Pay for Quality
Pay for Quality
Pay for Quality
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KCE Reports 118 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> 103<br />
In the US, with all the different schemes, the degree of negotiation between insurance<br />
companies or government and providers depends on the scheme. In the development of<br />
the IHA programme in Cali<strong>for</strong>nia the physician organisations were involved from the<br />
very beginning. The inclusion of these physicians was very much part of the reason that<br />
the initiative got off the ground.<br />
The experts agree that it is important to include providers in the implementing phase of<br />
a P4Q programme and to involve them in selecting the indicators. In fact, it is essential<br />
that the indicators have clinical credibility, that they have to be developed in consent<br />
with relevant clinicians and that they should be based on evidence based criteria.<br />
6.2.4.2 Acceptance by professionals<br />
In the UK, participation in the QOF scheme is quite high, probably because physicians<br />
were largely involved in the negotiation process, because the targets are easily reached<br />
by the majority of GP’s and because they can only gain additional income and can not<br />
loose money. According to the UK experts, such a loss of income would never be<br />
accepted by the professionals.<br />
In US acceptance was mixed: some physicians were supportive and became interested in<br />
making the most of P4Q by helping to develop good measures, while others were less<br />
supportive, because US programmes involve frequently a withhold and physicians feel<br />
that they are already underpaid.<br />
In Australia there is an interplay of <strong>for</strong>ces between 3 groups. The Australian medical<br />
association is generally opposed to P4Q as it supports heavily FFS arrangements. The<br />
royal Australian college of GP’s, which is a professional organization, is more supportive<br />
to these quality payments. The Australian general practice network, which is another<br />
GP organization network, is very supportive.<br />
The pilot P4Q programme in the Netherlands included only physicians who were<br />
supportive. It is difficult to predict the reaction of the majority of physicians when the<br />
scheme becomes nationally implemented.<br />
Experts agree that there remains substantial concern about P4Q schemes among groups<br />
of professionals. There is still a very polarized view of physicians, some are very<br />
opposed, and others are very supportive.<br />
6.2.4.3 Mandatory or voluntary participation<br />
As indicated above, participation in programmes can be mandatory or voluntary. The<br />
UK and Australia make use of voluntary P4Q programmes. In the Netherlands,<br />
participation in the pilot project is currently voluntary, but most probably participation<br />
will be mandatory in the future, with new arrangements in the health care system. In the<br />
US both mandatory as voluntary programmes can be identified.<br />
Some experts believe that participation in P4Q programmes, which make use of<br />
bonuses, should be voluntary. If you make these programmes mandatory, some<br />
participants will not make the ef<strong>for</strong>t to score well. However some experts state that<br />
data collection should be mandatory, to allow benchmarking within the group.<br />
Key points on implementing and communicating the programme<br />
• It is important to include providers in the implementing phase of a P4Q<br />
programme because it leads to greater acceptance.<br />
• Currently there is still a polarized view of physicians concerning P4Q.<br />
• Most experts believe that participation in a P4Q programme should<br />
voluntary, although according to some experts it can be important to make<br />
data collection and hence participation mandatory to allow benchmarking<br />
within the group.