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Jakovljevic M, Jakab M, Gerdtham U, McDaid D, Ogura S, Varavikova E, Merrick J, Adany R, Okunade A, Getzen TE. Comparative financing analysis and political economy of noncommunicable diseases. J Med Econ 2019; 22:722-727. [PMID: 30913928 DOI: 10.1080/13696998.2019.1600523] [Citation(s) in RCA: 116] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The pandemic of chronic non-communicable diseases (NCDs) poses substantial challenges to the health financing sustainability in high-income and low/middle income countries (LMICs). The aim of this review is to identify the bottle neck inefficiencies in NCDs attributable spending and propose sustainable health financing solutions. The World Health Organization (WHO) introduced the "best buy" concept to scale up the core intervention package against NCDs targeted for LMICs. Population- and individual-based NCD best buy interventions are projected at US$170 billion over 2011-2025. Appropriately designed health financing arrangements can be powerful enablers to scale up the NCD best buys. Rapidly developing emerging nations dominate the landscape of LMICs. Their capability and willingness to invest resources for eradicating NCDs could strengthen WHO outreach efforts in Asia, Africa, and Latin America, much beyond current capacities. There has been a declining trend in international donor aid intended to cope with NCDs over the past decade. There is also a serious misalignment of these resources with the actual needs of recipient countries. Globally, the momentum towards the financing of intersectoral actions is growing, and this presents a cost-effective solution. A budget discrepancy of 10:1 in WHO and multilateral agencies remains in donor aid in favour of communicable diseases compared to NCDs. LMICs are likely to remain a bottleneck of NCDs imposed financing sustainability challenge in the long-run. Catastrophic household health expenditure from out of pocket spending on NCDs could plunge almost 150 million people into poverty worldwide. This epidemiological burden coupled with population ageing presents an exceptionally serious sustainability challenge, even among the richest countries which are members of the Organization for Economic Co-operation and Development (OECD). Strategic and political leadership of WHO and multilateral agencies would likely play essential roles in the struggle that has just begun.
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Affiliation(s)
- Mihajlo Jakovljevic
- a Department of Global Health Economics and Policy , University of Kragujevac , Kragujevac , Serbia
| | - Melitta Jakab
- b World Health Organization Regional Office for Europe , WHO Barcelona Office for Health Systems Strengthening , Barcelona , Spain
| | - Ulf Gerdtham
- c Division of Health Economics , Lund University , Lund , Sweden
| | - David McDaid
- d London School of Economics and Political Science , London , UK
| | - Seiritsu Ogura
- e Faculty of Economics , Hosei University , Tokyo , Japan
| | - Elena Varavikova
- f Federal Research Institute of Public Health , Moscow , Russian Federation
| | - Joav Merrick
- g Division of Pediatrics , Hadassah Hebrew University Medical Center , Mt Scopus Campus , Israel
| | - Roza Adany
- h Department of Preventive Medicine, Faculty of Public Health , University of Debrecen MTA-DE Public Health Research Group , Debrecen , Hungary
| | - Albert Okunade
- i Fogelman College of Business & Economics , University of Memphis , Memphis , TN , USA
| | - Thomas E Getzen
- j Insurance and Health Management at the Fox School of Business , Temple University , Philadelphia , PA , USA
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Sankaran R, Sukul D, Nuliyalu U, Gulseren B, Engler TA, Arntson E, Zlotnick H, Dimick JB, Ryan AM. Changes in hospital safety following penalties in the US Hospital Acquired Condition Reduction Program: retrospective cohort study. BMJ 2019; 366:l4109. [PMID: 31270062 PMCID: PMC6607204 DOI: 10.1136/bmj.l4109] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To evaluate the association between hospital penalization in the US Hospital Acquired Condition Reduction Program (HACRP) and subsequent changes in clinical outcomes. DESIGN Regression discontinuity design applied to a retrospective cohort from inpatient Medicare claims. SETTING 3238 acute care hospitals in the United States. PARTICIPANTS Medicare fee-for-service beneficiaries discharged from acute care hospitals between 23 July 2014 and 30 November 2016 and eligible for at least one targeted hospital acquired condition (n=15 470 334). INTERVENTION Hospital receipt of a penalty in the first year of the HACRP. MAIN OUTCOME MEASURES Episode level count of targeted hospital acquired conditions per 1000 episodes, 30 day readmissions, and 30 day mortality. RESULTS Of 724 hospitals penalized under the HACRP in fiscal year 2015, 708 were represented in the study. Mean counts of hospital acquired conditions were 2.72 per 1000 episodes for penalized hospitals and 2.06 per 1000 episodes for non-penalized hospitals; 30 day readmissions were 14.4% and 14.0%, respectively, and 30 day mortality was 9.0% for both hospital groups. Penalized hospitals were more likely to be large, teaching institutions, and have a greater share of patients with low socioeconomic status than non-penalized hospitals. HACRP penalties were associated with a non-significant change of -0.16 hospital acquired conditions per 1000 episodes (95% confidence interval -0.53 to 0.20), -0.36 percentage points in 30 day readmission (-1.06 to 0.33), and -0.04 percentage points in 30 day mortality (-0.59 to 0.52). No clear patterns of clinical improvement were observed across hospital characteristics. CONCLUSIONS Penalization was not associated with significant changes in rates of hospital acquired conditions, 30 day readmission, or 30 day mortality, and does not appear to drive meaningful clinical improvements. By disproportionately penalizing hospitals caring for more disadvantaged patients, the HACRP could exacerbate inequities in care.
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Affiliation(s)
- Roshun Sankaran
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Devraj Sukul
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ushapoorna Nuliyalu
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Baris Gulseren
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
| | - Tedi A Engler
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
| | - Emily Arntson
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Hanna Zlotnick
- University of Michigan Gerald R Ford School of Public Policy, Ann Arbor, MI, USA
| | - Justin B Dimick
- University of Michigan Medical School, Ann Arbor, MI, USA
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
| | - Andrew M Ryan
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI 48109, USA
- Center for Healthcare Outcomes and Policy, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, Ann Arbor, MI, USA
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Girault A, Gervès-Pinquié C, Moisdon JC, Minvielle É. [Entre dynamique d'amélioration de la qualité des soins et conformisme administratif : comportements des établissements de santé français face au paiement à la performance (P4P)]. ACTA ACUST UNITED AC 2019; 14:78-92. [PMID: 31017867 PMCID: PMC7008690 DOI: 10.12927/hcpol.2019.25791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Le paiement à la performance (P4P) continue de se développer dans les systèmes de santé des pays industrialisés, malgré des preuves encore assez limitées de son efficacité. Cette étude propose de comprendre le comportement des établissements de santé face à ce nouveau mode de paiement en se basant sur l'expérimentation de P4P hospitalier conduite en France. Nous avons, pour cela, combiné une approche quantitative basée sur un questionnaire auprès des établissements participants et une analyse qualitative dans neuf établissements afin de mieux identifier les processus à l'œuvre. L'étude montre que des actions correctives ont été réalisées dans certains établissements mais que les effets du programme sur l'organisation restent en fait assez limités puisqu'ils s'opèrent davantage à la marge. Les comportements semblent être essentiellement le reflet d'une volonté de conformation des organisations aux attentes de la tutelle, sans transformations organisationnelles majeures. Il sera toutefois intéressant de voir comment des perceptions différentes structurent ces comportements sur le long terme.
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Affiliation(s)
- Anne Girault
- Ingénieure d'études, Chaire de recherche « Prospective en Santé » - EHESP /MNH-BFMRattachée à l'équipe « Management des Organisations de Santé (EA 7348) »École des Hautes Études en Santé PubliqueParis, France
| | - Chloé Gervès-Pinquié
- Économiste, Institut de recherche en santé respiratoire des Pays de la LoireAngers, France
| | - Jean-Claude Moisdon
- Chercheur associé à l'équipe « Management des Organisations de Santé (EA 7348) »École des Hautes Études en Santé Publique Paris, France
| | - Étienne Minvielle
- Directeur de l'équipe de recherche « Management des Organisations de Santé (EA 7348) »École des Hautes Études en Santé PubliqueParis, France
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Schnoor J, Braehler E, Heyde CE. Did we learn the lesson after 60 years of Management by Objectives? A survey among former physician executives in German hospitals. Work 2019; 62:353-359. [PMID: 30829645 DOI: 10.3233/wor-192869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Management by Objectives (MbO) has been shown to establish efficient team work in both industry and medicine. Its most important prerequisite for success is target agreements between managers and medical professionals on equal footing. In medicine, lump-sum financing urges the delivery of a health care service with minimal effort. Consequently, daily clinical life changed, with economic goals seeming to become priority over medical principles. OBJECTIVE To determine how well MbO can still be practiced in hospitals with lumped treatment prices. METHODS We used an anonymized questionnaire for already retired physician executives who completed their active leadership positions between 2010 and 2015 in Saxony (Germany). We asked various type of target agreements that had been used in order to achieve medical or economic targets. RESULTS AND CONCLUSIONS Out of 111 former executives, the questionnaires of 25 respondents could be analysed. Eight respondents confirmed target agreements that were mostly set by managing directors. If used, most targets had not been adapted to the infrastructure and personnel strength, nor were they coordinated with neighbouring departments. Four respondents received financial incentives. Most medical executives were unsatisfied and preferred to abandon further goal setting. Due to the low number of cases, the representativeness of the study is limited. Nevertheless, it might be questioned if a flat-rate remuneration system facilitates the change into an authoritarian leadership concept.
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Affiliation(s)
- Joerg Schnoor
- Department of Anaesthesiology and Intensive Care Medicine, COLLM KLINIK OSCHATZ, Oschatz, Germany
| | - Elmar Braehler
- Department of Psychology and Sociology, University Hospital Leipzig, Leipzig, Germany
| | - Christoph-E Heyde
- Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany
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Vlaanderen FP, Tanke MA, Bloem BR, Faber MJ, Eijkenaar F, Schut FT, Jeurissen PPT. Design and effects of outcome-based payment models in healthcare: a systematic review. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:217-232. [PMID: 29974285 PMCID: PMC6438941 DOI: 10.1007/s10198-018-0989-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 06/22/2018] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. METHODS We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. RESULTS We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. DISCUSSION Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.
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Affiliation(s)
- F P Vlaanderen
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands.
| | - M A Tanke
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands
| | - B R Bloem
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Department of Neurology, Radboudumc, Nijmegen, The Netherlands
| | - M J Faber
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Radboudumc, Nijmegen, The Netherlands
| | - F Eijkenaar
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - F T Schut
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Erasmus School of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands
| | - P P T Jeurissen
- Radboudumc, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
- Scientific Institute for Quality of Healthcare (IQ Healthcare), Celsus Academy for Sustainable Healthcare, Radboudumc, Nijmegen, The Netherlands
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Cheng I, Taylor D, Schull MJ, Zwarenstein M, Kiss A, Castren M, Brommels M, Yeoh M, Kerr F. Comparison of emergency department time performance between a Canadian and an Australian academic tertiary hospital. Emerg Med Australas 2019; 31:605-611. [PMID: 30811092 DOI: 10.1111/1742-6723.13247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare performance and factors predicting failure to reach Ontario and Australian government time targets between a Canadian (Sunnybrook Hospital) and an Australian (Austin Health) academic tertiary-level hospitals in 2012, and to assess for change of factors and performance in 2016 between the same hospitals. METHODS This was a retrospective, observational study of patient administrative data in two calendar years. The main outcome measure was reaching Ontario and Australian ED time targets for admissions, high and low urgency discharges. Secondary outcomes were factors predicting failure to reach these targets. RESULTS Between 2012 and 2016, Sunnybrook and Austin experienced increased patient volume of 10.2% and 19.2%, respectively. Bed capacity decreased at Sunnybrook (-10.8%) but increased at the Austin (+30.3%). For both years, Austin failed to achieve the Australian time target, but succeeded for all Ontario targets except for low urgency discharges. Sunnybrook failed all targets irrespective of year. The top factors for failing Ontario ED length-of-stay targets for both hospitals in 2012 and 2016 were bed request greater than 6 h, access block greater than 1 h, use of cross-sectional imaging, consultation and waiting for the emergency physician greater than 2 h. CONCLUSION Austin outperformed Sunnybrook for Ontario and Australian government time targets. Both hospitals failed the Australian targets. Factors predicting failure to achieve targets were different between hospitals, but were mainly clinical resources. Sunnybrook focussed on increasing human resources. Austin focussed on increasing human resources, observation unit and hospital beds. Intrinsic hospital characteristics and infrastructure influenced target success.
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Affiliation(s)
- Ivy Cheng
- Department of Medicine, University of Toronto, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,Department of Clinical Science and Education, Sodersjukhuset-Karolinska Institutet, Stockholm, Sweden
| | - David Taylor
- Emergency Medicine Research, Austin Health, Melbourne, Victoria, Australia
| | - Michael J Schull
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Merrick Zwarenstein
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Alex Kiss
- Institute for Clinical Evaluative Sciences, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Maaret Castren
- Emergency Medicine, Helsinki University, Helsinki, Finland
| | - Mats Brommels
- Medical Management Center, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Michael Yeoh
- Emergency Department, Austin Health, Melbourne, Victoria, Australia
| | - Fergus Kerr
- Austin Health, Melbourne, Victoria, Australia
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Ellegård LM, Glenngård AH. Limited Consequences of a Transition From Activity-Based Financing to Budgeting: Four Reasons Why According to Swedish Hospital Managers. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019838367. [PMID: 30983464 PMCID: PMC6466459 DOI: 10.1177/0046958019838367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 02/05/2019] [Accepted: 02/21/2019] [Indexed: 11/30/2022]
Abstract
Activity-based financing (ABF) and global budgeting are two common reimbursement models in hospital care that embody different incentives for cost containment and quality. The purpose of this study was to explore and describe perceptions from the provider perspective about how and why replacing variable ABF by global budgets affects daily operations and provided services. The study setting is a large Swedish county council that went from traditional budgeting to an ABF system and then back again in the period 2005-2012. Based on semistructured interviews with midlevel managers and analysis of administrative data, we conclude that the transition back from ABF to budgeting has had limited consequences and suggest 4 reasons why: (1) Midlevel managers dampen effects of changes in the external control; (2) the actual design of the different reimbursement models differed from the textbook design; (3) the purchasing body's use of other management controls did not change; (4) incentives bypassing the purchasing body's controls dampened the consequences. The study highlights the challenges associated with improvement strategies that rely exclusively on budget system changes within traditional tax-funded and politically managed health care systems.
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Walther F, Kuester D, Schmitt J. Impact of Complex Quality-Interventions on Patient Outcome: A Systematic Overview of Systematic Reviews. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2019; 56:46958019884182. [PMID: 31746255 PMCID: PMC6868575 DOI: 10.1177/0046958019884182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/23/2019] [Accepted: 09/27/2019] [Indexed: 01/08/2023]
Abstract
Quality of care and the increasing strategies to its promotion, especially in inpatient settings, led to the question which quality-interventions work best and which do not. The aim was to summarize and critically appraise the evidence on the effects of structure- and/or process-related quality-interventions on patient outcome in predominantly controlled and inpatient settings. A systematic overview of systematic reviews after electronic searches in Medline, Embase, Cinahl, and PsycINFO, supplemented by hand search and expert survey, was conducted. From a total of 1559 identified records, 37 reviews fulfilled the inclusion criteria. 26 reviews assessed process-related quality-interventions, 6 structure-related quality-interventions, and 5 combined structure- and process-related quality-interventions. In all, 19 reviews reported pooled effect estimates (meta-analysis). Based on the evidence of this systematic overview, stroke units and pathways can be recommended. Although patient-relevant improvements for interprofessional approaches and discharge planning have been reported, pooled effect estimated evidence are currently missing for these and other quality-interventions.
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Affiliation(s)
- Felix Walther
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Denise Kuester
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
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Value-based provider payment: towards a theoretically preferred design. HEALTH ECONOMICS POLICY AND LAW 2018; 15:94-112. [PMID: 30259825 DOI: 10.1017/s1744133118000397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Worldwide, policymakers and purchasers are exploring innovative provider payment strategies promoting value in health care, known as value-based payments (VBP). What is meant by 'value', however, is often unclear and the relationship between value and the payment design is not explicated. This paper aims at: (1) identifying value dimensions that are ideally stimulated by VBP and (2) constructing a framework of a theoretically preferred VBP design. Based on a synthesis of both theoretical and empirical studies on payment incentives, we conclude that VBP should consist of two components: a relatively large base payment that implicitly stimulates value and a relatively small payment that explicitly rewards measurable aspects of value (pay-for-performance). Being the largest component, the base payment design is essential, but often neglected when it comes to VBP reform. We explain that this base payment ideally (1) is paid to a multidisciplinary provider group (2) for a cohesive set of care activities for a predefined population, (3) is fixed, (4) is adjusted for the population's risk profile and (5) includes risk-mitigating measures. Finally, some important trade-offs in the practical operationalisation of VBP are discussed.
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Pross C, Geissler A, Busse R. Measuring, Reporting, and Rewarding Quality of Care in 5 Nations: 5 Policy Levers to Enhance Hospital Quality Accountability. Milbank Q 2018; 95:136-183. [PMID: 28266076 DOI: 10.1111/1468-0009.12248] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
| | | | - Reinhard Busse
- Berlin University of Technology.,European Observatory on Health Systems and Policies
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Burau V, Dahl HM, Jensen LG, Lou S. Beyond Activity Based Funding. An experiment in Denmark. Health Policy 2018; 122:714-721. [DOI: 10.1016/j.healthpol.2018.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 04/13/2018] [Accepted: 04/16/2018] [Indexed: 10/17/2022]
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Busse R, van Ginneken E. Cross-country comparative research – Lessons from advancing health system and policy research on the occasion of the European Observatory on Health Systems and Policies’ 20th anniversary. Health Policy 2018; 122:453-456. [DOI: 10.1016/j.healthpol.2018.05.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Abstract
BACKGROUND Payment models for palliative care vary across nations, with few adopting contemporary payments designs that apply to other parts of the health system. AIM To propose optimal payment arrangements for palliative care. APPROACH Review of relevant literature on funding mechanisms in health care generally and palliative care in particular. RESULTS Payment models for palliative care should move toward activity-based funding using an agreed classification, be uncapped funding with performance monitoring, and make explicit use of performance metrics and reporting. CONCLUSIONS If palliative care is to become a universally accessible service, new approaches to funding, based on the experience of funding reforms in other parts of the health system, need to be adopted.
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Affiliation(s)
- Stephen Duckett
- Health Program, Grattan Institute, 8 Malvina Place, Carlton, VIC, 3053, Australia.
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Abstract
Healthcare agencies should ensure that performance measures for accreditation or reimbursement are supported by sound scientific evidence and safeguarded from potential commercial influences, argue Peter Eichacker and colleagues
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Affiliation(s)
- Dharmvir S Jaswal
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Charles Natanson
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
| | - Peter Q Eichacker
- Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892, USA
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Ridde V, Yaogo M, Zongo S, Somé P, Turcotte‐Tremblay A. Twelve months of implementation of health care performance-based financing in Burkina Faso: A qualitative multiple case study. Int J Health Plann Manage 2018; 33:e153-e167. [PMID: 28671285 PMCID: PMC5900741 DOI: 10.1002/hpm.2439] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 05/25/2017] [Indexed: 11/18/2022] Open
Abstract
To improve health services' quantity and quality, African countries are increasingly engaging in performance-based financing (PBF) interventions. Studies to understand their implementation in francophone West Africa are rare. This study analysed PBF implementation in Burkina Faso 12 months post-launch in late 2014. The design was a multiple and contrasted case study involving 18 cases (health centres). Empirical data were collected from observations, informal (n = 224) and formal (n = 459) interviews, and documents. Outside the circle of persons trained in PBF, few in the community had knowledge of it. In some health centres, the fact that staff were receiving bonuses was intentionally not announced to populations and community leaders. Most local actors thought PBF was just another project, but the majority appreciated it. There were significant delays in setting up agencies for performance monitoring, auditing, and contracting, as well as in the payment. The first audits led rapidly to coping strategies among health workers and occasionally to some staging beforehand. No community-based audits had yet been done. Distribution of bonuses varied from one centre to another. This study shows the importance of understanding the implementation of public health interventions in Africa and of uncovering coping strategies.
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Affiliation(s)
- Valéry Ridde
- University of Montreal Public Health Research Institute (IRSPUM)MontrealQCCanada
- University of Montreal School of Public Health (ESPUM)MontrealQCCanada
| | - Maurice Yaogo
- Université Catholique de l'Afrique de l'Ouest—Unité Universitaire à Bobo‐DioulassoBobo‐DioulassoBurkina Faso
- Association Zama Forum pour la Diffusion des Connaissances et des Expériences novatrices en Afrique (Zama Forum/ADCE—Afrique)Bobo‐DioulassoBurkina Faso
| | - Sylvie Zongo
- Institut des Sciences des Sociétés (INSS‐CNRST)OuagadougouBurkina Faso
| | - Paul‐André Somé
- Association Action Gouvernance Intégration Renforcement (AGIR)OuagadougouBurkina Faso
| | - Anne‐Marie Turcotte‐Tremblay
- University of Montreal Public Health Research Institute (IRSPUM)MontrealQCCanada
- University of Montreal School of Public Health (ESPUM)MontrealQCCanada
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Mak HY. Managing imperfect competition by pay for performance and reference pricing. JOURNAL OF HEALTH ECONOMICS 2018; 57:131-146. [PMID: 29274520 DOI: 10.1016/j.jhealeco.2017.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 09/03/2017] [Accepted: 11/01/2017] [Indexed: 06/07/2023]
Abstract
I study a managed health service market where differentiated providers compete for consumers by choosing multiple service qualities, and where copayments that consumers pay and payments that providers receive for services are set by a payer. The optimal regulation scheme is two-sided. On the demand side, it justifies and clarifies value-based reference pricing. On the supply side, it prescribes pay for performance when consumers misperceive service benefits or providers have intrinsic quality incentives. The optimal bonuses are expressed in terms of demand elasticities, service technology, and provider characteristics. However, pay for performance may not outperform prospective payment when consumers are rational and providers are profit maximizing, or when one of the service qualities is not contractible.
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Affiliation(s)
- Henry Y Mak
- Department of Economics, Indiana University-Purdue University Indianapolis, 425 University Boulevard, Indianapolis, IN 46202, USA.
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Raspe H. [The Choosing Wisely Initiative (CWI): Background, aims and problems of a professional campaign against oversupply]. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2017; 129:12-17. [PMID: 29153355 DOI: 10.1016/j.zefq.2017.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The Choosing Wisely Initiative (CWI) started in 2012 follows a proposal by Howard Brody (2010). Using CWI, the US ABIM Foundation continued its work to strengthen medical professionalism. The text describes CWI's development, aims, mission, and dissemination. It discusses some of its limits and problems. An appendix tabulates similarities and differences between CWI and a (2016) subsequent initiative from the German Society of Internal Medicine (DGIM: Klug Entscheiden Empfehlungen/decide wisely recommendations).
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Affiliation(s)
- Heiner Raspe
- Gastwissenschaftler am Institut für Ethik, Geschichte und Theorie der Medizin, Soetenkamp 16, 48149 Münster, Germany.
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The impact of financial incentives on the implementation of asthma or diabetes self-management: A systematic review. PLoS One 2017; 12:e0187478. [PMID: 29107955 PMCID: PMC5673190 DOI: 10.1371/journal.pone.0187478] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 10/20/2017] [Indexed: 12/21/2022] Open
Abstract
Introduction Financial incentives are utilised in healthcare systems in a number of countries to improve quality of care delivered to patients by rewarding practices or practitioners for achieving set targets. Objectives To systematically review the evidence investigating the impact of financial incentives for implementation of supported self-management on quality of care including: organisational process outcomes, individual behavioural outcomes, and health outcomes for individuals with asthma or diabetes; both conditions with an extensive evidence base for self-management. Methods We followed Cochrane methodology, using a PICOS search strategy to search eight databases in November 2015 (updated May 2017) including a broad range of implementation methodologies. Studies were weighted by robustness of methodology, number of participants and the quality score. We used narrative synthesis due to heterogeneity of studies. Results We identified 2,541 articles; 12 met our inclusion criteria. The articles were from the US (n = 7), UK (n = 4) and Canada (n = 1). Measured outcomes were HbA1c tests undertaken and/or the level achieved (n = 10), written action plans for asthma (n = 1) and hospital/emergency department visits (n = 1). Three of the studies were part of a larger incentive scheme including many conditions; one focused on asthma; eight focussed on diabetes. In asthma, the proportion receiving ‘perfect care’ (including providing a written action plan) increased from 4% to 88% in one study, and there were fewer hospitalisations/emergency department visits in another study. Across the diabetes studies, quality-of-care/GP performance scores improved in three, were unchanged in six and deteriorated in one. Conclusions Results for the impact of financial incentives for the implementation of self-management were mixed. The evidence in diabetes suggests no consistent impact on diabetic control. There was evidence from a single study of improved process and health outcomes in asthma. Further research is needed to confirm these findings and understand the process by which financial incentives may impact (or not) on care. Trial registration Protocol registration number: CRD42016027411
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Keßler W, Heidecke CD. Dimensions of Quality and Their Increasing Relevance for Visceral Medicine in Germany. Visc Med 2017; 33:119-124. [PMID: 28560226 PMCID: PMC5447179 DOI: 10.1159/000462997] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND 'Quality in medicine' is a term used in a broad sense. In this work the definition and dimensions of quality in medicine and the implementation of a measurement and reporting system in Germany are discussed. Existing applications are described and possible future effects are pointed out. METHODS The ongoing process of implementing a quality reporting system into the German healthcare system is studied by publicly available legal texts, published reactions of stakeholders and publications of G-BA and IQTIG. Definitions of quality, dimensions of quality and quality measurement in medicine are studied by using textbooks as well as the world wide web and PubMed search. RESULTS Donabedian's 'dimensions of quality' are fundamental in dealing with quality in medicine. Existing measurement and reporting systems have immanent strengths and weaknesses, as the definition of quality is affected by one's point of view. The legislator will have to decide which 'dimension of quality' is mandatory and how to measure it. CONCLUSION Quality has become a control instrument with unforeseeable consequences. A clear definition of the used quality concept is as essential as the use of feasible measurement and reporting systems. The use of routine data could be an interesting option.
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Affiliation(s)
- Wolfram Keßler
- Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Claus-Dieter Heidecke
- Department of General, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany
- Chirurgische Arbeitsgemeinschaft für Qualität, Sicherheit und Versorgungsforschung (CAQS-V), Deutsche Gesellschaft für Chirurgie (DGCH), Berlin, Germany
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The influence of welfare systems on pay-for-performance programs for general practitioners: A critical review. Soc Sci Med 2017; 178:157-166. [PMID: 28226301 DOI: 10.1016/j.socscimed.2017.02.019] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 02/10/2017] [Accepted: 02/12/2017] [Indexed: 12/11/2022]
Abstract
While pay-for-performance (P4P) programs are increasingly common tools used to foster quality and efficiency in primary care, the evidence concerning their effectiveness is at best mixed. In this article, we explore the influence of welfare systems on four P4P-related dimensions: the level of healthcare funders' commitment to P4Ps (by funding and length of program operation), program design (specifically target-based vs. participation-based program), physicians' acceptance of the program and program effects. Using Esping-Andersen's typology, we examine P4P for general practitioners (GPs) in thirteen European and North American countries and find that welfare systems contribute to explain variations in P4P experiences. Overall, liberal systems exhibited the most enthusiastic adoption of P4P, with significant physician acceptance, generous incentives and positive but modest program effects. Social democratic countries showed minimal interest in P4P for GPs, with the exception of Sweden. Although corporatist systems adopted performance pay, these countries experienced mixed results, with strong physician opposition. In response to this opposition, health care funders tended to favour participation-based over target-based P4P. We demonstrate how the interaction of decommodification and social stratification in each welfare regime influences these countries' experiences with P4P for GPs, directly for funders' commitment, program design and physicians' acceptance, and indirectly for program effects, hence providing a framework for analyzing P4P in other contexts or care settings.
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Girault A, Bellanger M, Lalloué B, Loirat P, Moisdon JC, Minvielle E. Implementing hospital pay-for-performance: Lessons learned from the French pilot program. Health Policy 2017; 121:407-417. [PMID: 28189271 DOI: 10.1016/j.healthpol.2017.01.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 01/12/2017] [Accepted: 01/20/2017] [Indexed: 01/02/2023]
Abstract
Despite a wide implementation of pay-for-performance (P4P) programs, evidence on their impact in hospitals is still limited. Our objective was to assess the implementation of the French P4P pilot program (IFAQ1) across 222 hospitals. The study consisted of a questionnaire among four leaders in each enrolled hospital, combined with a qualitative analysis based on 33 semi-structured interviews conducted with staff in four participating hospitals. For the questionnaire results, descriptive statistics were performed and responses were analyzed by job title. For the interviews, transcripts were analysed using coding techniques. Survey results showed that leaders were mostly positive about the program and reported a good level of awareness, in contrast to the frontline staff, who remained mostly unaware of the program's existence. The main barriers were attributed to lack of clarity in program rules, and to time constraints. Different strategies were then suggested by leaders. The qualitative results added further explanations for low program adoption among hospital staff, so far. Ultimately, although paying for quality is still an intuitive approach; gaps in program awareness within enrolled hospitals may pose an important challenge to P4P efficacy. Implementation evaluations are therefore necessary for policymakers to better understand P4P adoption processes among hospitals.
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Affiliation(s)
- Anne Girault
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Martine Bellanger
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Benoît Lalloué
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Philippe Loirat
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Jean-Claude Moisdon
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
| | - Etienne Minvielle
- Management des Organisations de Santé (EA 7348), Ecole des Hautes Etudes en Santé Publique, 20 avenue George Sand, 93210 Saint-Denis, France.
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Kristensen SR. Financial Penalties for Performance in Health Care. HEALTH ECONOMICS 2017; 26:143-148. [PMID: 27928846 DOI: 10.1002/hec.3463] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 09/25/2016] [Accepted: 11/14/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Søren Rud Kristensen
- Manchester Centre for Health Economics, Institute of Population Health, University of Manchester, Manchester, UK
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