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