Revisiting the Meaning of 'Value' in Value-Based Healthcare: A Concept Analysis

Healthcare systems are undergoing major transformation driven by technological progress, growing patient involvement, workforce shortages, complex care needs, and rising costs. Against this backdrop, value-based healthcare has gained traction, yet the notion of 'value' remains ambiguously defined.

To clarify the concept of 'value' in value-based healthcare.

We conducted a concept analysis using Walker & Avant's eight-step method: (1) Select a concept; (2) Determine the aims; (3) Identify uses; (4) Define the concept's attributes; (5) Identify the model case(s); (6) Identify additional cases; (7) Identify antecedents and consequences; and (8) Define empirical referents.

Scoping review methods following the Joanna Briggs Institute (JBI) recommendations were used to introduce rigour in locating, screening, and extracting data. We used a deductive thematic analysis for data analysis.

We selected the concept of value in value-based healthcare because it lacked conceptual clarity to support healthcare systems transformations. We propose that value arises when outcomes-to-costs ratios (empirical referents) are considered in processes (uses) addressing healthcare systems transformations, characterised by more informed and engaged patients and rising costs (antecedents). Model case included consideration for all components (health, non-health outcomes, and direct, indirect, social costs) of the ratio, whereas additional cases showed that consideration for most, not all, or none of these components led to partial or no value creation. Value is used from individual to collective dimensions and at clinical, organisational and system levels (attributes) to improve patient experience, care team well-being, health equity, and population health, and to reduce costs (consequences).

A shared understanding of 'value' can guide its design, measurement, and implementation to support successful transformations toward value-based healthcare.

Our conceptual proposition of 'value' within value-based healthcare establishes a framework for a common understanding of 'value' that enables the successful transformation of health systems toward value-based healthcare.