Pay for Quality

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118 Pay for Quality KCE Reports 118 Sources (most relevant ones) See http://www.topaseurope.eu/; 249-253, 254 , 255 Total budget The estimated costs are +/- €1 000 per practice per year (so for Belgium €1 per patient per year) Table 13: Global medical record VII. GLOBAL MEDICAL RECORD Initiated by NIHDI (INAMI/RIZIV) Overall objective To support continuity of care between patients and GPs. Date of implementation in Belgium May 1, 1999 for a predefined population (May 1, 2002: for any patient) Target audience General practitioner and patient Content At the patient’s formal request the GP manages the GMR that must include a selection of medical data. The objectives are to centralize the patient’s medical data, to devote this central role to the GP, to improve the communication of the patient’s data between health providers and to reduce medical shopping by gaining the loyalty of the patient. Primary focus (structure, process Process outcome) Type of indicators used (if any) Existence of a GMR with at least one contact with the patient per year Purpose of indicators used Improve coordination of care. Type of incentives Financial. Payment of the GP for this new service: 27.50 €/year (2009) Full reimbursement of this annual fee to the patient and a decrease of the patient’s co-payment for other services provided by the GP. Results (if available) Continuous increase of the number of GMR (globally in Belgium: 44% of the insured population in 2005) Sources (most relevant ones) NIHDI (INAMI/RIZIV), insurers Total budget €104 966 317 (€27.50/GMR, based on figures 2007) Table 14: Prescription feedback VIII. PRESCRIPTION FEEDBACK (national council for quality promotion) Initiated by National Council for Quality Promotion Overall objective To reduce overuse of drug prescription in an evidence based way Date of implementation in Belgium 2003 Target audience GP and specialists Content The goal is to encourage an EBM-driven prescription attitude. The individual feedbacks include: Analysis of the doctor’s prescription of target drugs (antibiotics, antihypertensive drugs) with reference to global Belgian prescription of the same molecules and reference to peer review group members of LOK. The median prescription level is used as reference point. Recommendations or guidelines concerning the use of the target drugs. Invitation to discuss the results in the local group of medical evaluation (GLEM/LOK) Primary focus (structure, process Process. outcome) Type of indicators used (if any) Volume and choice of prescription of target drugs Purpose of indicators used To develop doctor’s awareness to be driven by EBM prescription To decrease the volume and cost of prescribed drugs To optimize adequate choice of antibiotic
KCE Reports 118 Pay for Quality 119 Type of incentives For antibiotics: increase of GP’s payment in 2004 (condition: change of global trend in prescription). This was a onetime general measure; support to the local groups Results (if available) Global tendency to decrease prescription of antibiotics (consequence of multiple approaches) 256, 257 Sources (most relevant ones) , NIHDI website Total budget €10 million in 2004 to increase the GP’s payment + Logistic support Table 15: Preventive module in global medical record IX. PREVENTIVE MODULE IN GLOBAL MEDICAL RECORD Initiated by NIHDI Overall objective To support evidence based preventive care Date of implementation in Belgium 2009 Target audience General practitioner and patients with an age between 45 and 74 years. Content Primary and secondary prevention. Examples of actions are influenza vaccination for elderly patients, cancer screening, cardiovascular risk screening, and smoking cessation advice. Implementation feasibility in a non electronic medical record is also secured, while electronic application formats are under Primary focus (structure, process outcome) preparation. Process targets, which are patient group specific (preliminary selection): counselling and advice (nutrition, physical exercises, smoking, alcohol), anamnesis and clinical investigation, aspirin use for cardio-vascular indications, screening (colon, uterus and breast cancer), vaccination (diphtheria, tetanus, influenza, pneumococcal), biological testing (glycaemia, creatinine, proteinuria, cholesterol) Type of indicators used (if any) Criteria for target selection are (1) the evidence base, (2) the feasibility of performance, based on organisational conditions at the system’s level, (3) the clinical impact (burden of disease), (4) the availability of target specific supportive tools and materials Purpose of indicators used To support and evaluate preventive action on different levels (GPs, local councils) Type of incentives A supplementary fixed fee of 10 euro per GMR, based on the module availability during two years and on reporting of module data during the third year. Results (if available) Not available. Evaluation of the initiative based on the volume of GMR coverage, sampling of target performance, and patient experience survey Sources (most relevant ones) Not available Total budget €38 169 957 (€10/GMR, based on figures of 2007) Table 16: Centres of reference X. CENTRES OF REFERENCE Initiated by DKV-Belgium as a private insurer (demand from foreign patients). Overall objective To define selection criteria for the selection of centres of reference. To create a network of centres of reference for the treatment of life-threatening or complex diseases. To inform foreign patients about these centres of reference. Date of implementation in Belgium In preparation Target audience Belgian hospitals. Content Selection criteria: objective and measurable. Primary focus (structure, process, A combined quality index.
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Wettelijk depot : D/2008/10.273/50
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Pay for Quality

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