Pay for Quality

96 Pay for Quality KCE Reports 118
6 INTERNATIONAL COMPARISON
6.1 INTRODUCTION
This chapter aims at answering the following research questions:
How is P4Q applied and how is it influenced by market, payer, provider and
other healthcare system characteristics.
Four countries are taken into account, the USA, the UK, the Netherlands and Australia.
For each country, semi structured interviews were conducted with key experts. (See
chapter 2 for further details on the methodological approach)
From chapter 4 it appears that the majority of P4Q schemes are conducted in the USA
and the UK. The Netherlands and Australia are two countries which are still in a
starting phase of implementing P4Q, with only a few P4Q schemes operational. For the
UK and the USA, two key experts per country have been interviewed. For the
Netherlands and Australia, one key expert per country was interviewed. The results of
these interviews will be reported in accordance with the topics of the conceptual
framework as mentioned in chapter 3.
6.2 DESCRIPTION
6.2.1 Health care system characteristics
The health care system characteristics are essential determinants in the implementation
of P4Q. An extensive overview of the health care system characteristics has been
provided in chapter 4.
6.2.2 Existing P4Q interventions
6.2.2.1 The United Kingdom
Since 2004, quality has been introduced as a major part of the general practitioners
remuneration in primary care in the UK. This occurred by means of the implementation
of the Quality and Outcome Framework (QOF) in the UK health care system. 236 This
framework has been described extensively in chapter 4. Participation in QOF is
voluntary, however because of the high incentive, participation is high. Previous
schemes, like ‘the good practices allowance’, which was launched in 1986, failed in their
objective. At the time the medical culture was characterized by the idea that quality
could not be measured and that there is no such thing as ‘a bad doctor’. From that time
on, the medical culture has changed in a sense that physicians and government began to
recognize that the quality is not as high as we like it to be and that there is some
variation between and within countries. High quality programme failures like ‘the Bristol
case’, in which the death rate for congenital heart surgery in the Bristol Royal Infirmary
was much higher than in other hospitals, was a kind of trigger to change medical culture.
In the UK, P4Q programmes came together with already existing quality initiatives,
hence physicians in the UK had already become familiar with quality assessments (for
example: audit programmes).
In 1990, there has also been a small P4Q scheme related to the immunization of
children and to cervical cytology, targeted at achieving 90% of children and 80% of
eligible women respectively. Initially this scheme wasn’t very popular but after a while it
was accepted and a larger coverage for these 2 indicators was obtained.
Recently, a pilot P4Q hospital scheme in the north West of England, called ‘advancing
quality’ e , has been introduced, which is basically an attempt to replicate the ‘Premier
Demonstration project’, a hospital P4Q programme which was implemented in the US
(see next paragraph). This scheme is an answer to ‘the next stage review’ report, in
which the surgeon lord Darzi, reasserted quality care being the key dimension in terms
of where we want health care to go to.
e for more information see the following link http://www.advancingqualitynw.nhs.uk/