title: The case of value-based healthcare for people living with complex long-term conditions.
abstract: There is a trend towards value-based health service, striving to cut costs while generating value for the patient. The overall objective comprises higher-quality health services and improved patient safety and cost efficiency. The approach could align with patient-centred care, as it entails a focus on the patient's experience of her or his entire cycle of care, including the use of well-defined outcome measurements. Challenges arise when the approach is applied to health services for people living with long-term complex conditions that require support from various healthcare services. The aim of this work is to critically discuss the value-based approach and its implications for patients with long-term complex conditions. Two cases from clinical practice and research form the foundation for our reasoning, illustrating several challenges regarding value-based health services for people living with long-term complex conditions.
  
  
  
  Achieving value-based health services that provide the health outcomes that matter to patients and providing greater patient-centredness will place increased demands on the healthcare system. Patients and their informal caregivers must be included in the development and establishment of outcome measures. The outcome measures must be standardized to allow evaluation of specific conditions at an aggregated level, but they must also be sensitive enough to capture each patient's individual needs and goals. Healthcare systems that strive to establish value-based services must collaborate beyond the organizational boundaries to create clear patient trajectories in order to avoid fragmentation. The shift towards value-based health services has the potential to align healthcare-service delivery with patient-centred care if serious efforts to take the patient's perspective into account are made. This is especially challenging in fragmented healthcare systems and for patients with long-term- and multi-setting-care needs.
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, Sweden. mel@du.se.|Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden. mel@du.se.
authors.forename: Marie
authors.identifier: 0000-0001-7044-8896
authors.initials: M
authors.lastname: Elf
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.|Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Maria
authors.initials: M
authors.lastname: Flink
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.|Department of Social Work, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Marie
authors.initials: M
authors.lastname: Nilsson
authors.affiliation: School of Education, Health and Social Studies, Dalarna University, Falun, Sweden.|Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.
authors.forename: Malin
authors.initials: M
authors.lastname: Tistad
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.|Department of Neurobiology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: von Koch
authors.affiliation: Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Stockholm, Sweden.|Functional Area Occupational Therapy & Physiotherapy, Karolinska University Hospital Huddinge, Stockholm, Sweden.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Ytterberg
mesh_terms: D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D003362:Cost-Benefit Analysis; D003695:Delivery of Health Care / Q000191:economics* / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D018802:Patient-Centered Care
keywords: Health expectations; Patient-centred care; Policy healthcare; Rehabilitation; Stroke; Value-based care