2026/04/29 by Farah Farahati, Hamid Sadri, Dominique Brandt +2 · 1 voice
Economics, Econometrics and Finance · Health Professions · #Economic and Financial Impacts of Cancer #Healthcare Policy and Management #Primary Care and Health Outcomes
paper · doi:10.20935/acadphealth8221
openalex publication_date 2026/04/29 · openalex created_date 2026/05/03 · openalex updated_date 2026/06/11
Value-based care (VBC) marks a shift away from volume-driven service delivery toward models that prioritize patient outcomes, system efficiency, and cost control. While both the United States and Canada have adopted VBC principles, their implementation reflects distinct governance and financing structures. In Canada, VBC is embedded within population-level planning and outcome-based funding, emphasizing whole-person care and public stewardship. In contrast, the U.S. approach is shaped by payer incentives, including performance-based reimbursement and risk-sharing contracts within a multi-payer landscape. These differences reflect broader contrasts in health system financing. In Canada, outcome-based funding is embedded within broader purchasing reform, where provincial ministries strategically allocate resources to support population health goals, integrated care, and long-term value. This approach prioritizes whole-person outcomes over transactional service delivery. In the United States, VBC is operationalized primarily through payment models—such as bundled payments, capitation, and shared savings contracts—that incentivize providers based on performance metrics and cost containment. These models are supported by Centers for Medicare and Medicaid Services (CMS) policy levers, initiatives like the Medicare Shared Savings Program (MSSP) and Bundled Payments for Care Improvement (BPCI). These programs tie reimbursement to quality benchmarks, patient outcomes, and cost-efficiency targets. While they promote accountability, they often function within fragmented systems where payer-driven incentives shape care delivery more than coordinated public planning. This study presents a structured comparative policy and outcomes review of value-based care implementation across both systems. Drawing on Organization for Economic Co-operation and Development (OECD), Canadian Institute for Health Information (CIHI), and CMS indicators and a structured synthesis of evaluated value-based care implementations published between 2015 and 2025, we compare reported trends in cost efficiency, preventable hospitalizations, and chronic disease outcomes in the United States and Canada. The reported literature commonly describes greater private-sector innovation in the U.S. and stronger equity and administrative efficiency in Canada. Both systems are converging on digital tools, shared accountability, and risk-adjusted models. The review suggests that sustainable VBC integration depends on hybrid financing, longitudinal outcome tracking, and higher alignment between public goals and private incentives. Cross-border collaboration offers opportunities to create a unified, high-value, and equitable care framework for North America.