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> 147<br />
<strong>Pay</strong> <strong>for</strong> quality is considered a preferred option over the present situation of direct<br />
payment without any definition of the desired quality related to it. Incentives that only<br />
lead to better data registration and coding, even a good annual report, are considered<br />
insufficient.<br />
When the Belgian accreditation system was evoked, stakeholders were straight<strong>for</strong>ward<br />
that this kind of incentive to continuous medical education wasn’t able to produce any<br />
quality output in its current use.<br />
8.2.3.1 Incentive structure<br />
Financial incentives<br />
Financial incentives are considered by the stakeholders as not only very effective, but<br />
probably as the only realistic ones that will lead to quality improvement, at least from<br />
the providers’ point of view. Different types of financial incentives were reported<br />
including direct funding, extra salary, company cars or the direct payment of e.g. clerks,<br />
software or equipment.<br />
No single negative consequence has been reported on the use of financial incentives in<br />
providers; neither did any stakeholder refer to cost-effectiveness. It is suggested that a<br />
sort of macro-economic incentives are needed when launching pay <strong>for</strong> quality<br />
programmes, followed by micro-economic incentives when the system is in place. Some<br />
stakeholders (primary care physicians) highlight that incentives sometimes might have<br />
negative consequences, and will miss their goal, as it was the case with the reward <strong>for</strong><br />
hallmarked medical record software. On the other hand if new legal initiatives are<br />
launched without the presence of an appropriate budget, this might lead to unintended<br />
consequences in the sense it becomes perceived as a penalty rather than an incentive.<br />
Some stakeholders in this context referred to what they called the structural under<br />
financing of the French-speaking Community, and its consequence, the lack of funding<br />
<strong>for</strong> prevention.<br />
Some stakeholders think that direct financial incentives should never be directed to<br />
patients in contrast to indirect advantages that are supported in case the patient<br />
participates at the programme.<br />
<strong>Quality</strong> grants/ Financial awards/ Per<strong>for</strong>mance funds / <strong>Quality</strong> infrastructure<br />
grants<br />
A few stakeholders suggested quality grants <strong>for</strong> specific infrastructure including e.g. a<br />
minimal package of equipment at the setup of a physician’s practice and the IMPULSEO<br />
programme. These examples weren’t clearly related to quality goals. Particular attention<br />
was given to the idea of paying <strong>for</strong> the development of quality project rather than paying<br />
<strong>for</strong> the achievement of quality indicators. Creating a positive atmosphere by launching a<br />
competition, and publicly rewarding selected projects, like the National Council on<br />
<strong>Quality</strong> Promotion has done, was sometimes mentioned as a good example.<br />
Non financial incentives<br />
What concerns the non financial incentives it is important to mention that some<br />
stakeholders considered financial incentives just as only one aspect of a global<br />
remuneration package. Elements such as quality of life, satisfaction with work, a good<br />
working atmosphere, good coordination of care, safety in the working place were<br />
equally considered important incentives. In order to improve the working conditions<br />
different proposals were made on non financial incentives. These included increased<br />
administrative support, practice assistance, extra training or education, coverage of the<br />
costs <strong>for</strong> continuing education, increased social protection and good medical software.<br />
Other incentives mentioned were the provision of in<strong>for</strong>mation and feedback at both the<br />
individual and peer level. Very important was that experiences with quality<br />
improvements were considered as an incentive in itself.<br />
Stakeholders that represented hospitals and insurers mentioned a particular incentive<br />
that is the ranking of both providers and hospitals, but recognized it would be difficult<br />
to implement and control. Such ranking should be based on core elements of care, but<br />
wasn’t specified what these were.