What is Value in Healthcare? A Qualitative Study of the Patient Perspective on Value

Abstract: The definition of value in healthcare has been subject to an extensive academic and medial debate over the last years. Although several frameworks for value in healthcare have been developed, most do not consider the patient perspective when defining value. This interpretive, qualitative interview study aims to explore how patient value is created in healthcare. We interviewed nine representatives from eight patient organisations in Sweden to understand patients' perspective of value. Using an abductive approach, a theoretical framework for analysis based in the literature on value-creation in the service industry was developed in parallel with the empirical material. We find that patients interpret value subjectively by evaluating perceived outcomes from healthcare. Healthcare processes form value propositions that are translated into functional and emotional outcomes of healthcare for patients. Outcomes are evaluated using patients' individual filters such as needs, expectations and prior experiences of healthcare. Furthermore, individual and situational filters are not fixed. Healthcare providers may increase perceived value for patients by either improving processes and/or moderating patients' filters through dialogue. Our results indicate that current healthcare value frameworks do not consider patients' subjective evaluation of outcomes when defining value. Current frameworks disregard emotional outcomes that patients may perceive as highly valuable. Patients' internal factors determining evaluation of outcomes need to be investigated further to fully understand patients' interpretation of value.