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