Background: Today's remarkable popularity of value-based health care (VBHC) is accompanied by considerable ambiguity concerning the very meaning of the concept. This is evident within academic publications, and mirrored in fragmented and diversified implementation efforts, both within and across countries.
Method: This article builds on discourse analysis in order to map the ambiguity surrounding VBHC. We conducted a document analysis of publicly accessible, official publications (n = 22) by actors and organizations that monitor and influence the quality of care in the Netherlands. Additionally, between March and July 2019, we conducted a series of semi-structured interviews (n = 23) with national stakeholders.
Results: Our research revealed four discourses, each with their own perception regarding the main purpose of VBHC. Firstly, we identified a Patient Empowerment discourse in which VBHC is a framework for strengthening the position of patients regarding their medical decisions. Secondly, in the Governance discourse, VBHC is a toolkit to incentivize providers. Thirdly, within the Professionalism discourse, VBHC is a methodology for healthcare delivery. Fourthly, in the Critique discourse, VBHC is rebuked as a dogma of manufacturability. We also show, however, that these diverging lines of reasoning find common ground: they perceive shared decision-making to be a key component of VBHC. Strikingly, this common perception contrasts with the pioneering literature on VBHC.
Conclusions: The four discourses will profoundly shape the diverse manners in which VBHC moves from an abstract concept to the practical provision and administration of health care. Moreover, our study reveals that VBHC's conceptual ambiguity largely arises from differing and often deeply rooted presuppositions, which underlie these discourses, and which frame different perceptions on value in health care. The meaning of VBHC - including its perceived implications for action - thus depends greatly on the frame of reference an actor or organization brings to bear as they aim for more value for patients. Recognizing this is a vital concern when studying, implementing and evaluating VBHC.
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http://dx.doi.org/10.1186/s12913-020-05614-7 | DOI Listing |
J Perianesth Nurs
January 2025
Medical Surgical Nursing Department, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil; JBI Brazilian Affiliated Center, School of Nursing, University of Sao Paulo, Sao Paulo, Brazil.
Purpose: To analyze available evidence in the literature on the effect of aromatherapy for the management of postoperative pain in the postanesthesia care unit (PACU).
Design: Systematic review according to the Joanna Briggs Institute (JBI) model and Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement.
Methods: The search was carried out in August 2023, using descriptors and keywords, in the Cumulative Index to Nursing and Allied Health Literature, Latin American and Caribbean Literature in Health Sciences, Cochrane Central Register of Controlled Trials, Excerpta Medica Database, PUBMED, Scopus, Virtual Health Library, Google Scholar, CAPES, BDTD, and ProQuest portals of theses and dissertations, with no language restrictions or time limit.
J Am Coll Cardiol
November 2024
Elite Centre for Individualized Medicine in Arterial Disease, Odense University Hospital, Odense, Denmark; Department of Cardiothoracic and Vascular Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark.
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J Am Coll Cardiol
December 2024
UCL MRC Unit for Lifelong Health and Ageing, University College London, London, United Kingdom; UCL Institute of Cardiovascular Science, University College London, London, United Kingdom; Centre for Inherited Heart Muscle Conditions, Cardiology Department, Royal Free Hospital, London, United Kingdom. Electronic address:
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J Am Coll Cardiol
December 2024
Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA; Adult and Child Center for Outcomes Research and Delivery Science, University of Colorado School of Medicine, Aurora, Colorado, USA.
As expensive therapeutics rise to the fore of heart failure management, out-of-pocket (OOP) medication costs have become increasingly relevant to patient care. Prescription medication costs influence medical decision-making and affect adherence. Yet, individualized cost estimates are seldom available during clinical encounters when prescription decisions are made.
View Article and Find Full Text PDFJ Am Coll Cardiol
December 2024
Barts Heart Centre, Barts Health NHS Trust, West Smithfield, London, United Kingdom; Institute of Cardiovascular Science, University College London, London, United Kingdom.
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