Delivering, measuring and rewarding value:Advancing value-based healthcare in integrated maternity care in the Netherlands

Résumé fourni par la source

If our healthcare system were a patient, it would be diagnosed as critically ill. Costs continue to rise while outcomes stagnate, workforce shortages persist while demand for care grows, and reimbursement still predominantly rewards volume rather than value. Value-Based Healthcare (VBHC) was introduced to address these issues: a strategy that defines the value of care as the outcomes achieved relative to the costs of delivering them. But what does it take to bring this idea into everyday practice? This dissertation explores that question through the lens of integrated maternity care in the Netherlands, structured around three interdependent pillars: delivering, measuring, and rewarding value. Conducted over two years in close collaboration with an integrated maternity care organisation and a healthcare insurer, it follows the redesign of two maternity care pathways — gestational diabetes care and pain relief during labour. Costs of care were calculated using Time-Driven Activity-Based Costing, and outcomes were captured in full through clinical measures and patient-reported experiences. Together, these insights were combined to map the actual value created by each redesign. Provider payment models that genuinely reward value-improving care remain remarkably scarce, in the Netherlands and internationally. Building on this mapped value, this dissertation presents one of the few concrete attempts to design an outcome-based payment model. By delivering, measuring and rewarding value, this dissertation shows how advancing value-based healthcare in the Netherlands helps reveal exactly where meaningful change is needed — a valuable step towards a more future-proof healthcare system.