Pay for Quality

34 Pay for Quality KCE Reports 118
• The principal agent theory broadly addresses relationships in which both
parties have different abilities, in which there is asymmetric information and
in which the parties have different goals. Related to a P4Q programme, the
“agent” (the health care provider) can be both a potential ally and a
potential source of resistance to P4Q.
• The use of clinical guidelines in current policies, variable patient
contributions, other quality programmes, the availability of management
information systems, the number of payers, the accuracy of the data system,
the vision of the payer regarding health care goals and the typology
(private/public/regional/…) are important mechanisms that influence the
way a payer can and will implement P4Q.
• Internal and external motivational drivers, the specifically targeted “unit”
(an individual or a group) and organizational aspects are of importance in
the behaviour of health care providers.
• Finally, patient demographics, co-morbidities, their socio-economic and
insurance status, information about price and quality and several patient
behavioural patterns influence the outcome of P4Q programmes.
• When planning the introduction of a P4Q programme, all relevant concepts
and contextual factors have to be understood and taken into account.
Furthermore, when introducing P4Q, money has to be made available,
either new money or by disinvestments elsewhere or planned savings within
the programme. A stepwise introduction (phasing), permits testing the
targets and indicators, gives the providers the chance to gear up for a P4Q
initiative and enables purchasers to evaluate the small scale impact before
applying it to the larger group. The way of communicating the programme
to the providers is seen as crucial in the success of the programme. The
evaluation of the programme itself is as important as communication and
implementation.