Pay for Quality

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12 Pay for Quality KCE Reports 118 In the UK Prof. Roland and Dr. Millet acted as key experts. Prof. Roland is a family practitioner for over 30 years. He currently works as a professor of Health Services Research at the University of Cambridge. He has been involved in the development and the evaluation of P4Q in the UK. His areas of expertise include the development of methods for measuring quality of care, and evaluating interventions to improve care. Dr. Millet is a consultant in public health at the Imperial College and completed a PhD on the impact of the Quality and Outcomes Framework in the GP contract on variations in diabetes management between ethnic groups. Currently, he is investigating the health care in the United States as a Harkness Fellow in Health Care Policy and Practice. His main current research interests are situated in the Health care quality improvement with a special attention on inequities in care. Prof. Braspenning was invited as key expert for the Netherlands. She works for the Scientific Institute for quality of health care (IQ healthcare) situated within the UMC Radboud. The research unit is specialized in research related to quality and quality improvement in health care. Prof. Braspenning’s research focuses on how to measure quality of care. Prof. Duckett acted as key expert for Australia. He is an economist who has been an academic at La Trobe University for several years. The last three years he has worked for the Queensland government at the Centre of Health Care Improvement. Currently, he is working as CEO at Alberta health services in Canada. With each key expert a 1 hour semi-structured interview was performed by two interviewers (PVH, DDS, or RR). The interview included the following 10 main questions: 1. Is there any form of pay for quality present in the health care system of your country, as you are aware of? 2. How did ‘pay for quality’ arise in your country? 3. What are/ were necessary cornerstones for the implementation of pay for quality, in the culture of your health care system? 4. How is ‘pay for quality’ developed and implemented in your country? 5. What are the reported or likely effects of ‘pay for quality’ in your country? 6. What is your opinion about P4Q programmes? 7. Which specific health system characteristics have largely influenced or will influence P4Q design, implementation and effects in your country? 8. What does the future hold for ‘pay for quality’ in your country? 9. What is your view on the current P4Q research status and its future evolution? 10. Which key recommendations do you formulate as an advice to a country at the first initial stage of considering the implementation of P4Q? A more comprehensive description of the questions used for the interviews can be found in appendix 11 An overview of the interview content, was provided to each expert as a preparation document. Each interview was conducted by means of the questionnaire and the interviews were recorded. The interview contents are reported extensively in chapter 6. The draft version of this chapter was send to all experts which gave them the possibility to change or clarify things wherever they wanted to.
KCE Reports 118 Pay for Quality 13 2.1.5 Conducting a systematic review of Belgian P4Q initiatives, and evaluating the feasibility of P4Q implementation, based on the comparison of current Belgian policy vs. findings from literature. The output of the systematic review on P4Q (see chapter 3 and 4) nor an additional search strategy using Dutch and French entry terms within the predefined search string identified any Belgian study. These limitations highlighted the need to collect the information as broadly as possible on a local scale by direct contact of all stakeholders involved. Because interviews of forty persons were planned as part of the chapter 8 data collection, these meetings were used as an opportunity to seek additional information on existing (P4)Q initiatives. They were asked to refer the research team to other persons involved in (P4)Q initiatives to provide additional information. These persons were contacted by phone and email, using a standardized template to collect (P4)Q initiative data. We write on purpose “(P4)Q” because, as will be shown in Chapter 7, the large majority of the current Belgian initiatives do focus on quality improvement, however do not apply P4Q. Nevertheless, a number of programmes did involve a kind of financial incentive. But this incentive wasn’t in any programme directly related to the measured performance of participants with regard to predefined quality targets. In Chapter 7 we provide an overview of all Belgian quality initiatives that were mentioned by the experts. These programmes provide possibilities to develop pay for quality initiatives, as will be further analyzed in section 7.2. The feasibility study makes use of the empirically revised conceptual framework (Chapter 5) to analyze strengths and weaknesses in current quality circle components to define P4Q threats and opportunities. The level of correspondence for both the quality initiative independent approach and the quality initiative dependent approach with the set of ‘to do’s’ is used as the central parameter. The feasibility of modifications is assessed (see Appendix 12). 2.1.6 Consultation of Belgian stakeholders as involved country representatives The assessment of the difficulties and possibilities to introduce Pay for quality in Belgium was performed following different steps. 2.1.6.1 Selection of stakeholders In a first step stakeholders were identified from national health care organizations, institutions or organisational bodies that represented a potential interest in pay for quality systems. The long list is presented in appendix 13. For each stakeholder, we identified mother tongue, the institution where the person is working and the stakeholder subpopulation the stakeholder belongs to. We aimed for 40 persons to be interviewed. In a second step, the list of stakeholders was submitted to different scorers (all academic experts), i.e. persons who know many people in the Belgian healthcare system. They were asked to evaluate whether the different stakeholders on the long list were persons who were sufficiently aware of and interested in the pay for quality topic. For each name, 4 options were possible (corresponding with a point): • Yes (1 point) • No (minus 1 point) • I do not know the person (no point) • I do not know whether it is worthwhile to interview this person (no point). All values were computed resulting into a classification of stakeholders. The scorers had the opportunity to comment and add another name. The latter was considered important in the case a stakeholder did not accept the interview or in case it was necessary to complete the list of a particular subgroup. The persons that acted as scorers to the long list were:
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