OBJECTIVES:

Value-based healthcare (VBHC) has been discussed globally as a potential solution to high costs and uneven quality of care in healthcare systems. This study carried out a systematic literature review (SLR) on the advances and challenges of the theme in Brazil.

METHODS:

Two keywords were used in the search: variations of the term VBHC and variations of the word Brazil. The research was carried out on the title, abstract, and keywords in six databases in December 2022. The integrative SLR classified the works according to four elements: (i) the exploration of the VBHC concept, (ii) the VBHC sub-strategies, (iii) the implementation stage according to the Teisberg framework, and (iv) the challenges for VBHC in Brazil.

RESULTS:

The search returned 228 papers, but the research continued with 23 studies after removing duplicate documents. Only 40% of the works defined VBHC using Porter's concepts. Most works showed that the increase in health costs represents the main reason for the growing discussions about VBHC, with two sub-strategies prevailing: "move to bundle payments" (40%) and "measure outcomes and/or cost for Every patient" (35 %). The implementation stage of VBHC initiatives varies between institutions. Most are in an intermediate stage, involving measures of health outcomes and cost (26%), although the studies do not cite compliance with the previous stages proposed by Teisberg. The main challenges for VBHC initiatives in Brazil are related to human (35%) and procedural (38%) barriers, involving the need to engage multi-stakeholders and overcoming the limits imposed by processes that prevent a change in the current payment model.

CONCLUSIONS:

Brazil has shown constant advances in the VBHC theme as in a marathon. Despite the achievements in recent years, there are still many challenges for the Brazilian health system to reach the final stretch of this marathon and enjoy all the benefits provided by VBHC.