Value-Based Care Adoption is Slow Across Global Health Systems

Value-based healthcare programs have been found to mostly be adopted in wealthy countries and in smaller parts of health systems, according to new data published in JAMA Health Forum.

Health systems around the world are facing growing pressure from rising costs, aging populations, staffing shortages and long-standing health inequities.

At the same time, patients and communities are demanding more accountable, affordable and effective care, study authors said.

In response to these challenges, health systems have turned to value-based health care (VBHC) as a promising way to improve outcomes while controlling costs.

Introduced in the U.S. in 2006, the VBHC model focuses on improving care by aligning payments with results, measuring outcomes and costs and organizing services around patient needs.

Introduced in the U.S. in 2006, the VBHC model focuses on improving care by aligning payments with results, measuring outcomes and costs and organizing services around patient needs.

A broader framework—the high-value health systems (HVHS) model—builds on this idea by outlining 10 components needed to deliver care that is not only effective and efficient but also fair and responsive to the needs of all people.

To better understand how these ideas are being put into practice, researchers of the study conducted a global review of VBHC initiatives launched between 2007 and 2023.

The researchers aimed to examine how well these efforts align with both the VBHC and HVHS initiatives and how they might be scaled to transform health systems more broadly.

Five major databases— including MEDLINE, PubMed, Embase, Health Business Elite and Web of Science— were reviewed for articles published between January 1, 2007, and July 7, 2023.

Both keyword and subject heading searches were used, and results were not limited by language.

Studies were included if they described how VBHC initiatives were actually being put into practice.

Studies that only focused on insurance, cost-effectiveness or theoretical models were excluded.

Two reviewers screened titles, abstracts and full texts. Data was then pulled from selected studies to look at where and how VBHC programs were used and whether they fit within the broader high-value health system (HVHS) framework.

Out of nearly 12,000 articles reviewed, 50 studies were included for the study.

Most VBHC initiatives were found in high-income countries, especially the U.S., with far fewer in middle-income nations.

Data revealed that 31 initiatives originated from the U.S. alone, with the Netherlands behind at 8 initiatives.

These programs were usually designed to solve local problems, such as high costs, uneven care quality and fragmented services.

It was found that many were led by doctors or health administrators and only a few involved patients in the planning process.

The most common VBHC strategies included tracking patient outcomes, measuring costs, using digital tools such as electronic health records and shifting toward bundled payment models.

However, none of the initiatives fully applied all the core parts of the VBHC or the HVHS frameworks.

Most programs operated at a small scale—typically within a single department or hospital—rather than across entire health systems.

Programs that used more HVHS components tended to be larger and more system-focused.

Based on results, the study had its strengths, as it offers a comprehensive, global view of how VBHC initiatives are being adopted and scaled across different health systems.

By observing these efforts against the VBHC and HVHS frameworks, it provides insight into what elements are being implemented and where.

The review also highlights national models from countries such as the Netherlands, Canada and England, highlighting how centralized health systems may be better positioned for broader implementation.

Another strength is the focus on digital tools and patient-reported outcomes, which are key to tracking performance and improving care.

However, the study also has limitations.

Researchers note the study was not pre-registered, which could affect its transparency, and it only included articles published in English.

In addition, most studies reviewed were early-stage evaluations rather than long-term investigations, limiting the data on real-world outcomes.

There was also very little data on VBHC in low- and middle-income countries.

For future research, authors recommend more longitudinal studies to evaluate long-term impacts of VBHC.

They also stressed a stronger focus on benchmarking, real-time data analytics and tailored approaches for lower-resource communities.

Authors suggest that expanding research in lower-income countries and integrating patient perspectives will be key to making VBHC more inclusive and effective.