Pay for Quality

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