Pay for Quality

More documents

Recommendations

Info

140 Pay for Quality KCE Reports 118 Some stakeholders insist that quality improvement initiatives should stay or become part of the basic mandatory health care insurance, to avoid selectivity and inequality. It is considered an unacceptable option if quality would be limited to the additional or private insurance sector. 8.1.1 Health care system characteristics All stakeholders consider key principles of our Belgian system to be individual freedom for patients and providers and a strong dedication in all actors to deliver high quality of care. It has been pointed out during the interviews that there is probably too much (therapeutic) freedom in our healthcare system and that pay for quality might serve as a solution to better deal with quality in general, and with the negative consequences of (therapeutic) freedom in particular. Another important characteristic of our health care system is that the payment system which is currently in place, -mainly based on fee for service-, implicitly assumes that quality will be delivered at all time and in all places. There are however very few clearcut quality criteria available that are related to (different levels of) payment (see the 14 examples of quality related initiatives, in chapter 7). The Belgian healthcare system is also criticized because of its disease-oriented approach, which favours a specialist and hospital focus, its priority for cure over care and even more over prevention, with little emphasis on primary care. For this reason the relation between primary and secondary care is considered as imbalanced, which could be an important barrier towards a movement of integrated care and the development of a more public health related approach. Another shortcoming of our system, as perceived by a substantial number of stakeholders, is that there is a lack in the transparency of the decision making process at all levels, with no open communication. As quality gradually becomes a topic that moves and concerns many stakeholders, quality issues should be clearly brought on the public agenda. Most stakeholders conclude that the current level of care is “suboptimal” leaving substantial room for improvement. But before any system of pay for quality can be installed, some stakeholders consider it important to first define what is meant by quality (within the Belgian context), its dimensions, its critical success factors and how it should be measured and promoted. This could prevent resistance to pay for quality initiatives in the long run. 8.1.1.1 Values of the system Key values of the Belgian healthcare system, as put forward by a few stakeholders, were “accountability” and “professional autonomy”. These elements were seen as two sides of the same coin, in the sense that more accountability would potentially lead to less autonomy, and vice versa. In this context improved “transparency” is seen as a value that could facilitate the acceptance of greater levels of accountability in our healthcare system. All stakeholders that mentioned the value “accessibility” considered it as a crucial value for our health care system as a whole, and when considering the implementation of pay for quality. Less agreement was noted between the stakeholders for what concerns the value of “privacy” and “confidentially” of data and medical information. Some stakeholders fear that less privacy would lead to less professional autonomy. Appropriateness of care also seemed to be an important value to some stakeholders. Pay for quality should therefore focus on both appropriate care at the right cost, whilst considering the short-term and long-term outcomes.
KCE Reports 118 Pay for Quality 141 8.1.1.2 The Belgian health insurance system A major obstacle in the achievement of quality of care, mentioned by multiple stakeholders is that the Belgian healthcare system is primarily focused on fee for service, and is not explicitly related to the quality of the services provided. As a consequence we do not have a solid tradition in quality measurement nor do we have a yardstick to define the concept of quality/performance. Most stakeholders agree that changes are necessary in the future. Budgetary context will force us towards an increased level of accountability of all the players in the system and widespread implementation strategies for quality including e.g. benchmarking. Another future driver towards quality is considered the ageing of the population and chronic diseases in particular. The Belgian system is centrally driven, based on public insurers companies, our so called “mutualities”. In this context a big divergence could be noted as to the roles of private and public insurers in the definition and execution of pay for quality programmes. Some stakeholders argue that private insurers shouldn’t be associated to pay for quality programmes since there is a danger of ‘risk selection’ and what is called “managed care”. Other stakeholders however want to open the debate on the role of private insurers in our health care system. There is strong agreement that it is of no use to simply copying existing pay for quality initiatives from other countries since all health care systems are different. 8.1.1.3 Type of payment system: FFS, capitation, structural or salary It is clear for all that, if pay for quality programmes would be installed in the future, an adequate financing system should be put in place, which should be more divers than the present system. Most stakeholders consider the fee-for-service system to be a strong incentive for action and service, as it ensures “availability” but not necessary “compliance to guidelines”. Pay for quality is seen as an opportunity to enlarge the diversity of paying systems by combining different systems into one programme. Capitation elements can mainly help primary care practices to act on practice populations rather than on individual complaints of patients. Structural financing for e.g. quality management and data monitoring is considered an important impetus for the implementation of pay for quality. Stakeholders see it as important that for every payment system a good analysis is required on what incentive types or quantities are desired and what are the potential negative consequences. If all the aforementioned elements become part of a transparent plan, many stakeholders are willing to accept budget shifts within the present budgets, shifting profits and economies in one area to support other areas of the health care system. Most suggest that new financing mechanisms will be needed for new pay for quality initiatives, especially for local and regional practice organisation and capacity building. 8.1.1.4 Competition between different subsystems, different levels of care and different providers. Important elements with regard to competition between different regions, levels of care and providers were put forward by multiple stakeholders. First, several stakeholders pointed out that the cultural differences in the way health care in general, and more specific quality issues are conceptualized and organised strongly differs between the Flemish and Walloon region of Belgium. From a legal perspective, ‘quality’ is the responsibility of the regions (Flanders and Wallonia), but since the federal government focuses on performance as well, the line between what is quality and what is performance is sometimes difficult to draw. Second, the competition between secondary and primary care still exists, and many stakeholders stress that quality should be transmural, with strong emphasis on the integration of both levels when implemented. In this context it is important that the differences between hospital and primary care are recognized. Hospital care is considered to be disease-oriented, whereas primary care targets integration, interpersonal relation and individual information.
Page 1 and 2:
Voordelen, nadelen en haalbaarheid
Page 3 and 4:
Voordelen, nadelen en haalbaarheid
Page 5 and 6:
Externe validatoren : Simpson (Univ
Page 7 and 8:
KCE Reports 118A Pay for Quality ii
Page 9 and 10:
KCE Reports 118A Pay for Quality iv
Page 11 and 12:
KCE Reports 118A Pay for Quality vi
Page 13 and 14:
KCE Reports 118A Pay for Quality vi
Page 15 and 16:
KCE Reports 118 Pay for Quality 1 S
Page 17 and 18:
KCE Reports 118 Pay for Quality 3 9
Page 19 and 20:
KCE Reports 118 Pay for Quality 5 W
Page 21 and 22:
KCE Reports 118 Pay for Quality 7 S
Page 23 and 24:
KCE Reports 118 Pay for Quality 9 2
Page 25 and 26:
KCE Reports 118 Pay for Quality 11
Page 27 and 28:
Page 29 and 30:
Page 31 and 32:
Page 33 and 34:
Page 35 and 36:
Page 37 and 38:
Page 39 and 40:
Page 41 and 42:
Page 43 and 44:
Page 45 and 46:
Page 47 and 48:
Page 49 and 50:
Page 51 and 52:
Page 53 and 54:
Page 55 and 56:
Page 57 and 58:
Page 59 and 60:
Page 61 and 62:
Page 63 and 64:
Page 65 and 66:
Page 67 and 68:
Page 69 and 70:
Page 71 and 72:
Page 73 and 74:
Page 75 and 76:
Page 77 and 78:
Clinical domain (disease) KCE Repor
Page 79 and 80:
Page 81 and 82:
Page 83 and 84:
Page 85 and 86:
Page 87 and 88:
Page 89 and 90:
Page 91 and 92:
Page 93 and 94:
Page 95 and 96:
Page 97 and 98:
Page 99 and 100:
Page 101 and 102:
Page 103 and 104: KCE Reports 118 Pay for Quality 89
Page 153: KCE Reports 118 Pay for Quality 139
Page 191: KCE Reports 118 Pay for Quality 177
Page 194 and 195: Wettelijk depot : D/2008/10.273/50
Page 196 and 197: 37. HTA Magnetische Resonantie Beel
Page 198: 108. Tiotropium in de behandeling v
show all

Pay for Quality

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?