Pay for Quality

KCE Reports 118 Pay for Quality 39
• Patient attribution based on which physicians had the greatest number of
claims and their eligibility for responsibility for measures based on specialty 69
4.2.2.3 Australia, the Netherlands, Germany, Italy, and Spain
In Australia there is a national health insurance arrangement which is supplemented by
private health insurances (about 40). Two major branches can be distinguished in
Australian health care, namely the medical setting (=primary care), which consists
mainly of general practitioners, and hospitals settings (=secondary care). The
responsibility for medical services rests with the commonwealth government, the
responsibility for hospital services rests essentially with the states. Medical services are
provided on a FFS basis.
One Australian P4Q evaluation study is performed in emergency departments of public
hospitals. Private hospitals and small country hospitals were excluded 213 . The other
study focused on family day care provided by child care centres and councils in a
metropolitan area 214 . The market, payer and provider characteristics are not further
specified in these studies.
In the Netherlands, a new law relating to care insurance has been introduced in 2006,
which resulted in a major switch from supply-driven care to demand-driven care.
Consequently, managed competition has been introduced in health care. Currently five
major private health insurances can be distinguished. These insurances are responsible
for purchasing health care based on quality and price. General Practitioners are largely
remunerated in a mixed model: capitation augmented by FFS. Hospitals are increasingly
commercial and payers negotiate with providers for prices. This allows competition
between providers and even across primary and secondary care.
One Dutch P4Q study was found, aimed at general practitioners with availability of
complete records in practices with at least 500 patients, and covered by one local
insurance company. No further information on these characteristics is provided 215 .
However this Dutch study does not explicitly recognizes and rewards high levels of
quality and quality improvement, therefore this programme can not be seen as a P4Q
programme as defined in this report, consequently the results of this study will not be
taken into account in the evidence section.
The included German P4Q study is also aimed at general practitioners, without further
specification of market, payer and provider type 216 . These authors used the degree of
initial interest in participation as a practice inclusion criterion.
In Italy, one P4Q study was performed in a National Health Service environment. Six
local health authorities were included as payers. The providers consisted of public
maternity hospitals and immunization clinics 217 .
Finally, in Spain, the Catalan Institute of Health offers primary healthcare services to
80% of the population in the region. The targeted primary care teams consist of
physicians and nurses 218 . No further details are provided on these characteristics.