Pay for Quality
Pay for Quality
Pay for Quality
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152 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> KCE Reports 118<br />
Widening gaps in per<strong>for</strong>mance among providers<br />
Some stakeholders expect two basic attitudes in practitioners: those who want to<br />
develop their value and impact by subscribing to pay <strong>for</strong> quality programmes, and others<br />
who don’t want to involve in it. Various factors will play a role in this, like e.g. part-time<br />
working.<br />
8.2.6.6 Organisational system change and extra cost / time required<br />
Many stakeholders mentioned that the programmes should not be too complicated<br />
either at the process level or at the assessment level. Otherwise, additional costs,<br />
workload and time required to fulfil the programme would be excessive <strong>for</strong> both<br />
general practitioners and small size hospitals. Doubts were raised in GP stakeholders on<br />
the ability of the government to keep quality programmes simple. To deal with<br />
complexity of programmes several suggestions were made: coordination at the local<br />
level within group practice in primary care or coordination of the programmes at the<br />
national level to support the providers when per<strong>for</strong>ming extra tasks related to the<br />
implementation of the programme.<br />
8.2.7 Implementing and communicating the programme<br />
8.2.7.1 Involvement of providers in setting goals<br />
For most stakeholders, the involvement of the professionals in the definition of goals<br />
seems to be essential. The rationale behind this idea is that providers directly face<br />
problems ‘in the field’, have access to local data and perfectly know the work that has<br />
to be per<strong>for</strong>med. They also represent the most direct link to the patient who is the first<br />
target unit. Stakeholders also mentioned that the involvement of providers is in itself a<br />
way of promoting quality, motivating providers, and preparing them <strong>for</strong> self-assessment<br />
and external evaluation.<br />
Some stakeholders mentioned the need <strong>for</strong> an institution to help providers in defining<br />
goals and to make the link between the different actors of a programme. Some of the<br />
existing institutions have, to their point of view, the competencies and the required<br />
organisational framework. Organizations/institutions that were mentioned were NIHDI<br />
and the Forum des Associations des Généralistes (FAG).<br />
8.2.7.2 Involvement of patients in setting goals<br />
Some stakeholders think patient’s representatives should be part of the board which<br />
sets the goals of the P4Q programmes as patients are primarily concerned by the quality<br />
of healthcare. Moreover patients’ representatives are members of many committees at<br />
the Ministry of Health, consumers’ associations or the Health Promotion Council, giving<br />
them a wide, transversally and realistic overview of health care. It is noted that this<br />
opinion wasn’t supported by any of the providers’ representatives (except one) but only<br />
by patients themselves, insurers and regional government.<br />
8.2.7.3 Communication to patients<br />
Stakeholders think that the authorities should clarify the definition, concepts and the<br />
aim of quality as a first important step towards the development of pay <strong>for</strong> quality.<br />
Then, a clear communication to the patients is required to maximize their commitment<br />
to the programme. Stakeholders agree there is a need <strong>for</strong> increased public<br />
accountability towards the patient, as this indicated in related legislation. Stakeholders<br />
however strongly differ in their opinions to what extent in<strong>for</strong>mation about prices<br />
and/or quality should be made available to the public.<br />
Many stakeholders state that at least every citizen should be able to consult up-to-date<br />
in<strong>for</strong>mation whether or not a particular hospital or service applies quality improvement<br />
approaches and follows up on its per<strong>for</strong>mance. Some stakeholders take a step ahead<br />
and suggest that the disclosure of a list of indicators that are related to quality in so<br />
called ‘reference centres’, is a mandatory minimum.