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