Leda Marino
Vincenza Capone- Department of Humanities, University of Naples Federico II, Naples, Italy
Background: Healthcare systems constantly evolve to improve care quality and resource utilization. One way is implementing Value-Based Healthcare (VBHC) an economic approach. This scoping review aims to identify and describe the literature on VBHC, particularly its psychosocial aspects, to uncover research gaps.
Method: The review followed the PRISMA guidelines for Scoping Reviews. We took the following 14 steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) 15 mapping data; (e) collecting, synthesizing and reporting results. A detailed Boolean search was conducted from January 2021 to August 31, 2021, across APA PsycINFO and PubMed databases using keywords such as “Value-Based Healthcare” and “psychosocial perspective.” Initially, three reviewers screened 70 e-records independently, assessing titles, abstracts, and full-text against the inclusion criteria. Discrepancies regarding the evaluation of the articles were resolved through consensus sessions between the reviewers.
Results: The final review included 14 relevant e-records in English from peer-reviewed sources, focusing on quantitative and qualitative research. From the analysis, four areas emerged: (1) Value chains in Healthcare; (2) Styles, activities, and practices of value co-creation in Healthcare; (3) Value co-creation in the encounter process; (4) Value co-creation in preventive health services.
Conclusion: The scoping review findings suggest several potential key aspects, including the interdependence between patients and healthcare organizations, organizational culture in healthcare, and the role of patient-centered approaches that focus on relationships, communication, and social support in healthcare. This can be achieved through patient engagement, patient-centered care and communication, health literacy, psychosocial support services, comprehensive psychosocial assessments, care coordination, and continuity of care. Integrating psychosocial elements in VHBC enhances quality and optimizes resource use. Findings highlight the need to develop practical guidance on how to implement a culture of value in care that takes into account the psychosocial aspects that have emerged, but not fully addressed. The pandemic teaches that the workforce poorly receives sudden and unsystematic changes. This review could provide an initial basis for the redesign of value in healthcare and a paradigm shift that has already begun with patient-centered medicine and patient engagement.
1 Introduction
Value-Based Healthcare (VBHC) is an economic approach that prioritizes patient outcomes over service volume to enhance care quality and optimize resource allocation. It originated from the works of Porter and Teisberg (2006), Porter (2009), Porter (2010) and Porter and Lee (2013). The approach focuses on aligning financial incentives with patient results for greater healthcare efficiency. VBHC traditionally focuses on continuously measuring health outcomes and relative costs. It emphasizes the importance of considering the distribution of resources to the population (allocative value), the appropriateness of resource use for specific health needs (technical value), and the alignment of health outcomes with patient expectations (personal value) (Kaplan and Witkowski, 2014). The cost of care for a specific condition is the sum of all related expenses (Depla et al., 2023). According to literature (Beard et al., 2020), hospitals treating chronic diseases such as diabetes can benefit from shifting to VBHC. This can result in better health management, healthier lives for patients, and reduced costs by emphasizing preventive measures and efficient treatments, reducing unnecessary procedures and overall healthcare expenditure. VBHC measures value by assessing the full care cycle, including the patient’s condition, diagnosis, outcomes, satisfaction, and related aspects (Gray, 2018). This requires calculating the costs and effectiveness of resources used. However, evaluating value solely based on costs is insufficient. According to a scoping review by Gunawan et al. (2022), most implementations of VBHC focus only on outcomes and costs, neglecting its multidimensional nature. None of the studies reported complete success in applying all aspects of VBHC. Therefore, hospital leaders need to understand that VBHC adoption involves more than just partial implementation (Gunawan et al., 2022). While traditional discussions of VBHC have emphasized its economic aspects, as noted by Kim et al. (2013) and Kaplan and Porter (2011), recent literature suggests the need to explore its psychosocial dimensions (van Engen et al., 2022).
1.1 Healthcare and psychosocial aspects
Healthcare is not only about medical treatments, but also about interpersonal relationships, communication and patient experiences within the healthcare system (Lewis, 2022). Therefore, when considering the value of healthy organizations, it is important to focus on the psychosocial component and the contribution of human resources. The psychosocial aspects of healthcare (Caprara et al., 2019), including patient satisfaction, mental well-being, communication, social support, shared decision making and patient engagement, are crucial in shaping the healthcare experience and have a direct impact on patient outcomes, treatment adherence and healthcare utilization patterns (Beach et al., 2006; Epstein and Street, 2011; Groene, 2011; Capone, 2016; Barello et al., 2021; Gorli and Barello, 2021). The literature (Virlée et al., 2020) highlights the importance of going beyond purely economic measures and considering the relational, psychological and social aspects of care. Such an approach can potentially improve patient outcomes, the well-being of healthcare workers and organizational culture (Capone, 2022; Marino and Capone, 2023). In summary, despite the increasing adoption of VBHC (Gunawan et al., 2022), defining, measuring and understanding the value of healthcare is a challenging task that requires the inclusion of psychosocial dimensions and consideration of the common matrix of social and economic issues (Osei-Frimpong, 2016). This scoping review aims to highlight the psychosocial dimensions of VBHC by describing the potential psychosocial factors that contribute to value creation in healthcare, with a consequent reduction in costs and considerable advantages for the management, also economic, of health and public health organization. In summary if properly systematized and implemented, have the potential to transform healthcare delivery and improve outcomes for all stakeholders (Teisberg et al., 2020).
2 Method
Given the exploratory nature of the study, a scoping review seemed the most appropriate choice (Schettino and Capone, 2022). It was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta–Analysis–Scoping Review (PRISMA-ScR) (Tricco et al., 2018) checklist to ensure a systematic and consistent scoping review. After a preliminary search of the scientific literature, we focused primarily on the Value-Based Healthcare traditional framework to extend the working context progressively. We have started with the following steps: (a) defining the research question; (b) identifying relevant studies; (c) selecting studies; (d) charting the data; (e) collecting, summarizing, and reporting the results. Initially, we defined a clear research question, forming the foundation of the entire review. Subsequently, we identified relevant studies through a literature search across the choice databases, employing specific keywords and inclusion/exclusion criteria that involved with the research question. Then, the study selection phase involves screening titles and abstracts for relevance, followed by a full-text review of eligible studies, applying the criteria set. The data was charted by extracting key information from each study, such as author, year, methodology and findings. The final stage encompassed collecting, summarizing, and reporting the results and synthesizing the data to identify themes, gaps, and potential areas for future research. This process is furthered by frameworks such as Arksey and O'Malley (2005), focusing on the breadth of scope; Levac et al. (2010), enhancing suggestions related to the extraction process; and Tricco et al. (2018), addressing advancements in scoping review practices, particularly in database searching. Following the triple-review model, each reviewer evaluated the articles separately to ensure a complete, impartial, and reliable evaluation. Regarding the field of psychosocial health, a scoping review (Augustinavicius et al., 2018, pp. 3–4) recommends involving multiple reviewers in the valuation article’s process for evaluating the relevance of academic articles and to resolve eventual discrepancies.
Regarding the registration on open science framework, we adopt the following criteria: scoping reviews, as defined by Arksey and O'Malley (2005), are a form of knowledge synthesis which addresses broader topics where many different study designs might be applicable. Different from systematic reviews, which have a well-established tradition of prospective registration to enhance transparency and reduce publication bias (Moher et al., 2009), it is possible for scoping reviews not to follow this protocol. This distinction arises because scoping reviews often have more flexible methodologies, which evolve as the review progresses, making prospective registration less practical (Peters et al., 2015). Levac et al. (2010) highlight that scoping reviews are particularly useful for not being extensively reviewed before, which may necessitate adjustments to the review protocol as new insights emerge (Tricco et al., 2018). This is aligned with the lack of a mandatory requirement for methodological quality assessment or risk of bias of included studies typical for the unique objectives of scoping reviews (see Section 2.5). Therefore, while transparency in research is important, the unique characteristics and developmental stages of scoping review methodologies provide a valid rationale for not adhering to the prospective registration process typically associated with systematic reviews (Peters et al., 2021). However, we included this aspect in the limits (see Section 4.1).
2.1 Research question
The research methodology employed a bottom-up approach (Gregory, 1990) utilizing the VBHC’s framework. This approach guided the development of specific research questions aimed at exploring the existence of psychosocial dimensions of VBHC. These questions are:
1. Does a psychosocial perspective exist within the VBHC framework?
2. How is this perspective characterized?
3. What key psychosocial factors significantly impact the perceived value in healthcare?
In alignment with the PICO strategy described by Giorgi et al. (2020), the research delineated its scope as follows:
a. Target population: included both patients and healthcare professionals.
b. Focus of the study: aspects of well-being and factors contributing to discomfort.
c. Outcomes: related to the perceived value in healthcare.
d. Methodological approach: quantitative and qualitative research designs were employed.
These elements underpin the research’s primary objective: to describe a non-economic, specifically psychosocial, viewpoint within healthcare organizations.
2.2 Search strategy
To determine the most suitable search strategy, three specialists in the fields of health and organizations were consulted. Relevant articles were identified through three electronic databases: APA, PsycINFO and PubMed. Thus, the electronic records were identified utilizing a bibliographic search conducted by inserting the algorithm of keywords such as: “Value-Based Healthcare,” “psychosocial perspective”; “psychological variables,” and Boolean operators (“AND,” “OR,” and “NOT”). An example search strategy: Title-Abs-Key (Value-Based Healthcare OR Value-Based Health Care AND psychosocial perspective OR psychological variables) AND [LIMIT-TO (Language, “English”)] (date of last research: 31 August 2023).
2.3 Inclusion and exclusion criteria
The peer-reviewed articles were selected on the basis of the following inclusion criteria: (1) qualitative and quantitative empirical studies, (2) written in English, (3) with full-text available online, (4) with clearly defined and explicit methods (5) with clearly implications. Gray literature articles, letters to editor, conference’s abstracts, commentaries and book chapters were excluded, too. Furthermore, articles on topics that are too distant were excluded, for example in-depth field: (e.g., laparoscopic surgery); tool’s specificity (e.g., digital devices); distant theoretical frameworks (e.g., psychiatric focus); purely economic aspects (e.g., drug-related expenses); general services (e.g., tourism) (see Flow Diagram).
Due the exploratory aim of study, no temporal or geographical restriction were used. The origin and the type of health organization were reported in the Table 1. Beyond this, is necessary to specify some aspects of our reflection process that could clarify our choices. Below, we attempt to summarize them.
1. Articles without VBHC Mention: While the primary focus of our research is on Value-Based Healthcare (VBHC), articles that not explicitly mentioned VBHC were still considered if they had clearly defined methods and implications aligned with the broader themes of VBHC to ensure a comprehensive description of the field, including perspectives and methodologies that might indirectly contribute to VBHC discourse.
2. Meaning of “Implications”: By “implications,” we refer to the practical or theoretical consequences of the study’s findings that differ from “results,” which are the direct outcomes of the research. Implications are more about how the results can be interpreted or applied in a broader context, including their relevance to VBHC principles.
3. Specific Outcomes Sought: The study was particularly interested in outcomes related to integrating psychosocial factors in healthcare, patient-centered care, and the effectiveness of healthcare services from a quality and cost perspective. These outcomes were sought to understand how they intersect with VBHC principles.
4. Articles Excluding Psychosocial Factors: If an article did not include explicit psychosocial factors, were it was determine if they it offered significant insights or methodologies that could indirectly contribute to understanding the role of psychosocial factors in VBHC.
5. Identification of Psychosocial Factors: Psychosocial factors were identified through a careful literature review. These factors included but were not limited to patient, healthcare provider attitudes, perceptions, experiences, social support systems, and the impact of these factors on healthcare outcomes.
Table 1. Description of included studies.
2.4 e-records selection process
The initial search identified 70 potential studies for review. After removing 10 duplicates, the titles and abstracts of 60 articles were independently evaluated for relevance by three reviewers specializing in the psychosocial health field. Each article was screened for inclusion by all reviewers. After a consensus session, 35 studies were dismissed as they not align with the set criteria. The remaining 25 studies underwent full-text assessment, resulting in a further 14 being excluded. Consequently, 14 articles were ultimately selected for the scoping review. Throughout the content analysis phase, the reviewers frequently discussed discrepancies or ambiguities in the study selection process (Haan et al., 2021). This deliberation was repeated to establish agreement on the emerging thematic core concepts.
The flowchart (see Figure 1) illustrates the literature search and screening procedure used in this review. Detailed information on the 14 chosen articles is available in Table 1. The post-analysis categorization of the content of the articles led to the definition of four primary thematic groups, identified by their recurring themes (refer to the Results section).
Figure 1. Flow diagram of the literature search strategy and review process, following PRISMA 2020 flow diagram rules.
2.5 Quality appraisal
In line with scoping review practice, the included studies have not been assessed in terms of quality (Tricco et al., 2016; Haan et al., 2021). It is worth noting that the primary aim of scoping studies is not to assess the quality of evidence. Indeed, they are recognized for their utility in identifying literature gaps and mapping the breadth of research on a particular topic, as suggested by Arksey and O'Malley (2005). Instead, they focus on exploring the range and nature of research activity in a certain field. This approach is particularly beneficial for topics where the literature is vast or has not been comprehensively reviewed.
3 Results
Four main thematic areas were identified:
1. Value chains in healthcare; 2. Styles, activities, and practices of value co-creation in healthcare; 3. Value co-creation in the encounter process; 4. Value co-creation in preventive health services. Table 1 summarizes the studies related to different core concepts that emerged, reporting for each paper, the authors; the description of objectives and participants; the method and tools; and the main results.
3.1 Area 1: value chains in healthcare
Studies in this area (Barnabè and Perna, 2019; Fjeldstad et al., 2020; European Society of Radiology, 2021) highlight the essential role of interdependence between the organization and the patient for value creation in healthcare services. In line with the Value-Based Health Care (Porter and Lee, 2013), this determines the effectiveness of outcomes and performance measurement. The need to create value and improve the products and services delivered through care is putting pressure on healthcare organizations and leaders. However, healthcare organizations have been hampered in implementing value processes by the widespread use of cost reduction rather than service redesign (Porter and Teisberg, 2006). Redesigning the healthcare system is critical to achieving effectiveness, efficiency and advances in care, innovation and scientific research. Changing a system’s architecture by increasing investments or reducing costs can lead to sustainable value, but also poses challenges and increases negative outcomes. Examples demonstrate how physicians and patients collaborate as co-producers of healthcare services to create value and achieve positive health outcomes. Personalized care, tailored to individual patient needs, is crucial for optimal results (Epstein and Street, 2011). This can be accomplished using appropriate stakeholders, information, and technologies. For instance, a highly personalized emergency response involving multiple healthcare workers benefits a person with various injuries from a car accident. Recognizing the interdependence between healthcare actors is crucial in pursuing value creation. It is related to the concept of a “value chain” consisting of repeatable and standardized treatment processes used by healthcare workers and patients to achieve desired outcomes which is valuable. Implementing a chain configuration for specific interventions can lead to higher efficiency, improved results, and cost reduction (Barnabè and Perna, 2019; Fjeldstad et al., 2020). However, addressing the issue of differentiation is essential, as standardized solutions may not be suitable for patients with complex medical problems who require personalized care. A value network configuration is proposed to address this challenge, enabling flexible interaction between stakeholders such as patients, physicians, researchers, and organizations. Such networks rely on combinations of platforms and personnel to enhance efficiency and effectiveness (Prahalad and Ramaswamy, 2004). Networked organizations rely less on hierarchy and more on peer collaboration and self-organization, resulting in an “actor-oriented” organizational architecture. This architecture allows for quick adaptation to changing needs through resource reconfiguration. A networked organizational architecture has the potential to facilitate various types of interactions necessary for clinical care, improvement, and research. Shared databases and aggregated knowledge support research accessible to researchers. Integrating of dispersed elements through the network contributes to value chains and the “value shop” concept, which emphasizes personalized responses to patient problems. In the context of the Value Shop, healthcare is based on individual patient-professional relationships. It involves a predictable cycle, including case acquisition, diagnosis development, personalized treatment selection, and solution verification. The value shop prioritizes breadth (managing various medical conditions) and depth (providing expertise) (Gadolin et al., 2020). The increasing complexity of diagnostic and curative interventions, driven by medical knowledge and expectations, has shifted the focus from a single provider of solutions to collaboration among healthcare workers from different disciplines and organizational systems (Rawlinson et al., 2021).
3.2 Area 2: styles, activities, and practices of value co-creation in healthcare
Studies in this area (McColl-Kennedy et al., 2012; Sweeney et al., 2015; Ng et al., 2018; Virlée et al., 2020) consider the activities and behaviors of healthcare workers and patients in creating value. In the past, healthcare customers were considered passive recipients outside the realm of the company. However, with the emergence of the Consumer Culture Theory (CCT), customers can now co-create value with the company and its members (Vargo and Lusch, 2016). This shift allows clients to play an active role in the process. Collaborative interactions between individuals and their caregivers are recognized as crucial in effectively managing chronic diseases like cancer, as outlined by the Patient Engagement Model (Graffigna et al., 2020) have the opportunity to integrate resources from healthcare companies, complementary therapies, and private sources such as colleagues, family members, and friends to co-create value (McColl-Kennedy et al., 2012). The co-creation of value is defined as the benefit derived from integrating resources through activities and interactions with collaborators in the client’s service network.
Patients can also co-create value through personal activities and behaviors, such as positive thinking and emotional self-work (McColl-Kennedy et al., 2012). More empirical research is needed on the role of healthcare customers in value creation and its impact on their quality of life, although it is recognized that certain styles of value creation increase organizational productivity. The different approaches to co-creating value are highlighted by McColl-Kennedy et al. (2012). In addition, it has been found that the involvement of users in shared decision-making leads to improved psychological well-being, better medical outcomes and higher levels of satisfaction with the care they receive. The active involvement of users in healthcare management, particularly in the case of chronic conditions, is highlighted by Sweeney et al. (2015). Clients employ use resources beyond healthcare providers, including complementary therapies, private sources, and autonomous positive-thinking activities. For organizational actors, it is important to understand how individuals co-create value to improve their health and well-being.
Sweeney et al. (2015) identified some themes of value co-creation activities, which can be performed within the health facility, through private sources, or market sources. These activities range from information sharing and compliance with basic requirements to positive thinking and emotional regulation. The authors argue that marketing, health psychology, and medical literature support the outcomes for clients and healthcare companies.
Ng et al. (2018) focus on identifying resources that health clients and caregivers can utilize. Resources are knowledge, skills, or personality traits that individuals value for their characteristics or to achieve desired outcomes. Traditional marketing theories primarily consider goods as units of exchange, but recent research recognizes the importance of knowledge and skills in resource integration to create value. Actors involved in a service draw on the resources brought by other actors. Ng et al. (2018) identify several resources relevant to customer value creation in healthcare. These include the sense of belonging, personal commitment, time availability, perception of complexity, service-related skills, risk tolerance, risk awareness, and economic resources. These resources vary among clients and influence healthcare providers’ integration process and activities.
Concerning the last point, Virlée et al. (2020) explain how patients with chronic illnesses co-create value by integrating their resources with various stakeholders. Resource integration activities in healthcare require different skills and efforts from patients and interactions with stakeholders, leading to varying effects on patients’ well-being. In their research, Virlée et al. (2020) explored the factors determining patients’ ability and willingness to engage in resource integration activities and how they relate to their well-being. They identified individual, relational, and systemic factors that act as resource integration facilitators or inhibitors. At the individual level, health literacy and engagement behavior were significant factors. Patients’ knowledge had an impact on their value co-creation activities, specifically their adherence to treatment, co-production activities, and diet and exercise. Previous studies have demonstrated that health literacy impact health behaviors and patient participation in managing their health. In terms of engagement behavior, patients who are more involved in managing their health tend to comply more with involved in medical instructions and engage in autonomous activities. These patients willingly contributed and used resources that affected their well-being.
Several antecedents were identified at the relational level. A crucial role was played by the responsiveness of carers and healthcare teams. This factor had an impact on adherence to prescriptions, mutual learning activities and co-production. Adherence and co-learning activities were also influenced by trust in healthcare workers, especially in relation to assurance. Patients’ adherence to prescriptions and coping activities and their participation in decision-making were influenced by effective communication by health care workers, using understandable language. Factors such as geophysical proximity, system connectivity, and social support were identified at the systemic level. Patients living far from healthcare facilities faced limitations in certain activities, such as physical rehabilitation or regular follow-ups. Lack of system connectivity, including inadequate communication and coordination among stakeholders, posed barriers to patient activities for value co-creation. Social support from non-professional networks, including partners, family, friends, and other patients, significantly influenced patient compliance, co-learning activities, and lifestyle changes. Overall, resource integration activities positively influenced patients’ psycho-physical well-being, as Virlée et al. (2020) highlighted.
3.3 Area 3: value co-creation in the encounter process
Studies in this area (Osei-Frimpong et al., 2015; Osei-Frimpong, 2016; Osei-Frimpong, 2017; Osei-Frimpong and Owusu-Frimpong, 2017) highlight how the paradigm shift from passive health clients to patient-centered models bridges a gap in the use of patients’ values, needs, and preferences to guide clinical decisions in service delivery. Research is needed to understand how interdependence in the physician-patient dyad can be a resource for value co-creation (Osei-Frimpong et al., 2015, p. 1).
There are important outcomes of value for healthcare workers and patients. In their study, Osei-Frimpong et al. (2015) state that the actors involved in the encounter have different objectives. Patients perceive value differently based on their expectations. The value of healthcare is conceived as healing, involvement in decision-making, positive experience, understanding the patient, making the correct diagnosis, prescribing appropriate medication, patient compliance, patient satisfaction, and operational efficiency (Osei-Frimpong et al., 2015; Osei-Frimpong and Owusu-Frimpong, 2017). The co-creation of value improves service results, and physicians and patients expressed elements that could enhance the value created during the consultation. These include involvement by the health service, recognition of the patient, reduction of complications or recurrences, and improvement of the health service.
The social context, beliefs and perceptions, and partnership of the dyad are critical areas that support the value co-creation process. The social skills of physicians, level of interactions, and knowledge and skills influence the experiences of physicians and patients. Mutual respect, interpersonal skills, friendliness, empathy, and respect for the patient are important in value co-creation (Osei-Frimpong et al., 2015). The nature of interaction during the consultation process, including listening, explaining, responding, and understanding, influences value co-creation. Two-way communication and active patient participation are preferred over a simple question-and-answer session (Osei-Frimpong et al., 2015). Beliefs and perceptions of patients and healthcare workers, including emotions, trust, and confidence, impact their experiences and value co-creation. Physician reassurance and positive feedback contribute to value creation. Physician-patient collaboration requires active participation and understanding. Patients desire greater involvement in the consultation and a shift away from a paternalistic approach (Osei-Frimpong et al., 2015). Patient adherence to care and compliance with medical instructions positively correlate with value outcomes. Understanding the value needs of the patient before the encounter is essential to reduce conflicts between actors (Osei-Frimpong, 2016). The patient’s commitment to treatment adherence and participation is largely driven by intrinsic motivation. Participation remains central to achieving worthwhile goals, and the social skills of caregivers influence patient participation (Osei-Frimpong, 2017). The patient’s “pre-encounter” expectations and trust influence perceived experiential value and satisfaction. Older patients attribute a higher positive experiential value to shared decision-making. The encounter between physicians and patients is considered a criterion to evaluate the service provision and perceived value. Commitment, information sharing, collaboration, trust, and clarity of roles are essential (Osei-Frimpong and Owusu-Frimpong, 2017). Cognitive and behavioral elements during the encounter produce valuable outcomes. Negative experiences compromise healing, well-being, and positive evaluation of the care service (Osei-Frimpong and Owusu-Frimpong, 2017). Healing, improved well-being, compliance, reduced visits to health facilities, and improved engagement between actors are valuable outcomes of the co-creation process. Elements such as participation, sharing, a relationship beyond prescription, hospital context, and communication contribute to the value created in the physician-patient encounter (Osei-Frimpong and Owusu-Frimpong, 2017).
3.4 Area 4: value co-creation in preventive health services
A final area highlighted how even preventive organizational contexts are characterized by actions and behaviors considered “value” by healthcare workers and patients. Studies in this area (Zainuddin et al., 2011, 2013, 2016) emphasize the active role of patients in healthcare, highlighting that preventive health services by society not only diminish public health system expenses but also yield benefits beyond mere cost savings. These advantages embrace emotional well-being and social health, which contribute to the broader functional value of healthcare initiatives. In this sense, healthcare organizations’ demand and supply studies must include “non-economic benefits” by adopting a well-being and pro-activity perspective. Adopting a marketing perspective that is not only aimed at financial gains and competitiveness can be detected both organizationally and for employees and users (Zainuddin et al., 2016). The first study (2011) investigates the value of healthcare from consumers’ point of view, following the social marketing approach in free public prevention services. Six themes emerged from the interviews conducted with the participants, inspired by Holbrook’s classification (Holbrook, 2006):
1. Convenience and health behavior: Convenience and ease of access to health services and facilities were considered fundamental. Practical and structural aspects that facilitate valuable outcomes fall under the functional dimension of value.
2. Control: Participants felt that regular screening and following healthy habits recommended by the prevention service gave them a sense of control over their health. This control is part of the functional and emotional dimensions of value.
3. Peace of mind: Following preventive behavior reduces negative emotions and provides service users with positive emotional reinforcement and reassurance. This aspect contributes to the emotional dimension of value.
4. Behaviors as reinforcement of beliefs: Preventive behavior reinforces individuals’ belief that they act healthily and are healthy. This aspect also falls under the emotional dimension of value.
5. Identifying oneself as having influence: Successfully experiencing preventive health services and adopting healthy behaviors contributes to the social dimension of value. Participants reported encouraging and persuading others to undergo breast cancer screening, creating a virtuous circle.
6. Benefits of one’s behavior for others: Adopting preventive health behaviors impacts micro-contexts and the wider community. It addresses the altruistic dimension of value, reducing costs to the health system and benefiting others.
The study found that the healthcare client’s engagement in value creation increases when the expert figure is less present. This finding strongly influences value creation in services that empower patients. Additionally, the study found that cognitive contributions positively influence emotional value, as well as functional value. Functional value enables healthcare clients to take control of their health by providing practical means to achieve emotional value, which is the desired goal of well-being. In addition, functional value is a stronger key to health client satisfaction than other dimensions, such as emotional value (Zainuddin et al., 2013). Furthermore, social value showed its influence on value creation, especially when health clients with prior experience in self-management of prevention transferred their knowledge about new adherents to preventive protocols (Zainuddin et al., 2016).
4 Discussion
This review examines the relational and psychosocial factors in Value-Based Healthcare (VBHC). It is evident that certain psychosocial aspects have emerged but require further development or systematic understanding. The discussion outlines the key differences that underpin our reflections: (1) The interdependence between patients and healthcare organizations should be considered; (2) The organizational culture plays a significant role in shaping healthcare worker interactions and patient care approach; (3) Healthcare should be framed as a client/customer relationship, with a focus on shared decision-making, patient satisfaction, partnership, patient-centered communication, and trust as psychosocial aspects for improving psychological well-being and quality of healthcare while reducing costs; (4) There is a need for a systematic study of non-financial perspectives in healthcare and for systematically assessing efficacy beliefs in health value creation. The review examines the structure of healthcare systems and the interactions between patients, physicians, and researchers. Organizational culture, as described by Schein (1983), is central to this discussion as it influences the dynamics among healthcare professionals, their approach to patient care, and their responses to challenges. These factors collectively shape patient experiences and health outcomes (Barry and Edgman-Levitan, 2012). Furthermore, this text highlights the difference between personalized medicine and patient-centered care. Personalized medicine involves customizing treatments based on individual patient characteristics, whereas patient-centered care emphasizes patient engagement, decision-making, communication, respect, and trust (Hood and Friend, 2011). The latter aligns more closely with a VBHC’s psychosocial perspective.
4.1 VBHC’s psychosocial perspective
The following are some of the more specific considerations in relation to the areas that have emerged from the review.
The first area underscores the role of patient-healthcare provider interdependence in shaping effective healthcare delivery and outcomes. The primary aspect we note is the interdependence between patients and health organizations, emphasizing mutual reliance and collaboration for better healthcare outcomes (Porter and Teisberg, 2006). From a psychosocial standpoint, this interdependence fosters patient engagement, increases health literacy, and empowers patients in their healthcare decisions (Hibbard and Greene, 2013). Such an approach is not only in line with the psychosocial framework of VBHC but also aims to elevate patient satisfaction and health outcomes.
The second area of study highlighted the use of terms like “health client” or “customer,” framing the healthcare perspective. It suggests that shared decision-making could improve psychological well-being and satisfaction with care. However, a more systematic investigation needs to examine the positive aspects of mental and psychosocial well-being. Nevertheless, no related evidence regarding mental and psychosocial well-being (Keyes, 2005) has been systematically investigated in VBHC. Moreover, aspects related to positive mental well-being, such as a sense of belonging, health literacy, and physician and patient skills (Capone et al., 2022), are posited but not investigated from a psychosocial health perspective. The studies included in the review also touch on the value co-creation concept and the importance of effective communication in healthcare, underlining the necessity for the perception of efficacy in health communication, as Bandura (1993) and others (Ong et al., 1995; Ha and Longnecker, 2010; Street and Haidet, 2011) have suggested. The review also addresses the role of social support, differentiating between non-professional network support and health organizational support (Uchino, 2006). While the former includes assistance from personal connections like family and friends, the latter involves structured support from healthcare organizations and workers. This support is more formal and structured, focused on meeting healthcare needs, ensuring patient safety, and fostering a supportive work environment for healthcare workers (Capone et al., 2022). Both types are essential, but in the context of VBHC, health organizational support is more significant.
The third area of study shifts to patient-physician relationships, highlighting the importance of aspects such as partnership, trust, and clear communication. These elements are crucial for a patient-centered approach (Epstein and Street, 2011) and align with the concept of patient-centered communication (PCC; Stewart, 1995; Capone, 2016), which is vital for reducing healthcare costs and enhancing the quality of the physician-patient relationship. This approach contrasts with physician-centered communication and improves the quality of the physician-patient relationship by providing clear information, showing empathy, and being expressive in non-verbal language. PCC promotes patient engagement and reduced physician-patient conflict, decreased patient avoidance, and increased satisfaction with the quality of care. Moreover, promoting patient-centered communication can reduce healthcare costs (Hong and Oh, 2020), in line with the economic goals of VBHC.
Finally, the fourth area of study discusses aspects such as “non-economic benefits” in healthcare, particularly preventive health services. This aligns with Bandura’s socio-cognitive theory (Bandura, 2004), emphasizing the role of self-efficacy in health-related value creation. However, there is a need for more systematic studies to assess the role of efficacy beliefs in this process. As mentioned above, efficacy beliefs related to health have a fundamental role in the psychosocial perspective (Bandura, 2018). We acknowledge these studies’ efforts to include a socio-cognitive perspective. However, we must highlight the need to asses studies and tools that systematize the role of efficacy beliefs in the health value creation process from a non-financial perspective because the gap remains. Advancing our understanding of efficacy beliefs in non-economic healthcare can enrich psychosocial discourse and contribute to holistic interventions.
4.2 Limitations of the study
As scoping studies do not seek to assess evidence quality, they cannot determine whether particular studies provide robust or generalizable findings (Arksey and O'Malley, 2005). As part of the scoping review process, the articles included in the review were not assessed for accuracy. First of all, we have already discussed in the Methods section (See paragraph 2) the appropriateness of not following the open science registration framework for this scoping review. We also only considered articles in English. This practice can impose limitations on the generalizability of their results: the exclusion of significant research findings published in other languages the overlooking of culturally specific or geographic specific perspectives potentially marginalizing findings from non-English speaking regions, an overrepresentation of viewpoints from English-speaking countries and a lack relevance of different cultural contexts (Meneghini and Packer, 2007; Amano et al., 2016). Furthermore, it is important to note that, as noted by Paez (2017), the removal of gray literature may have introduced study bias. In addition, the use of keywords did not always ensure consistency with subject areas and may have suffered from a subjective criterion that should be better controlled in subsequent studies. Due to the prevalence of the cross-sectional method and the different geographical areas, the results cannot be considered generalizable. Finally, the methodological framework of the work could have been strengthened by including statistical indices of agreement on the thematic categories identified. Nevertheless, this analysis is valuable for exploring peer-reviewed articles in the context of healthcare value.
5 Conclusion
The findings of this scoping review will contribute to a better understanding of the psychosocial dimensions of Value-Based Healthcare, inform policy and practice, and identify gaps in the literature for future research. Several studies have indicated, albeit weakly, some psychosocial aspects of value in health that should be further explored and implemented, as shown in this scoping review. In line with the broadening horizons that the literature on value is embracing (Teisberg et al., 2020; Lewis, 2022), we propose a possible future agenda in this regard:
• Patient Engagement (Barello et al., 2022): Engaging patients in managing their psychosocial well-being could be a key aspect of VBHC. This may involve providing resources, tools, and interventions to promote self-care, and coping strategies.
• Patient-Centered Care and Communication (Sheeran et al., 2023): VBHC could emphasize patient-centeredness, which includes considering patients’ psychosocial needs and preferences. It involves actively listening to patients, understanding their values, beliefs, and goals, and incorporating these factors into the care plan. Effective communication ensures that patients are actively involved in decision-making, leading to improved treatment adherence and better health outcomes. It also promotes patient satisfaction and engagement, which are key indicators of value in healthcare.
• Health literacy (Barello et al., 2022): Health literacy empowers individuals to make informed decisions about their health, leading to improved health outcomes. It acts as a bridge between healthcare workers and patients, facilitating effective communication, promoting trust, and fostering a patient-centered care approach. Investing in health literacy initiatives, such as improving health education, should promote clear and accessible health information, enhance communication skills, and prioritize patient well-being and cost efficiency.
• Psychosocial Support Services (Capone et al., 2022): VBHC recognizes the importance of providing psychosocial support services as part of comprehensive care. This may include access to mental health professionals, social workers, counselors, or support groups to address patients’ emotional and social needs.
• Psychosocial Assessments (Marino and Capone, 2023): Comprehensive assessments of patients’ psychosocial well-being could be integrated into the care process. This may involve evaluating traditional factors such as socioeconomic status, cultural background, and implementing a tool to measure psychosocial dimensions of value in health related to patients and physicians.
• Patient-Reported Outcome Measures (PROMs) (Depla et al., 2023): PROMs are tools used in VBHC to assess patients’ perspectives on their health status and quality of life. These measures capture psychosocial aspects, such as emotional well-being, social functioning, and the impact of the illness on daily life.
• Care Coordination and Integration (Lewis, 2022): VBHC emphasizes care coordination and integration across healthcare settings, including mental health services, social services, and community resources. This ensures that patients’ psychosocial needs are addressed holistically and that they receive appropriate support beyond clinical interventions.
• Continuity of Care (Porter and Kramer, 2019): VBHC recognizes the importance of continuity in the patient-professional relationship. Consistency in healthcare relationships promotes trust, communication, and understanding of patients’ psychosocial needs over time.
Author contributions
LM: Conceptualization, Data curation, Investigation, Methodology, Project administration, Resources, Writing – original draft, Writing – review & editing. VC: Conceptualization, Investigation, Project administration, Supervision, Writing – review & editing.
Funding
The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. The Italian Psychological Association (AIP) Organizational Section supports this research publication by contributing 500 euros. This research participated in the “Mini-Grant Call for Research Dissemination Support, 2023 Edition,” and emerged as the winner.
Acknowledgments
The authors would like to thank the two reviewers for their valuable suggestions for improving the article and would like to thank Dr. Giovanni Schettino for participating in the evaluation and selection process of the articles as an independent reviewer.
Conflict of interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher’s note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: value-based healthcare, psychosocial perspective, healthcare organizations, organizational perspective, scoping review
Citation: Marino L and Capone V (2024) Psychosocial factors contributing to value creation in value-based healthcare: a scoping review. Front. Psychol. 15:1323110. doi: 10.3389/fpsyg.2024.1323110
Edited by:
Christopher Tompkins, Brandeis University, United StatesReviewed by:
Gerardo Petruzziello, University of Bologna, ItalyElizabeth Austin, Macquarie University, Australia
Copyright © 2024 Marino and Capone. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Leda Marino, leda.marino@unina.it