Beyond Metrics: Rethinking Value in Digital Transformation of Healthcare
摘要
The ongoing digital transformation of healthcare raises new questions regarding the production, measurement, and distribution of value in contemporary medicine. This chapter examines the risks and opportunities associated with digital medicine through a sociological perspective, emphasizing the various and often conflicting definitions of “value” within healthcare systems. Drawing upon classical social theory—particularly the works of Karl Marx, Max Weber, and Boltanski & Thévenot—it analyzes the distinctions among use value, exchange value, and symbolic value in health practices, and how these are influenced by institutional and cultural contexts. Special attention is accorded to the emergence of “Value-Based Healthcare” (VBHC) as a predominant framework in health policy and digital innovation. Whilst VBHC advocates for efficiency and outcome-oriented care, it also bears the risk of reducing complex health needs to quantifiable metrics, thereby potentially marginalizing aspects such as equity, dignity, and relational care. This chapter critically examines how digital tools—comprising algorithms, Key performance indicators (KPIs), wearables, and telemedicine—may reinforce technocratic paradigms, aggravate existing inequalities, and introduce novel forms of surveillance and exclusion. Through a comparative approach, the chapter reflects on the tensions between solidaristic welfare models in Europe and insurance-driven systems in the United States, emphasizing how digitalization intersects with broader socio-political structures. The role of supranational organizations (e.g., WHO, OECD, European Union) in promoting standardized frameworks of value is also addressed. In conclusion, the chapter advocates for a pluralistic and situated understanding of value in digital medicine—one that integrates clinical, human, ethical, and social dimensions. It proposes a shift from efficiency-centered paradigms toward more inclusive, participatory, and relational forms of healthcare innovation, where technology serves not only performance but also proximity, equity, and democratic accountability.