The connotations of Value-Based Healthcare: interpretive perspectives and differences in perceptions

This study aims to elucidate the connotations of Value-Based Healthcare (VBHC), correct misconceptions, and explore perceptual differences among distinct groups.

An analytical framework for VBHC connotations was first constructed from five perspectives: subject-object and subjective-objective relations, the individual and the collective, the refined value equation, conceptual categories and scope, and value implications. A questionnaire was then developed, and statistical analyses, including analysis of variance (ANOVA) and chi-square tests, were conducted on the collected survey data.

Significant differences existed between older adults and other age groups regarding the public welfare orientation, equity, and cost perceptions. Perceptions of "patient-centeredness," subjective utility, and marginal value varied significantly by education, region, and urban-rural residency. Compared to other cohorts, older adults prioritized health outcomes, and middle-aged to older groups focused on functional recovery, whereas survival duration was not a primary concern. Individuals with graduate degrees, the public, patients, and urban residents prioritized health outcomes; conversely, other groups balanced health outcomes and costs, though none prioritized costs alone. Healthcare leaders prioritized hospital expenses, whereas others prioritized patients' financial burdens. Although functional recovery was universally favored, urban residents valued survival duration, whereas county and township populations emphasized the likelihood of disease recurrence and recovery sustainability.

(1) Overall, respondents exhibited weak cost awareness; rather than prioritizing health outcomes or costs individually, they favored a balance between health outcomes and costs and prioritized functional recovery over survival duration. (2) Older adults and eastern populations leaned toward the individual, the public welfare orientation, and efficiency, whereas other age cohorts and western populations favored the collective, equity, and the public interest. Central populations focused on the collective but attempted to reconcile equity and efficiency, embodying a unique, moderate value paradigm. (3) Urban populations interpreted "patient-centeredness" from a multi-stakeholder perspective, emphasizing objective health outcomes and survival duration, whereas county/township populations more readily accepted subjective utility and diminishing marginal value, considering costs more frequently.