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