Pay for Quality

138 Pay for Quality KCE Reports 118
Finally, it is clear that society evolves towards a higher demand for accountability.
Patients expect to receive quality healthcare. P4Q can be used, both for internal as for
external accountability. This P4Q driven accountability, based for example on a one
month wage quality bonus, requires a more difficult and fundamental shift in how
current ‘agents’ and ‘principals’ deal with each other. As exemplified in current quality
initiatives, at present quality of care is often regarded as an internal issue, with an
internal approach, characterized by a high level of freedom and adaptation of quality
goals, targets, the measurement system, etc. When financing is linked to quality an
independent body needs to verify both the quality improvement process and its
performance. This implies a shift towards an external quality auditing approach.
Initiatives such as hospital accreditation and the use of the EPA tool fit best with this
independent position.
Because it’s more a question of will than of feasibility the biggest threat to P4Q
implementation is the perception by stakeholders (providers, payers, policymakers, etc.)
of P4Q as a threat. Only with positive engagement and support P4Q implementation
can succeed. P4Q, if implemented, should therefore become their shared tool, based on
a broad involvement and consensus, to realign healthcare with its central mission.