Redefining value: a discourse analysis on value-based health care

Area of Science:

• Health Services Research
• Health Policy Analysis
• Sociology of Health

Background:

• The widespread adoption of value-based health care (VBHC) is marked by significant conceptual ambiguity.
• This ambiguity is reflected in academic literature and diverse implementation strategies globally.
• Understanding these differing perspectives is crucial for effective VBHC initiatives.

Purpose of the Study:

• To analyze the ambiguity surrounding the concept of value-based health care (VBHC).
• To identify and characterize the different discourses shaping the understanding and implementation of VBHC.
• To explore common ground and divergences in perceptions of VBHC among stakeholders.

Main Methods:

• Employed discourse analysis to map the ambiguity of VBHC.
• Conducted a document analysis of 22 official publications from Dutch healthcare quality organizations.
• Performed 23 semi-structured interviews with national stakeholders between March and July 2019.

Main Results:

• Identified four distinct discourses on VBHC: Patient Empowerment, Governance, Professionalism, and Critique.
• Each discourse presents a unique view on VBHC's primary purpose, from patient decision-making to provider incentives.
• Shared decision-making emerged as a common element across discourses, contrasting with prior VBHC literature.

Conclusions:

• The identified discourses significantly influence VBHC's practical application in healthcare delivery and administration.
• Conceptual ambiguity in VBHC stems from differing underlying presuppositions about value in healthcare.
• Recognizing these diverse frames of reference is essential for studying, implementing, and evaluating VBHC.