A value-based healthcare approach

This study explores the interpretations of a recently implemented value-based healthcare (VBHC) approach within a Danish healthcare region. We examine managerial perceptions of VBHC and how it seeks to balance quality and cost while incorporating patient perspectives. Our research involves interviews with hospital managers at different organizational levels, where we delve into their explanations of how they approach VBHC. Applying institutional logics, our case study reveals the complexities inherent in public healthcare management's understanding of integrating patient perspectives. We find that at the regional level, VBHC guidelines primarily emphasize quality indicators, suggesting a strategic focus on quality over finances due to the absence of cost guidelines. Consequently, we identify a unified accentuated willingness among managers to transcend the traditional focus on productivity associated with New Public Management. In this context, department managers highlight intuitive decision-making approaches and innovative initiatives, which are decoupled from cost information. This decoupling is attributed to a lack of financial expertise at the department level. These managers rely heavily on notions of appropriateness in their reflections on VBHC. On a department level, the term “value” is interpreted as representing the patient perspective, rather than being solely a monetary value of outcomes. Although the latter is often indirectly embedded in decision-making processes, we posit that nuanced aspects of decision-making and the collective logics mobilized at various levels of hospital management, particularly in relation to VBHC, remain underexplored areas in the accounting literature.