Evolution of the Value-Based Approach: Focus on High-Value Health Systems and Their Application in the Global and Russian Context

Introduction. The optimization of global healthcare systems in response to the challenges of recent decades, including the COVID-19 pandemic, the increasing burden of chronic diseases, population aging, and rapid advances in biomedical technologies, clearly highlight the need to shift from traditional models of healthcare delivery to innovative approaches. This article examines the key concepts of healthcare transformation: value-based healthcare (VBHC) and high-value health systems (HVHS). It analyzes their interrelationships, similarities and differences, and the experience of their practical implementation globally. Key considerations for the Russian Federation in the context of the transition to HVHS are highlighted. The goal was to carry out a comparative analysis of VBHC and HVHS and examine their relationship and evolution, as well as to study the global experience of their implementation for further elaboration of a competitive healthcare system in Russia. Materials and methods. To achieve the study's goals, a combination of general scientific research methods was used: systematization and conceptual analysis, comparative analysis, generalization, and descriptive and analytical synthesis. The study relied on data obtained through content analysis of scientific publications published in open data sources, including PubMed, Springer Nature, and eLibrary.ru from January 1, 2020, to September 1, 2025. The keywords “value-based healthcare” and “healthcare systems” were used in the search. Results. The analysis revealed a clear evolutionary trajectory from the VBHC model focusing on individual diseases to the systemic HVHS paradigm encompassing all healthcare. A comparison of the concepts revealed their complementarity: the VBHC model functions as a tactical tool at the healthcare delivery level, while HVHS represents a strategic framework at the macro level. Global experience shows that no country has fully implemented all components of these models. In the context of the Russian Federation, uneven progress has been noted.

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