Pay for Quality

KCE Reports 118 Pay for Quality 139
8 PERCEPTIONS AND OPINIONS OF
STAKEHOLDERS IN BELGIUM
In this chapter, opinions, quotes and reflections from 40 high-level stakeholders’
interviews were put together in a format that follows the conceptual framework
described in chapter 3.
Stakeholders’ opinions and reflections presented in this chapter include both the items
for which consensus exists as well as the differences as they were reported. Three main
parts are presented including: a first part on the present Belgian health care system, a
second part referring to items related to quality improvement and a third part including
a concrete planning with regard to the implementation of pay for quality in Belgium.
This chapter aims at answering the following research question:
To what extent are the current financing scheme, databases and other tools
(guidelines, quality indicators) appropriate to implement P4Q in the Belgian
health care setting? What are the most important facilitating and hindering
factors?
8.1 PART I: THE BELGIAN HEALTH CARE SYSTEM FACING
QUALITY OF CARE.
Despite the stakeholders were selected from the leading persons in the Flemish and
Walloon part of the Belgian healthcare system, a first important and general finding is
that a substantial number of them are not familiar with the concept of pay for quality.
The stakeholders often have a limited view on the concept. Their knowledge and
experiences with pay for quality are often related to their own area of expertise,
respectively hospitals, primary care, pharmaceutical care or insurance. For this reason,
pay for quality has to be considered as a relative new concept to the Belgian healthcare
system. All stakeholders were willing to reflect openly upon the strengths, weaknesses,
opportunities and threats of a potential pay for quality system in Belgium, which is
considered a challenging concept, innovative and promising for some, dangerous,
unwanted and of limited use to others.
Most of the stakeholders see quality as an intrinsic element in the present Belgian
system. They emphasized that it is a normal requirement for all providers to deliver
high quality care, with or without a pay for performance system. They suggested also to
primarily invest in a better understanding and overview with regard to the intrinsic
quality of the present system, before introducing programmes that additionally pay for
quality.
Many stakeholders critically pointed out that at present “the P becomes before the Q”
within our Belgian health care system, meaning that discussions on payment have a
much higher priority compared to the quality that should be related to it.
Many stakeholders clearly believe that in the future an open reflection on quality will be
introduced on the political agenda, if not already the case. As there is a demand for an
annual budget growth of 4.5% in the years to come, the quality of care will automatically
be questioned as society cannot be asked to pay for bad quality. Budgetary constraints,
the ageing of the population, the exponential growth of people with chronic conditions
and ‘voice of the customer’ will further provide an impetus in the search for innovative
ways to deal with (poor) quality.
A more positive conviction is also put forward that well conceived and transparent
quality initiatives can contribute to the legitimacy and cost-effectiveness of the health
care system. Pay for quality might provide a new meaning to “accountability” at both the
system and individual level.