Pay for Quality

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2 Pay for Quality KCE Reports 118 5.1.9 Patient characteristics ................................................................................................................... 83 5.2 DISCUSSION AND CONCLUSIONS ................................................................................................... 83 5.2.1 Reported effect of Pay for Quality programmes ..................................................................... 83 5.2.2 Reported cost effectiveness and modelling effects of P4Q programmes ........................... 87 5.2.3 Reported impact of P4Q on equity ............................................................................................ 89 5.2.4 Revising the conceptual framework based on evidence ........................................................ 92 6 INTERNATIONAL COMPARISON ............................................................................ 96 6.1 INTRODUCTION ...................................................................................................................................... 96 6.2 DESCRIPTION ............................................................................................................................................ 96 6.2.1 Health care system characteristics ............................................................................................. 96 6.2.2 Existing P4Q interventions ........................................................................................................... 96 6.2.3 P4Q concepts .................................................................................................................................. 99 6.2.4 Implementing and communicating the programme ............................................................... 102 6.3 EVIDENCE .................................................................................................................................................. 104 6.3.1 Likely effect according to the experts ..................................................................................... 104 6.3.2 Unintended consequences according to the experts ........................................................... 104 6.4 DISCUSSION AND CONCLUSION ................................................................................................... 105 6.4.1 Key recommendations for design and implementation ........................................................ 105 6.4.2 What the future holds ................................................................................................................. 107 6.4.3 Conclusions ................................................................................................................................... 107 7 P4Q IN BELGIUM ........................................................................................................ 109 7.1 DESCRIPTION OF (PAY FOR) QUALITY INITIATIVES IN BELGIUM ....................................... 109 7.1.1 Introduction ................................................................................................................................... 109 7.1.2 Methods .......................................................................................................................................... 111 7.1.3 Results ............................................................................................................................................ 111 7.1.4 Discussion ...................................................................................................................................... 126 7.2 FEASIBILITY STUDY OF IMPLEMENTATION OF P4Q IN BELGIUM ........................................ 127 7.2.1 Introduction ................................................................................................................................... 127 7.2.2 Methods .......................................................................................................................................... 127 7.2.3 Results ............................................................................................................................................ 127 7.3 DISCUSSION AND CONCLUSIONS ................................................................................................. 137 8 PERCEPTIONS AND OPINIONS OF STAKEHOLDERS IN BELGIUM .............. 139 8.1 PART I: THE BELGIAN HEALTH CARE SYSTEM FACING QUALITY OF CARE. .................. 139 8.1.1 Health care system characteristics ........................................................................................... 140 8.1.2 Payer characteristics .................................................................................................................... 142 8.1.3 Provider characteristics .............................................................................................................. 142 8.1.4 Patient characteristics ................................................................................................................. 143 8.2 PART II: IMPROVING QUALITY THROUGH P4Q ......................................................................... 144 8.2.1 Quality and its dimensions, as seen by Belgian stakeholders .............................................. 144 8.2.2 Patient populations and goals for quality projects ................................................................. 145 8.2.3 Incentives ....................................................................................................................................... 146 8.2.4 Target audience for P4Q programmes .................................................................................... 149 8.2.5 Quality measurement in P4Q programmes ............................................................................ 149 8.2.6 Evaluation of the programme .................................................................................................... 151 8.2.7 Implementing and communicating the programme ............................................................... 152 8.3 PART III: CONCRETE PLANNING IN THE BELGIAN SITUATION .......................................... 154 8.3.1 The need for an “evidence collecting institute” ..................................................................... 154 8.3.2 A new role for a revised National Council on Quality Promotion (NCQP) .................. 154 8.3.3 Think global, act local: the crucial need for organizing at the local level, and paying for local support initiatives ............................................................................................................................ 154 8.3.4 How and where to start in Belgium ......................................................................................... 155 8.3.5 Schematic view .............................................................................................................................. 155 9 DISCUSSION ............................................................................................................... 156 9.1 QUALITY .................................................................................................................................................... 157 9.1.1 Defining quality ............................................................................................................................. 157
KCE Reports 118 Pay for Quality 3 9.1.2 Measuring quality .......................................................................................................................... 158 9.2 INCENTIVE ................................................................................................................................................ 159 9.3 THE OVERALL HEALTH CARE SYSTEM ........................................................................................... 160 9.4 PAYER CHARACTERISTICS .................................................................................................................. 160 9.5 PROVIDER CHARACTERISTICS .......................................................................................................... 160 9.6 PATIENT CHARACTERISTICS ............................................................................................................. 161 9.7 IMPLEMENTATION ................................................................................................................................. 161 9.8 TOWARDS P4Q IN BELGIUM? ............................................................................................................ 162 10 REFERENCES ............................................................................................................... 165
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Pay for Quality

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