Pay for Quality

KCE Reports 118 Pay for Quality 113
Primary focus (structure, process
outcome)
quality scheme. The GP, as care coordinator, and the specialist
for support earn 80€ per patient per year.
2. At the quality content level, the National Council for the
Promotion of Quality defined the inclusion and exclusion criteria,
the optimal follow up and the average targets in line with
international guidelines and options. From 2011 onwards,
outcome data will be collected electronically to evaluate the
evolution over time, and to judge the impact of the system.
3. At the local multidisciplinary network level regions for
implementation of chronic care itineraries will be defined, care
managers will be installed, and the local GP’s groups, the local
integrated homecare services (GDT/SISD) and the specialists
covering the area are brought together. Pilots are contracted for
4 years, and granted 93.000€ per area (between 75 000 and 186
000 inhabitants). Data will be aggregated per local area to
support feed back and benchmarking.
Reaching individual defined targets (in line with international
targets), by a set of processes (minimum obligatory set),
supported by rearranging and re-tasking of existing structures
adding 2 new functions: the primary care educator and the care
itinerary manager
Type of indicators used (if any) Set of outcome parameters (from 2011).
For the different diseases, some of the crucial targets are
considered as quality indicators.
For diabetes the choice was made to use HbA1c, systolic BP,
LDL cholesterol, and BMI as indicator. With these indicators, the
message is strengthened that diabetes is a complex metabolic
syndrome that include cardiovascular risk management, and that
weight control is important.
For Chronic Renal Insufficiency, eGFR, blood pressure, Hb,
Creatinin, and parathormone are selected.
Purpose of indicators used Evaluate the global programme and provide regional data to
networks for benchmarking.
Type of incentives Annual supplementary capitation fee (80€) for GP and for SP, no
co-payment for patient, defined fee for educator, financial
support for local multidisciplinary networks (93 000€/ 125 000
inhabitants). Balanced package of annual care-payments for GP’s
and specialist, omitting all financial constraints for patients,
enhanced payment for upgrading of home nurses and dieticians as
educators, and important introduction of an opportunity for a
management function to support primary care as an
organizational structure.
Results (if available) From 2011 on
Sources (most relevant ones) International publications of preparative pilots 2003-2007 in
241, 242
Leuven and Aalst, budget evaluation report end 2009.
Total budget €30.7 million