Care for all is no longer guaranteed according to the Dutch Healthcare Authority. Dutch hospitals face increasing pressure in dealing with an increase in healthcare demand, staff shortages and financial uncertainty. To address these challenges the Dutch government introduced the Integral Care Agreement in which Shared Decision Making (SDM) is introduced as a way to tackle current healthcare problems. To support SDM, tools such as Decision Aids can be used. Decision Aids contain evidence based information on the treatment of a patient. This information helps the patient understand their medical condition and it facilitates them in choosing a treatment method that aligns with their values and preferences.

However, the adoption of decision aids seem to be lagging. This is due to the lack of clarity and financial uncertainty the implementation of Decision Aids bring. Hospitals are reimbursed for the care they deliver through a Diagnosis Treatment Combination (DBC). It is known that surgical DBCs generate more income for hospitals than non-surgical DBCs. A consequence of effective decision aid implementation is that patients opt for more conservative treatments, which could press the rise in demand for healthcare. However, as more patients choose for conservative treatments, the income of hospitals may decrease. If hospitals do not anticipate these changes in patient distribution across treatment options, they might become financially unstable.

This study aimed to help hospitals in their transition to Value Based Healthcare by evaluating the impact of Decision Aids. Current evaluation methods include analysing the changes in DBC and care activity volumes. A mixed methods approach was applied through 4 phases. Research methods included semi-structured interviews with healthcare professionals and System Dynamics Modeling.

Results showed a decrease in revenue for hospitals under the current financial system when Decision Aids are implemented, given that they cause for an increase in conservative treatments.

This study highlighted that these evaluation methods fall short in doing right compared to the quality improvement VBHC brings to care. Recommendations include finding a new evaluation method that is based on value-driven outcomes.