This chapter explores the relationship between costs and value and considers ways to improve the payoffs from our health spending. It considers three broad categories of expenses: waste in production, over consumption of services, and high prices of labor and inputs. Statistics suggest that the lack of coordination of care for patients with the most complex medical conditions affects the health care spending significantly. In fact, new pharmaceuticals, new technology, and ever-emerging new medical know-how are constantly identifying better ways to address illness and disease. Malpractice insurance costs would not decrease evenly for all medical providers. The cost outcome for electronic medical records (EMR) is likely to be mixed, based on the type of provider. In value-based purchasing (VBP), payers hold providers accountable for cost and quality of care. Attempts at slowing cost growth have largely focused on reducing payments to providers or on restraining services covered by insurance companies.