Desirability and feasibility of value-based healthcare in the Dutch Military Health System: a cross-sectional study

BACKGROUND: Value-Based Healthcare (VBHC) emphasises delivering high-quality care measured by patient outcomes rather than the volume of services. Although mostly partially implemented in civilian health systems, VBHC integration within military health systems (MHS) lags behind. Given current geopolitical developments and the unique operational demands of military healthcare, this study aimed to assess the desirability and feasibility of implementing VBHC in the Dutch MHS. METHODS: A cross-sectional, descriptive survey was conducted in 2024 among active-duty personnel in the Netherlands Armed Forces. Stratified sampling targeted three stakeholder groups—care recipients, care providers, and care facilitators—followed by voluntary response recruitment. A self-administered online questionnaire assessed familiarity with VBHC, perceived desirability and feasibility of its implementation, and prioritised components for application. The survey was structured around case-based scenarios derived from the Linnean VBHC framework, adapted to the military context. Quantitative data were analysed using descriptive statistics and Likert-scale medians; open-ended responses were analysed thematically. RESULTS: Of 912 eligible participants, 290 completed the survey (32% response rate), comprised of 45% care recipients, 33% care providers, and 22% care facilitators. Most respondents (67%) had over 15 years of military service; 58% held higher education degrees. Familiarity with VBHC increased throughout the survey. Overall, 96% of respondents perceived VBHC as valuable for the Dutch MHS. Notably, 64% believed VBHC could benefit both regular and operational care. A collaborative implementation approach involving all three stakeholder groups was preferred by 82%. However, concerns were raised about feasibility in large-scale combat operations, highlighting the need to align VBHC components with military readiness and mission-critical objectives. CONCLUSION: This study provides initial evidence supporting broad acceptance of VBHC within the Dutch MHS, particularly for non-operational military healthcare contexts. While desirability was high, practical applicability raised concerns, especially regarding combat and operational care settings. These findings suggest the potential for VBHC integration, but emphasize the necessity for a military-specific adaptation. Future research should explore targeted implementation strategies that balance patient-centered outcomes with the unique operational demands of military healthcare environments.