Value-based healthcare logics and their implications for Nordic health policies

Abstract

Value-based healthcare (VBHC) is a widely approved logic for financing services, using innovative care models and evaluating healthcare outcomes. It is consistent with the Triple Aim framework of simultaneously improving population health, patient experience and the costs of care. In Nordic countries, VBHC has been mainly implemented as a strategic concept in developing hospitals. Despite the evident interest in VBHC as a management trend in healthcare organisations, the studies concerning the implications of VBHC logics on health policies have been scant. This study aimed to fill this gap by building a conceptual bridge between national health policy and value-based care. Through the Triple Aim framework, we explored how VBHC goals have evolved in Finnish Government Programmes from 1995 to 2015 by using qualitative document analysis and interviews. The study addresses the evolution and national impacts of VBHC. Our results show that the goals of Triple Aim gradually become evident at the Finnish health policies. All three Triple Aim goals were present, though the equal prioritisation of these goals only emerged in 2015, also highlighting patient experience. We argue that VBHC logics have indeed affected Nordic welfare policies, not only at the organisational level but also concerning performance measurement and care delivery. This may imply that the diffusion of VBHC logics evolves from healthcare organisations to policymaking instead of top-down. Particularly in publicly financed systems, VBHC indicates a transformation to a new public governance ideology, accelerating policy goals that promote customer responsiveness and value creation for citizens.

Redesigning value-based hospital structures: a qualitative study on value-based health care in the Netherlands

“…At this moment, the [hospital name] has chosen not to make the switch, and maybe we will never do that, because in the end it will be a matrix anyway. You want coordination within the specialties, but you also want coordination across specialties (9).…”

“…While the pioneering work on VBHC has informed a range of health policies across the globe [9][10][11][12], the actual reorganization into value-based hospital structures remains unclear and understudied [10,13,14]. This study aims to provide a deeper understanding of how hospitals realign their organizational structure with the creation of value for patients.…”

Performance management and hybridization of healthcare – case of the accountable care organization

“…The shift from "volume to value" (cf. Porter, 2010) can also be considered a value-creation mechanism (Vakkuri et al, 2021) or a reflection of external, institutional pressures imposed by recent policy and management trends to retain legitimacy (Colld en and Hellstr€ om, 2018;Kokko and Kork, 2020). The demand for patient-centredness drove actors to align their service models around patient care paths, which required new forms of ownership and performance management and measurement.…”

“…This applies to the healthcare context, affording a basis for differentiation between the analysis levels of health policy, health systems and health organizations. At policy level, the objectives of the healthcare system are set (Tuohy, 2012; Kokko and Kork, 2020) and initiated in national development programmes. At meso-level, political goals are operationalized in governable and manageable objectives.…”

From centralized DRG costing to decentralized TDABC-assessing the feasibility of hospital cost accounting for decision-making in Denmark

“…There is a growing body of literature investigating the phenomenon of value-based healthcare initiatives in hospitals [23,25,26,35,36], which particularly focuses on the more strategic elements of providing services from a patient perspective [35][36][37]. Another stream of literature focuses on the implementation of TDABC in relation to VBHC [7,16,27,28,38], where most of these studies have to narrow the scope of study down to department or facility level to comprehend the complexity [38,39].…”