Doctors as Resource Stewards? Translating High-Value, Cost-Conscious Care to the Consulting Room

Marjolein Moleman*, Teun Zuiderent-Jerak, Marianne Lageweg, Gianni L. van den Braak, Tjerk Jan Schuitmaker-Warnaar

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


After many policy attempts to tackle the persistent rise in the costs of health care, physicians are increasingly seen as potentially effective resource stewards. Frameworks including the quadruple aim, value-based health care and choosing wisely underline the importance of positive engagement of the health care workforce in reinventing the system–paving the way to real affordability by defining the right care. Current programmes focus on educating future doctors to provide ‘high-value, cost-conscious care’ (HVCCC), which proponents believe is the future of sustainable medical practice. Such programmes, which aim to extend population-level allocation concerns to interactions between an individual doctor and patient, have generated lively debates about the ethics of expanding doctors’ professional accountability. To empirically ground this discussion, we conducted a qualitative interview study to examine what happens when resource stewardship responsibilities are extended to the consulting room. Attempts to deliver HVCCC were found to involve inevitable trade-offs between benefits to the individual patient and (social) costs, medical uncertainty and efficiency, and between resource stewardship and trust. Physicians reconcile this by justifying good-value care in terms of what is in the best interest of individual patients–redefining the currency of value from monetary costs to a patient’s quality of life, and cost-conscious care as reflective medical practice. Micro-level resource stewardship thus becomes a matter of working reflexively and reducing wasteful forms of care, rather than of making difficult choices about resource allocation.

Original languageEnglish
Pages (from-to)215-239
Number of pages25
JournalHealth Care Analysis
Issue number3-4
Early online date13 May 2022
Publication statusPublished - Dec 2022

Bibliographical note

Funding Information:
This work was funded by the Medical Specialties Council (CGS), department of the Royal Dutch Medical Association.

Publisher Copyright:
© 2022, The Author(s).


  • Cost-conscious care
  • Health care costs
  • High-value care
  • High-value, cost-conscious care
  • Medical professionalism
  • Resource stewardship


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