accessible, high-quality veterinary care. Adopting value-based veterinary practices is a welcome development.
Further Reading
Brown CR, Garrett LD, Gilles WK, et al. Spectrum of care: more than treatment options. J Am Vet Med Assn. 2021;259(7):712-717. https://avmajournals.avma.org/view/journals/javma/259/7/javma.259.7.712.xml
Einav L, Finkelstein A, Gupta A. Is American pet health care (also) uniquely inefficient? Am Econ Rev. 2017;107(5):491-495. https://www.aeaweb.org/articles?id=10.1257/aer.p20171087
Pantaleon L. Why measuring outcomes is important in health care. J Vet Int Med. 2019;33(2):356-362. https://onlinelibrary.wiley.com/doi/abs/10.1111/jvim.15458
Quain A, Ward MP, Mullan S. Ethical challenges posed by advanced veterinary care in companion animal veterinary practice. Animals. 2021;11(11). https://www.mdpi.com/2076-2615/11/11/3010
Stull JW, Shelby JA, Bonnett BN, et al. Barriers and next steps to providing a spectrum of effective health care to companion animals. J Am Vet Med Assn. 2018;253(11):1386-1389. https://avmajournals.avma.org/view/journals/javma/253/11/javma.253.11.1386.xml