The role of value-based healthcare in decision-making by executives in hospitals in the Netherlands:A nationwide evaluation

Background: This observational study investigates the role of value-based healthcare (VBHC) principles in executive decision-making in Dutch hospitals.Methods: A total of 379 questionnaires were sent to executives in 69 Dutch hospitals. The survey included questions prioritizing VBHC and other elements in decision-making and the weight and frequency at which each VBHC element was considered.Results: Responses were received from 82.6% of hospitals (57/69) and 26.9% of executives (102/379). 'Clinical outcomes' and 'costs' were most often considered in decision-making whereas 'integration of care delivery across separate facilities' and 'bundled payments' were considered the least. VBHC was reported as being considered in decision-making 8 out of 10 times and was given a median score of 8 out of 10. Members of the board of directors placed a higher priority on 'clinical outcomes', 'internal politics', 'the ambition of healthcare professionals' and 'integrating care delivery across separate facilities' and perceived that they include these elements more frequently than other direct colleagues.Conclusion: This study reveals that, although VBHC is generally considered in managerial decision-making, 'clinical outcomes' and 'costs' predominantly have priority. Action must be taken to ensure executives implement all VBHC elements in decision-making to maximize the effects of VBHC