Pay for Quality
Pay for Quality
Pay for Quality
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KCE Reports 118 <strong>Pay</strong> <strong>for</strong> <strong>Quality</strong> 5<br />
What are the necessary conditions <strong>for</strong> applying P4Q in Belgium in the context of<br />
already existing quality initiatives?<br />
• Design, implementation, evaluation. What are the current initiatives<br />
• in Belgium in the public and private sector to enhance quality of care by way<br />
of financial incentives linked to quality of care measures? Is there any<br />
evidence of their impact on quality?<br />
• Conditions. To what extent are the current financing scheme, databases and<br />
other tools (guidelines, quality indicators) appropriate to implement P4Q in<br />
the Belgian health care setting? What are the most important facilitating and<br />
hindering factors?<br />
The research questions are in principle relevant to the diverse types of healthcare:<br />
general and mental health care, primary care and hospital care. The IOM report on P4Q<br />
gives some examples of programmes in skilled nursing facilities and home health<br />
agencies 2 . Initiatives in these settings are however still rare and often lack the<br />
availability of quality of care data. Being a first explorative study on P4Q in Belgium, our<br />
study scope in terms of setting is restricted primary care and medical or surgical<br />
hospital care. The similarities and differences between both settings in terms of P4Q<br />
will be addressed as a part of the study.<br />
In this study we clearly distinguish P4Q from other quality improvement interventions,<br />
such as accreditation and public reporting. These tools do not necessarily contain a<br />
financial incentive. However, their influence as a possible co-intervention with P4Q will<br />
be discussed.<br />
The report consists of nine chapters. Chapter 2 explains the general methodology that<br />
was followed. The next chapters each address a specific research question. Chapter 3<br />
presents a theoretical framework of P4Q. In Chapter 4 the evidence base of P4Q is<br />
systematically reviewed. In Chapter 5 a revision of the framework based on the<br />
evidence is discussed. Chapter 6 comprises an international comparison, based in<br />
interviews with international experts. Chapter 7 gives a description of the current<br />
existing P4Q initiatives in Belgium and includes a feasibility study of the implementation<br />
of P4Q in Belgium. In Chapter 8 the perceptions and opinions of key stakeholders in<br />
Belgium regarding P4Q are addressed. Finally Chapter 9 provides a roundup of the<br />
results of the previous chapters, leading to general conclusions and recommendations.