Accounting for value-based management of healthcare services: challenging neoliberal government from within?

This paper examines the political rationality and governing technology underpinning value-based management (VBM) in the Danish healthcare system. VBM is a neoliberal mode of governing healthcare via competitive pay-for-performance schemes. At the same time, it has somewhat paradoxically cleared a space for criticising such neoliberal schemes. VBM implies an insatiable demand for knowledge that seeks to map the health outcomes and costs of treatment; a demand challenging the neoliberal governmentality that informs it.

Management scholars have inspired a new series of reforms that, under the heading of ‘value-based management’, seeks to link hospital funding to accounts of actual treatment outcomes and costs. Based on the Danish experience, this paper suggests that the shift from a pay-for-performance system based on narrow conceptions of output, such as the number of patients treated, to one measuring actual health outcomes for patients is promising. However, the requirement for extensive knowledge linking health outcomes to full cycle treatments and their costs significantly challenges the adoption of a fair pay-for-performance system.