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> 65<br />
Key points on reported cost effectiveness and modelling effects of P4Q<br />
programmes<br />
Cost effectiveness<br />
• One study in the UK and two in the USA focus on cost-effectiveness of P4Q<br />
programmes.<br />
• From the twelve QOF-indicators, investigated in the UK study, only one,<br />
diabetes retinal screening seemed to be not cost-effective.<br />
• The USA study focussing on P4Q programmes in primary care (diabetic<br />
care) showed a positive return on investment ranging between 1.6 and 2.5<br />
per invested US dollar.<br />
• The third study evaluated the cost-effectiveness of hospital P4Q<br />
programmes focussing on heart care. Applying a $50 000 per QALY<br />
threshold, the programme seems to be cost-effective even in a worst case<br />
scenario.<br />
Modelling costs<br />
• Three UK studies, and two USA studies predicted short term financial<br />
consequences or long term health consequences of P4Q programmes.<br />
• Concerning the long term financial consequences, one USA study has<br />
investigated two P4Q programmes. One programme is break-even, it<br />
collects money in a pool of funds that is used to pay bonuses afterwards. The<br />
other programme redistributes almost $10 million more than it collects.<br />
• Another US programme estimated the potential decrease in payments due<br />
to the reduction of post-admission complications in hospital care. The<br />
implementation of such a P4Q programme could result in a payment<br />
reduction to hospitals between 0% and 3.29%. The overall reduction equals<br />
to 1.01% of hospital payments, with corresponds with a reduction in<br />
payments of $1.005 billion.<br />
• One UK study explored the link between financial incentives and likely<br />
population health gain within the QOF system. As a result there seems to be<br />
no obvious relationship between payment and health gain <strong>for</strong> these 8<br />
interventions.<br />
• Finally two UK studies estimated the health gain if a number of QOF quality<br />
measures were to be met. The first study uses the baseline activity as<br />
comparator, the second study uses no activity as comparator. In the first<br />
study reaching the cholesterol target and the targets concerning<br />
hypertension management were the most effective in preventing CHD<br />
events in cardiovascular patients. In the second study, influenza<br />
immunization and primary prevention <strong>for</strong> hypertension carry the greatest<br />
potential <strong>for</strong> lives saved, although is must be noted that influenza<br />
immunization already reaches high achievements. Hence, taking the<br />
baseline activities into account, the results of this study are an<br />
overestimation of potential life gain.