Fee Based to Value Based Nursing Paper


Value-based care in nursing refers to the quality of healthcare services offered to patients. It is a system of care that was introduced to tackle the problem of a shift in the demographics, rampant poor quality outcomes, and the ballooning cost of healthcare. In contrast, the fee-for-value system is where health outcomes/quality is measured based on what the customer can afford. In simple terms, value means that high-end customers get high-quality healthcare services whereas low-end customers get a lower quality of healthcare services. Fee for value is a highly controversial system because the model is simply a reward for expensive interventions.

How Value-Based System Improves Healthcare

Value-based care creates room for Interprofessional collaboration leading to improved patient outcomes. In the fee-for-value system, healthcare facilities work against each other to increase their profits. In this system, patients are merely seen as customers who bring in money. Thus, the more customers the higher the profitability. Based on this analogy, healthcare facilities work in competition against each other. Conversely, in a value-based system, the focus is on improving the health of patients which means that doctors and nurses from the same and different healthcare facilities collaborate with the view of improving patient outcomes.

Value-based care reduces costs for patients while it advocates for better outcomes. The words value and quality are the lifeblood of value-based care which means patients pay less for quality healthcare services. In most cases, the focus of value-based care is preventative care which is less costly compared to treating chronic ailments such as diabetes, hypertension, or cancer. Based on this analogy, value-based care aims to educate and sensitize members of the public to adopt a healthy lifestyle that would prevent them from contracting these chronic diseases.

Besides advocating for the members of the public to live healthy lifestyles, value-based care uses models of treatment that make patients spend less on medication as they get their health back on track. By focusing on prevention as its core modus operandi, value-based care ensures that patients use less money for medication because they are healthy. For example, value-based care helps to eliminate poor habits such as smoking, obesity, excessive alcohol consumption, and overeating. These factors are the biggest contributors to chronic conditions.

Value-based care promotes patient satisfaction which is a critical benchmark in the provision of quality healthcare. Healthcare facilities can use patient satisfaction as a measurement for their performance. Duly, healthcare facilities that satisfy their customers through high-quality healthcare get rewarded with a good reputation. Value-based care’s sole focus is the health of patients which means the overall long-term goal of this model is improving the quality of life of societies (World Health Organization, 2017).

This model of operation runs on the mantra that the healthier the nation, the less money is spent on healthcare. This statement is true because most developed countries today have a huge budgetary allocation for health especially for treating people suffering from chronic diseases that could have been prevented if people adopted a healthier lifestyle.

The model of value-based care has transformed the practice of medicine due to a reduction in medical errors. As mentioned earlier, the focus of value-based care is the quality of healthcare accorded to patients. For this reason, value-based care has adopted the core values of professional nursing that impact the quality of care (Gray, 2017). The core values of nursing practice used in value-based care include; altruism, autonomy, human dignity, integrity, and social justice. These core nursing practices define how nurses, physicians, and other medical professionals dispense their duties. These core values require medical professionals to dispense their duties with the utmost care, professionalism, justice, and knowledge.

Distinction Between/Physicians Working in Fee Service versus Value-Based

In the fee-for-service model, physicians, nurses, and hospitals are paid based on the number of services provided each day. For example, if a doctor sees ten patients in a day, he gets paid for those ten patients based on the price of each treatment. In simple terms, doctors, nurses, and hospitals are paid based on the number of patients they attend each day, thus, the higher the number of customers, the better. The healthcare providers working under the fee-for-service model get compensated on the number of visits, tests, and medical procedures. Consequently, this model seeks to increase the number of patients/customers because they are profit-motivated.

On contrary, physicians and nurses under the value-based care model are compensated for the quality of care they provide, not quantity. This type of model is customer-centered and takes a more team-oriented approach where different health professionals and healthcare facilities collaborate to improve patient outcomes (Gray, 2017). Another critical feature of value-based care is that the health professionals under this model have more accountability because the expectations put on them concerning patient outcomes are much higher than their colleagues -for working in the fee-for-value model.

Value-based care boosts the reputation of healthcare facilities. Today, patient safety is one of the parameters for judging healthcare facilities. Patient safety is at the top of many hospitals because patients do not want to go to healthcare facilities that have a bad reputation concerning safety (World Health Organization, 2017). Many patients would rather pay more to get medication from hospitals with good quality patient care.

Shared Power between Physicians And Nurses In Healthcare and Its Impact.

The quality of healthcare to patients is impacted by the environment where the care is given. The relationship between nurses and physicians directly impacts the quality of care to patients. Strained relationships between nurses and physicians adversely affect the quality of care whereas positive relationships between nurses and physicians result in positive patient outcomes. While tensions are common in any workplace, however, these can be solved through proper communication between co-workers. Proper communication between nurses and doctors can alleviate unnecessary conflicts and misunderstandings (Siedlecki, & Hixson, 2017). For example, doctors must make clear orders to nurses so that there are no misunderstandings when attending to patients. Most importantly, there must be mutual respect between physicians and nurses for a conducive work environment to prevail.

Physicians must treat nurses as equal partners in dispensing healthcare to patients. The truth is that doctors cannot operate without nurses and the reverse is also true. Based on this analogy, nurses and physicians must work closely together to offer quality healthcare to patients (Siedlecki, & Hixson, 2017). In terms of ranking, physicians rank higher than nurses in any healthcare-giving facility. However, in terms of dispensing their duties to patients, the two must work closely together sharing power, skills, and knowledge, in the effort to provide quality care to patients.

Shared power between nurses and physicians enhances patient safety. Patient safety in hospitals reduces risks of harm or injury. The objective of patient safety is to curb risks and harm that may happen to patients during their stay or visit to healthcare facilities (Burgener, 2020). Patient safety is a critical factor in quality care while reducing errors that harm both patients and hospitals (Burgener, 2020). Today, patient safety is a phenomenon that healthcare facilities cannot ignore. Facilities that do not take patient safety seriously suffer from costly lawsuits and damaged reputations.


Value-based care has numerous benefits to patients and healthcare facilities. To patients, the biggest advantage of this health model is improved outcomes, safety, and quality of care. Concerning quality, value-based care provides quality care to patients because all systems work together in collaboration for the benefit of patients. For healthcare facilities, the idea of patient satisfaction creates a good reputation which in turn translates into profitability. Another critical advantage of value-based care is that it reduces the cost of medication.

The fact that this model of healthcare emphasizes primary prevention means that people spend less money on health. In contrast, the fee-to-service health model emphasizes quantity rather than quality. This means that physicians and nurses are compensated based on the number of patients they attend. This type of care does not emphasize the quality of care provided. Its mode of operation is that customers get different quality of care depending on their pocket.


  • Burgener, A. (2020). Enhancing communication to improve patient safety and to increase patient satisfaction. The Health Care Manager, 39(3), 128-132. doi: 10.1097/HCM.0000000000000298
  • Gray, M. (2017). Value based healthcare. doi: https://doi.org/10.1136/bmj.j437
  • Siedlecki, S. L., & Hixson, E. (2017). Relationships between nurses and physicians matter. Online J Issues Nurs, 20(6). DOI: 10.3912/OJIN.Vol20No03PPT03
  • World Health Organization. (2017). Patient safety: making health care safer (No.WHO/HIS/SDS/2017.11). World Health Organization.