Pay for Quality

164 Pay for Quality KCE Reports 118
Both experts and Belgian stakeholders believe that it is important that government and
clinical leadership recognize that quality is variable and improvement is important. For a
P4Q programme to be successful a cultural shift towards this recognition is needed.
P4Q programmes should thereby be seen as part of a range of quality improvement
activities and not as stand-alone initiatives. Finally it must be stressed out that for a P4Q
programme to work, it is necessary to take into account the lessons learned from past
P4Q programmes.
Future research on Pay for Quality should focus on the effects of P4Q on currently less
informed domains such as continuity of care, patient and provider experience, and cost
effectiveness of program use, as compared to the use of existing implicit financial
incentives. To date potential issues in regard to intrinsic motivation effects have been
largely neglected in current healthcare research and need specific attention in future
studies, making use of survey and qualitative methods. Knowledge from economics,
psychology and social sciences can be leveraged further to refine P4Q design
recommendations. The international comparison of P4Q within different health systems
should be broadened to include a wider implicit incentive scope and to provide explicit
attention to the use of incentives in developing countries. Within the context of the
Belgian healthcare system, if policy makers decide to refocus incentives toward quality
of care, research should shift from an exploratory to a pilot testing phase, making use of
demonstration projects.