Value in healthcare is often defined as the patient outcome relative to the resources or costs employed in attaining the patients' outcome. But just defining value in the healthcare delivery system is a vexing challenge. Defining value requires clarity on what factors, features or attributes are valued and the value attached to each. This commentary dissects this approach and offers some hopefully useful principles and conclusions. I argue that improving value requires an appreciation not only of patient value but also that of providers, organizations and companies and values associated with health system goals and society. I then propose principles for the measurement of value and policies to incentivize high value care. The most important message is that single actions or actors will not do much to improve healthcare value and we must value coordinated activities with shared accountability.

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