Khalil Hanan, Ameen Mary, Davies Charles, Liu Chaojie
Department of Public Health, La Trobe University, Bundoora, VIC, Australia.
Faculty of Medicine, Nursing and Health Sciences, Clayton, VIC, Australia.
Front Public Health. 2025 Apr 9;13:1514098. doi: 10.3389/fpubh.2025.1514098. eCollection 2025.
Value-Based Health Care (VBHC) is an increasingly important healthcare paradigm that focuses on maximizing health outcomes relative to the cost of care delivered. Various healthcare organizations have adopted VBHC principles, but significant barriers remain in adapting care models, engaging stakeholders, and measuring outcomes. Moreover, the lack of standardized methods for measuring outcomes and financial sustainability further complicates the transition to VBHC. Understanding the factors that facilitate or hinder VBHC adoption is crucial to informing policy and practice for broader implementation. The objective is to map the literature addressing VBHC concerning population, study characteristics, funding models, outcome measures, and barriers and facilitators.
Following the JBI methodology and the PRISMA-ScR reporting guidance, a scoping review was undertaken to include primary and secondary research on VBHC across various healthcare settings. Searches were undertaken in nine relevant databases. Peer-reviewed quantitative and qualitative studies published in English were included and analyzed. A total of 145 studies were included after screening 2,725 studies.
The findings show that the United States leads VBHC research, contributing 65% of the studies, followed by European countries. Cohort and cross-sectional studies were predominant, focusing on various populations, including hospitals, surgical patients, and cancer patients. Key findings highlight that Value-Based Purchasing and Time-Driven Activity-Based Costing models were the most frequently reported funding models. Traditional in-hospital care remains the dominant delivery model, with increasing interest in telemedicine. Outcome measure were diverse, ranging from patient-reported outcomes to cost savings for both patients and providers. Barriers to VBHC implementation include insufficient funding, fee-for-service model persistence, and resistance from healthcare professionals. Facilitators included strong leadership, multidisciplinary collaboration, and the use of digital tools.
The review highlights the need for consistent outcome measurements, financial incentives, and improved data transparency to ensure the successful and scalable implementation of VBHC across healthcare systems. While VBHC shows promise in improving healthcare efficiency and quality, challenges remain in aligning financial and operational structures to fully support this paradigm shift.
基于价值的医疗保健（VBHC）是一种日益重要的医疗保健模式，其重点是在提供医疗服务的成本基础上，最大限度地提高健康结果。各种医疗保健组织都采用了VBHC原则，但在调整护理模式、吸引利益相关者以及衡量结果方面仍存在重大障碍。此外，缺乏衡量结果和财务可持续性的标准化方法，进一步使向VBHC的转变复杂化。了解促进或阻碍VBHC采用的因素对于为更广泛实施的政策和实践提供信息至关重要。目的是梳理关于VBHC的文献，涉及人群、研究特征、资助模式、结果指标以及障碍和促进因素。
遵循JBI方法和PRISMA-ScR报告指南，进行了一项范围综述，纳入了各种医疗保健环境中关于VBHC的初级和二级研究。在九个相关数据库中进行了检索。纳入并分析了以英文发表的同行评审定量和定性研究。在筛选了2725项研究后，共纳入了145项研究。
研究结果表明，美国在VBHC研究方面处于领先地位，占研究的65%，其次是欧洲国家。队列研究和横断面研究占主导地位，关注各种人群，包括医院、手术患者和癌症患者。主要发现突出表明，基于价值的采购和时间驱动的作业成本核算模式是最常报告的资助模式。传统的住院护理仍然是主要的提供模式，对远程医疗的兴趣日益增加。结果指标多种多样，从患者报告的结果到患者和提供者的成本节约。VBHC实施的障碍包括资金不足、按服务收费模式的持续存在以及医疗保健专业人员的抵制。促进因素包括强有力的领导、多学科合作以及数字工具的使用。
该综述强调需要一致的结果测量、财务激励以及提高数据透明度，以确保VBHC在整个医疗保健系统中成功且可扩展地实施。虽然VBHC在提高医疗保健效率和质量方面显示出前景，但在调整财务和运营结构以充分支持这一范式转变方面仍存在挑战。
