Pay for Quality

2 Pay for Quality KCE Reports 118
5.1.9 Patient characteristics ................................................................................................................... 83
5.2 DISCUSSION AND CONCLUSIONS ................................................................................................... 83
5.2.1 Reported effect of Pay for Quality programmes ..................................................................... 83
5.2.2 Reported cost effectiveness and modelling effects of P4Q programmes ........................... 87
5.2.3 Reported impact of P4Q on equity ............................................................................................ 89
5.2.4 Revising the conceptual framework based on evidence ........................................................ 92
6 INTERNATIONAL COMPARISON ............................................................................ 96
6.1 INTRODUCTION ...................................................................................................................................... 96
6.2 DESCRIPTION ............................................................................................................................................ 96
6.2.1 Health care system characteristics ............................................................................................. 96
6.2.2 Existing P4Q interventions ........................................................................................................... 96
6.2.3 P4Q concepts .................................................................................................................................. 99
6.2.4 Implementing and communicating the programme ............................................................... 102
6.3 EVIDENCE .................................................................................................................................................. 104
6.3.1 Likely effect according to the experts ..................................................................................... 104
6.3.2 Unintended consequences according to the experts ........................................................... 104
6.4 DISCUSSION AND CONCLUSION ................................................................................................... 105
6.4.1 Key recommendations for design and implementation ........................................................ 105
6.4.2 What the future holds ................................................................................................................. 107
6.4.3 Conclusions ................................................................................................................................... 107
7 P4Q IN BELGIUM ........................................................................................................ 109
7.1 DESCRIPTION OF (PAY FOR) QUALITY INITIATIVES IN BELGIUM ....................................... 109
7.1.1 Introduction ................................................................................................................................... 109
7.1.2 Methods .......................................................................................................................................... 111
7.1.3 Results ............................................................................................................................................ 111
7.1.4 Discussion ...................................................................................................................................... 126
7.2 FEASIBILITY STUDY OF IMPLEMENTATION OF P4Q IN BELGIUM ........................................ 127
7.2.1 Introduction ................................................................................................................................... 127
7.2.2 Methods .......................................................................................................................................... 127
7.2.3 Results ............................................................................................................................................ 127
7.3 DISCUSSION AND CONCLUSIONS ................................................................................................. 137
8 PERCEPTIONS AND OPINIONS OF STAKEHOLDERS IN BELGIUM .............. 139
8.1 PART I: THE BELGIAN HEALTH CARE SYSTEM FACING QUALITY OF CARE. .................. 139
8.1.1 Health care system characteristics ........................................................................................... 140
8.1.2 Payer characteristics .................................................................................................................... 142
8.1.3 Provider characteristics .............................................................................................................. 142
8.1.4 Patient characteristics ................................................................................................................. 143
8.2 PART II: IMPROVING QUALITY THROUGH P4Q ......................................................................... 144
8.2.1 Quality and its dimensions, as seen by Belgian stakeholders .............................................. 144
8.2.2 Patient populations and goals for quality projects ................................................................. 145
8.2.3 Incentives ....................................................................................................................................... 146
8.2.4 Target audience for P4Q programmes .................................................................................... 149
8.2.5 Quality measurement in P4Q programmes ............................................................................ 149
8.2.6 Evaluation of the programme .................................................................................................... 151
8.2.7 Implementing and communicating the programme ............................................................... 152
8.3 PART III: CONCRETE PLANNING IN THE BELGIAN SITUATION .......................................... 154
8.3.1 The need for an “evidence collecting institute” ..................................................................... 154
8.3.2 A new role for a revised National Council on Quality Promotion (NCQP) .................. 154
8.3.3 Think global, act local: the crucial need for organizing at the local level, and paying for
local support initiatives ............................................................................................................................ 154
8.3.4 How and where to start in Belgium ......................................................................................... 155
8.3.5 Schematic view .............................................................................................................................. 155
9 DISCUSSION ............................................................................................................... 156
9.1 QUALITY .................................................................................................................................................... 157
9.1.1 Defining quality ............................................................................................................................. 157