Value-based healthcare: is it truly patient-centred?

Abstract

In this thesis, we explored the relationship between value-based healthcare (VBHC) and patient-centred care (PCC). First, we searched the literature for evidence of VBHC supporting PCC. We found that studies on VBHC often use measures that concern process indicators or costs and scarcely use patient-centred outcomes. The lack of focus on patient-centred outcomes creates a knowledge gap on whether VBHC supports PCC. Second, we examined the role of patient-reported outcome measures (PROMs) in VBHC supporting PCC. In our study, PROMs prompted more discussions on patient-reported outcomes e.g. anxiety, but they did not significantly improve observed or patient-reported patient-centredness. Patients expressed expecting biomedical-focused consultations and clinicians questioned the feasibility of discussing PROMs in individual care. Third, we performed a qualitative analysis of clinical consultations in diabetes care. This allowed us to gain insight on patient-clinician collaboration in making care fit, which may contribute to the alignment of PCC and VBHC. Lastly, we addressed the tensions and possibilities for alignment of VBHC, PCC, and Health Equity through an expert panel study. Our findings highlight that linking patient goals to outcomes fosters care that aligns with individual preferences while promoting equitable resource allocation to achieve the highest value for populations.