Barriers and Strategies for Inclusion of Value-Based Healthcare in Contract Negotiations in the Netherlands: Study Among Hospital and Insurer Executives

BackgroundThis paper analyses why, despite its recognized importance, value-based healthcare (VBHC) has not gained more prominence in negotiations between health insurers and hospitals in the Netherlands.MethodsData collected by interviews used a standardized questionnaire with closed- and open-ended questions. Respondents included hospital and insurer executives, and experts on VBHC in the Netherlands.ResultsHospital and insurer executives addressed issues of cost containment, volume management, and care availability. Despite recognising the potential of VBHC to enhance patient outcomes and experiences, reluctance persists due to uncertainties about cost-savings, its complexity, lack of data, and competing priorities. Hospital executives advocated experiments with VBHC, trust-building, and continuous evaluation, with strategies to standardise measures, enhance information technology (IT) infrastructure, promote data transparency, foster collaboration, and educate stakeholders. Participants also underlined the need for systemic change and governmental action.ConclusionsNegotiations mostly focus on cost containment and volume management. This reflects a systemic emphasis on immediate financial concerns over long-term value creation. The hesitancy in transitioning to VBHC underscores the need for collaborative strategies and systemic shifts to prioritise patient-centric care. External factors such as fee-for-service payment systems further complicate VBHC adoption, requiring governmental intervention and cultural transformation to align incentives and promote sustainable healthcare practices.