10 Chapter 1 In many countries, the healthcare sector is facing major challenges such as increased demand for healthcare services, capacity problems in hospitals, and rising healthcare costs.1 Without significant changes to the current system, the three essential elements of a good healthcare system – accessibility, affordability, and high quality – will inevitably come under pressure.2 To keep healthcare sustainable, changes are needed. As a result, healthcare professionals have adopted the principles of Value-Based Healthcare (VBHC) which have gained momentum nationally and internationally.3 VBHC is a system that prioritizes individual health goals in relation to choices and decisions of care and quality improvement while making optimal use of resources (money, time, carbon, and space).4 A basic feature of VBHC is to provide care in a setting with the highest value: low-complexity care is not provided in expensive settings (i.e., hospitals or specific hospital departments) by expensive care providers (medical specialists and specialized nurses) but rather in lower-cost settings outside the hospital. To achieve this, substitution of care may be required. In the Netherlands, government policy has focused on shifting care from hospital to out-of-hospital care settings.5 As an example, in Dutch maternity care, antenatal cardiotocography (aCTG) was introduced as a pilot experiment in midwife-led primary care (MLC) for specific indications. Until recently, aCTG was only performed in obstetrician-led care (OLC) in a hospital setting. Recent technological developments in healthcare facilitated the performance of MLC-aCTG in primary care by trained midwives using a portable CTG system to be used at the pregnant woman’s home or in the midwifery practice.6 Value-Based Healthcare Globally, the most common model for healthcare delivery and payment is a feefor-service model that reimburses healthcare providers for the services provided.7 This model has been criticized for incentivizing the overuse of healthcare services, contributing to skyrocketing healthcare costs, and straining the healthcare system.7,8 In recent decades, new insights have been developed that have led to a growing interest in the concept of value in healthcare.9 Rather than focusing solely on output or reducing costs, healthcare providers are encouraged to focus on creating value for patients. Porter and Teisberg introduced the concept of VBHC.9 They define the value of a healthcare service as the outcome relative to all costs incurred to achieve that outcome, with the aim of aligning incentives to deliver high-quality, cost-effective care that improves patient outcomes, as opposed to the traditional fee-for-service model. Patient value is one of the key elements of VBHC. Results of care that matter to patients include clinical outcomes of disease and recovery as well as patients’ wellbeing and experiences with care.10 To create value for patients, it is necessary to 1)
RkJQdWJsaXNoZXIy MTk4NDMw