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. 2019 Apr 27;19(1):256.
doi: 10.1186/s12913-019-4081-6.

Value based competition in health care's ethical drawbacks and the need for a values-driven approach

A Stef Groenewoud  1 , Gert P Westert  2 , Jan A M Kremer  2
Affiliations

Value based competition in health care's ethical drawbacks and the need for a values-driven approach

A Stef Groenewoud et al. BMC Health Serv Res. .

Abstract

Value Based competition in Health Care (VBHC) has become a guiding principle in the quest for high quality health care for acceptable costs. Current literature lacks substantial ethical evaluation of VBHC.In this paper we describe how a single-minded focus on VBHC may cause serious infringements upon at least four medical ethical principles: 1) it tends to neglect patients' personal values; 2) it ignores the intrinsic value of the caring act; 3) it disproportionately replaces trust in professionals with accountability, and 4) it undermines solidarity.Health care needs a next step in VBHC. We suggest a 'Values-Driven Health Care' (VDHC) approach that a) takes patients' personal values as prescriptive and guiding; b) holds a value account that encompasses health care's intrinsic (gift) values; c) is based upon intelligent accountability that supports trust in trustworthy professionals, and d) encourages patients to raise their voices for the shared good of health care.

Keywords: Accountability; Competition; Ethics; Indicators; Intrinsic value; Patient values; Trust; Value based health care; Values driven health care.

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Competing interests

The authors declare that they have no competing interests.

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