Association for Public Policy Analysis & Management

“Value based health care” is a policy idea that have gained significant international attention as an instrument to optimize the relationship between expenditures and value for citizens and society. - While the core concepts are intuitively appealing there have been much more diversity in the interpretation and many challenges in converting the ideas into successful practices. There are many examples of aspirations to use VBHC, but apart from the limited number of cases presented by Porter and associated there are few examples of full scale implementation showing clear and positive results. It appears that there are significant challenges in translating the general ideas to practical policy.

The present paper aims to take stock of VBHC developments in Denmark and Sweden as examples of countries with a highly developed data-infrastructure, which make them “most-likely-cases” for implementing VBHC. We pursue this aim through a number of steps. First we discuss why the VBHC idea has gained support in the two Nordic health care systems based on agenda-setting theories from public administration. Second we develop a typology of VBHC projects and provide an overview of projects that have been initiated in Denmark and Sweden with reference to the VBHC concept. Based on this descriptive analysis we discuss explanations for the current state of implementation. Finally, we discuss different options for moving forward based on theoretical models of incentive schemes and the experiences from the projects.