Pay for Quality

KCE Reports 118 Pay for Quality 79
5.1.7 Payer characteristics
The relationship of the typology of the payer (e.g. private/public) to P4Q results is not
reported to be significant in the current P4Q evaluation studies (W), but this has
received little attention.
One major element, which is called in the original conceptual framework ‘other
incentive programmes running’, confirms the role of the dilution effect stated above.
One study reports the significant positive relationship with the proportion of revenue
generated by the P4Q payment system 194 . Other authors found a similar relationship
for the influence of other health plan or Health Maintenance Organization (HMO)
reimbursement mechanisms 185 , the difference in belonging to one or more managed
care plans 180 and the percentage of HMO penetration 207 , 208 . All these results confirm
the importance of the dilution effect in the American healthcare system (W).
In the USA, where various payer and insurance arrangements are present, delegation of
utilization management for hospital admission by an HMO to the physician organization
showed a small association with P4Q performance 198 , 199 , 207 . However, having hospital
admitting privileges or being a preferred Medicaid provider showed no relationship in
another study 180 (W).
There is no further evidence on the effect of other payer characteristics.
Figure 7: P4Q context: Payer characteristics
Payer characteristics
Use of clinical guidelines in current policy:
Lack of reporting, although this seems one of the mediators of the general quality
improvement trend co existing with the introduction of P4Q (see UK example) (N)
Variable patient contribution in function of provider and/or technology performance:
Lack of reporting in the USA (N). P4Q in the other countries is designed without a variable
patient contribution.
Other incentive programmes running:
Important influence of a dilution effect by other incentive programmes when not aligned
(W)
Availability of management information systems:
The different approaches do not translate into differences in clinical effect (S). Lack of
reporting in the included studies of payer and provider work experience effects (N).
Number of payers: see importance of dilution effects (W)
Accuracy of the data information system and underlying databases:
Use of sufficient validity safeguards in most studies. Evidence of gaming by providers to a
very limited degree (W).
Vision of the payer with regard to health objectives:
Lack of reporting (N)
Typology (private/public; local, regional, national…):
Scarce reporting of an absence of effect of these differences (W)