Pay for Quality

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108 Pay for Quality KCE Reports 118 For collecting the P4Q data it would be advantageous to invest in IT development and to make use of a system in which data are extracted automatically. Despite the fact that until now, there hasn’t been any evidence on unintended consequences, experts agree that further investigation into unintended consequences is desirable. Concerning the indicators, experts suggest finding a balance between rewarding high achievement on quality indicators and rewarding improvement. The ideal incentive should range between 5 and 25%. An incentive that is too high could provoke gaming effects; an incentive that is too low on the other hand could limit the impact in terms of quality improvement. Finally it may be advantageous to create a uniform system, in which indicators are the same for all physicians Key points on discussion and conclusion • The following most important recommendations are made by the experts: be clear about what the priorities and objectives are, include all stakeholders in the negotiation process, invest in IT development and make data collection automatic, make use of a phased approach, find a balance between rewarding high achievement and rewarding improvement, examine unintended consequences, develop other quality improvement initiatives to complement P4Q schemes • All experts agree that P4Q programmes can be of value when organised in the right way. They are convinced that P4Q will gain on importance in the future but they all agree that ongoing evaluation is necessary.
KCE Reports 118 Pay for Quality 109 7 P4Q IN BELGIUM 7.1 DESCRIPTION OF (PAY FOR) i QUALITY INITIATIVES IN BELGIUM 7.1.1 Introduction Chapter 7 transfers knowledge from previous chapters towards the context of Belgian healthcare. The overall study objective is to assess the feasibility, advantages and disadvantages of P4Q implementation in Belgium. Previous chapters already extensively clarified that health system, payer, provider and patient characteristics are of a significant influence on how P4Q might or might not reinforce quality of care within a specific context. In addition, the design of components of the central quality circle, which is the core of any P4Q initiative, also depends on what is already in place in Belgium in terms of quality support. Based on reports such as provided by the European Observatory on Health Systems and Policies (2007) 240 , the health system, payer, provider and patient characteristics in Belgium can be described as followed: Healthcare jurisdictions in Belgium, as a federal state, are divided over a national and regional j level. The federal government is responsible for the regulating and financing of the compulsory health insurance, determining accreditation criteria, financing hospitals, legislation covering professional qualifications, registration of pharmaceuticals and their price control. The three regional governments are responsible for health promotion (prevention), maternity and child health services, different aspects of elderly care, the implementation of hospital accreditation standards, and the financing of hospital investment. In terms of jurisdiction especially the tools supporting cost containment are managed at the federal level. The Belgian health system is primarily funded through social security contributions and taxation. Public sector funding as a percentage of total expenditure fluctuates around 70%. The six non-profit non commercial Belgian sickness funds, acting as care purchasers, receive a prospective budget from the National Institute for Sickness and Disability Insurance to finance the healthcare costs of their members. The dominant payment system of medical providers is Fee For Service, although the amount of fixed payments is increasing (e.g. for the use of medical imaging, clinical biology and certain drugs as part of hospital care). Capitation is only used to reimburse a few primary health care centres. Specialists and the majority of GPs are paid on a FFS basis. Hospital accommodation services, nursing activities and emergency services are financed via a fixed prospective budget system based on diagnosis related groups. GPs and specialists work mostly as private self employed independent contractors, with the exception of some GPs in primary health care centres and specialists in university hospitals who are salaried (
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