Pay for Quality

154 Pay for Quality KCE Reports 118
8.3 PART III: CONCRETE PLANNING IN THE BELGIAN
SITUATION
8.3.1 The need for an “evidence collecting institute”
All stakeholders agree that pay for quality, if implemented, should be based on sound
scientific evidence on standards, indicators, and internationally proven ways to achieve
them to provide the best guarantees for success. Stakeholders highlight the need for
independent and academic scientific advice to help decision makers on the subject. This
could be an extended KCE- or WIV/IP type, or an academic consortium type, acting as
Independent Scientific Advisory Institute. Others defend the idea of one single national
institute that will finally become responsible for the development and implementation of
pay for quality programmes in Belgium. Reference is made by some to existing examples
in our neighbouring countries: NIVEL or Dutch Institute for Health and Welfare. Only
when concepts and instruments are scientifically validated, decision makers can come to
action.
8.3.2 A new role for a revised National Council on Quality Promotion
(NCQP)
All stakeholders agree that Pay for Quality should be a governmental-led initiative,
responsible for the coordination, implementation and follow up. For some of them, it
should be initiated and guided by a multidisciplinary initiative, joining academic and
public health scientists, providers’ representatives (GPs, specialists), trade unions,
scientific societies, the National Council of Hospitals, insurers and patients’
representatives. This group should define the goals, the content and the implementation
strategy for pay for quality programmes.
There is no unanimity which governmental body should lead it. Some mentioned an
extended NIHDI group, bringing in nurses and patient representatives. Many
stakeholders refer to the National Council for Quality Promotion, established 8 years
ago for this purpose. Many propose that, if that choice is made, adaptations are
necessary to make the present council more performant, as there is a under
representation of the hospital organisations and its directors, the main focus is currently
on medical aspects in primary and ambulatory care. There is also a need for a new
management style and new impact possibilities. Some even argue a complete make-over
of the present body. Or do we need a new specific agency on Quality Implementation
issues?
Patient representation is felt important in the organisation of pay for quality, but it is
not clear amongst the stakeholders who should represent them: insurers, government,
mutualities or specific patient organisations. There is debate on the role of the
mutualities in this: some see this as a new function for their future, some state that a
conflict of interest will arise.
8.3.3 Think global, act local: the crucial need for organizing at the local level,
and paying for local support initiatives
Centrally-led pay for quality initiatives are felt needed, but not to be sufficient by many
stakeholders. The idea of decentralisation in pay for quality programmes was supported
by multiple stakeholders. Ownership is an important aspect whilst therapeutic freedom
is a sensitive issue in Belgian healthcare. Initiatives that are locally developed in
individual practices, hospitals or regional networks are considered to provide the best
guarantees for success. Best practice examples have to relate to the local situation,
opportunities and context. A decentralised pool of interest is necessary in the real local
environment. Support, knowledge and qualification should be available at the local level.
Quality managers in hospital as well as in primary care are judged by many stakeholders
to play a crucial role in the management of the intermediate level. If this level is
important, there should also be foreseen an important budget that includes training,
implementation, data-collection, feedback and reflection.