Understanding value-based healthcare – an interview study with project team members at a Swedish university hospital

The purpose of this study is to explore how representatives from four project teams understand the concept of value-based healthcare (VBHC), since each representative is responsible for one of the pilot projects implementing VBHC at a university hospital in Sweden. A qualitative design was used to gain understanding of VBHC. Open-ended interviews were used as the data-collection method and content analysis of the transcribed interviews was carried out. Participants’ understanding of VBHC focused on how value was created for the patient and on measuring medical outcomes and costs, although costs were to some extent put aside. To measure value for the patients, it was the health professionals’ perspective about what patient should value that dominated the understanding of the concept VBHC. VBHC was understood as a strategy to strengthen value innovations and to loosen the grip of economic control. Benchmarking was seen as a future possibility to develop value innovations. Changes in organizational culture were understood by participants as a need to change healthcare from being professional-centred to patient-centred. The way the concept was understood omits parts of the original concept. This has implications for whether or not the concept as it is described by the participants should be understood as VBHC according to the intentions of the strategy described. The development of outcome measures was predominantly based on the health professionals’ experiences, which is why the patients’ perspective needs to be strengthened. Further studies of the process of implementing VBHC are needed.