Pay for Quality

KCE Reports 118 Pay for Quality 145
8.2.1.4 Patient centeredness
Patient centeredness was highlighted as a dimension of quality of care by mainly
stakeholders representing providers, insurers and patients. Patient centeredness is a
concept with a lot of different dimensions and operationalized in different ways by
different providers. Some relate it to service to patients, positive communication with
patients and taking individual responsibility for the patient. Several aspects of patient
centeredness were put forward by the stakeholders including service to patients, open
communication with patient, taking individual responsibility for the patient, management
of the disease by the patients themselves and information management. For what
concerns the latter, some stakeholders argue that patients should be informed on the
involvement of providers in quality approaches, (particularly when hospitalized), referral
to specialists or when informed consent is needed. The importance of privacy and
confidentiality was also cited. Patient-centeredness was not presented by the
stakeholders as an approach that starts and finishes with patients’ expectations and
priorities.
As opposed to this, the Belgian healthcare system is considered by some stakeholders
as still having strong paternalistic reflexes where the provider and the system know
what is good for the patient without asking him/her.
8.2.1.5 Cost-effectiveness, efficiency of care
Most stakeholders recognized the importance of cost-effectiveness as a dimension of
quality of care, but it was especially highlighted by Flemish stakeholders.
8.2.1.6 Continuity of services, coordination of care
The dimensions continuity of services and coordination of care were recognized as
important dimensions of quality of care. Especially continuous and integrated care were
underlined by some stakeholders as an unattained objective in Belgium. Where the
focus on integrated care is somewhat more explicit in primary care compared to other
levels of the healthcare system, multidisciplinary coordination needs to be improved at
all levels, and especially between hospital and primary care. Our current dominant
payment system (fee for service) has led to fragmentation of care to a large extent.
Pay for quality is therefore considered a valuable option to improve continuity of care
and coordination of services since it allows for a variation in the sources of income in
providers that might lead to a broadening of their look on diseases and related
processes.
8.2.2 Patient populations and goals for quality projects
8.2.2.1 Defining goals
A central remark made by several stakeholders is that objectives must be valuable to
patients, providers, insurers and the government. Stakeholders highlight the need for a
preliminary and global assessment of our current health care system first, rather than
setting goals for delimitated problems.
When defining goals for pay for performance programmes, stakeholders made
reference to the global definition on health, as defined by the World Health
Organization (WHO). The WHO defines health as ‘a state of optimal physical, social
and mental well-being’. For this reason, both clinical care, health promotion/preventive
care are aspects of care for which goals should be defined. As a concrete example, a
global approach for cardiovascular diseases should combine both medical risk factor
management and a health promotion approach for behavioural changes. In this context,
some of the stakeholders suggested that it would be necessary to enhance the
practitioners’ knowledge and competencies in these domains. Another key feature of
pay for quality programmes is that they should target the full care continuum and need
to bridge the gap between clinical care and public health.
Global goals of pay for quality programmes that were addressed by the stakeholders
were under- and overuse of care services, with an accent on underuse of services.
Particular goals that were considered important by the stakeholders included the