Pay for Quality

KCE Reports 118 Pay for Quality 1
Scientific summary
Table of contents
1 BACKGROUND AND OBJECTIVES ............................................................................ 4
2 METHODS ........................................................................................................................ 6
2.1 MIXED METHODS APPROACH .............................................................................................................. 6
2.1.1 Conceptual framework and international evidence .................................................................. 6
2.1.2 Selection of and data-extraction from articles related to equity ......................................... 11
2.1.3 Revision of the conceptual framework into an evidence based state of the art
framework ........................................................................................................................................................
........................................................................................................................................................... 11
2.1.4 Consultation of international experts as P4Q involved country representatives ............ 11
2.1.5 Conducting a systematic review of Belgian P4Q initiatives, and evaluating the feasibility
of P4Q implementation, based on the comparison of current Belgian policy vs. findings from
literature. ...................................................................................................................................................... 13
2.1.6 Consultation of Belgian stakeholders as involved country representatives ....................... 13
3 A THEORETICAL FRAMEWORK FOR P4Q ............................................................. 16
3.1 P4Q CONCEPTS ........................................................................................................................................ 16
3.1.1 Quality .............................................................................................................................................. 16
3.1.2 Incentives ......................................................................................................................................... 21
3.2 THE P4Q CONTEXT ................................................................................................................................ 24
3.2.1 The health care system ................................................................................................................. 24
3.2.2 The payer-provider relationship ................................................................................................. 25
3.2.3 The patients ..................................................................................................................................... 28
3.3 IMPLEMENTING AND COMMUNICATING THE PROGRAM ...................................................... 29
3.4 P4Q PRINCIPLES FOR DESIGN AND IMPLEMENTATION ........................................................... 31
4 THE EVIDENCE BASE FOR P4Q: A SYSTEMATIC REVIEW OF THE PEER
REVIEWED LITERATURE ........................................................................................... 35
4.1 INTRODUCTION ...................................................................................................................................... 35
4.2 DESCRIPTION OF STUDIES ................................................................................................................... 35
4.2.1 General description ....................................................................................................................... 35
4.2.2 Contextual aspects ........................................................................................................................ 36
4.2.3 Patient characteristics ................................................................................................................... 41
4.2.4 Description of P4Q interventions .............................................................................................. 43
4.2.5 Implementing and communicating P4Q programmes ............................................................. 48
4.2.6 Existing and concurrent quality improvement initiatives ....................................................... 51
4.3 GENERAL EVIDENCE ............................................................................................................................... 54
4.3.1 Reported effect of Pay for Quality programmes ..................................................................... 54
4.4 REPORTED COST EFFECTIVENESS AND MODELLING EFFECTS OF P4Q PROGRAMMES59
4.4.1 Cost-effectiveness of Pay for Quality ......................................................................................... 59
4.4.2 Modelling costs or effectiveness ................................................................................................. 61
4.5 EVIDENCE RELATED TO EQUITY ....................................................................................................... 66
4.5.1 Reported evidence on equity ....................................................................................................... 66
5 REVISING THE CONCEPTUAL FRAMEWORK BASED ON EVIDENCE ............ 71
5.1 INTRODUCTION ...................................................................................................................................... 71
5.1.1 Quality goals and targets .............................................................................................................. 71
5.1.2 Quality measurement .................................................................................................................... 72
5.1.3 P4Q incentives ................................................................................................................................ 74
5.1.4 Implementing and communicating the programme ................................................................. 75
5.1.5 Evaluation of the programme ...................................................................................................... 76
5.1.6 Health care system characteristics ............................................................................................. 77
5.1.7 Payer characteristics ...................................................................................................................... 79
5.1.8 Provider characteristics ................................................................................................................ 80