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> 39<br />
• Patient attribution based on which physicians had the greatest number of<br />
claims and their eligibility <strong>for</strong> responsibility <strong>for</strong> measures based on specialty 69<br />
4.2.2.3 Australia, the Netherlands, Germany, Italy, and Spain<br />
In Australia there is a national health insurance arrangement which is supplemented by<br />
private health insurances (about 40). Two major branches can be distinguished in<br />
Australian health care, namely the medical setting (=primary care), which consists<br />
mainly of general practitioners, and hospitals settings (=secondary care). The<br />
responsibility <strong>for</strong> medical services rests with the commonwealth government, the<br />
responsibility <strong>for</strong> hospital services rests essentially with the states. Medical services are<br />
provided on a FFS basis.<br />
One Australian P4Q evaluation study is per<strong>for</strong>med in emergency departments of public<br />
hospitals. Private hospitals and small country hospitals were excluded 213 . The other<br />
study focused on family day care provided by child care centres and councils in a<br />
metropolitan area 214 . The market, payer and provider characteristics are not further<br />
specified in these studies.<br />
In the Netherlands, a new law relating to care insurance has been introduced in 2006,<br />
which resulted in a major switch from supply-driven care to demand-driven care.<br />
Consequently, managed competition has been introduced in health care. Currently five<br />
major private health insurances can be distinguished. These insurances are responsible<br />
<strong>for</strong> purchasing health care based on quality and price. General Practitioners are largely<br />
remunerated in a mixed model: capitation augmented by FFS. Hospitals are increasingly<br />
commercial and payers negotiate with providers <strong>for</strong> prices. This allows competition<br />
between providers and even across primary and secondary care.<br />
One Dutch P4Q study was found, aimed at general practitioners with availability of<br />
complete records in practices with at least 500 patients, and covered by one local<br />
insurance company. No further in<strong>for</strong>mation on these characteristics is provided 215 .<br />
However this Dutch study does not explicitly recognizes and rewards high levels of<br />
quality and quality improvement, there<strong>for</strong>e this programme can not be seen as a P4Q<br />
programme as defined in this report, consequently the results of this study will not be<br />
taken into account in the evidence section.<br />
The included German P4Q study is also aimed at general practitioners, without further<br />
specification of market, payer and provider type 216 . These authors used the degree of<br />
initial interest in participation as a practice inclusion criterion.<br />
In Italy, one P4Q study was per<strong>for</strong>med in a National Health Service environment. Six<br />
local health authorities were included as payers. The providers consisted of public<br />
maternity hospitals and immunization clinics 217 .<br />
Finally, in Spain, the Catalan Institute of Health offers primary healthcare services to<br />
80% of the population in the region. The targeted primary care teams consist of<br />
physicians and nurses 218 . No further details are provided on these characteristics.