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