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Giancotti M, Mauro M, Rania F. Exploring the effectiveness of a P4P scheme from the perspective of Italian general practitioners: A replication study. Int J Health Plann Manage 2022; 37:1526-1544. [DOI: 10.1002/hpm.3417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2021] [Accepted: 01/03/2022] [Indexed: 11/08/2022] Open
Affiliation(s)
- Monica Giancotti
- Department of Clinical and Experimental Medicine Magna Graecia University of Catanzaro Catanzaro Italy
| | - Marianna Mauro
- Department of Clinical and Experimental Medicine Magna Graecia University of Catanzaro Catanzaro Italy
| | - Francesco Rania
- Department of Law, Economics and Sociology Magna Graecia University of Catanzaro Catanzaro Italy
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Shin WY, Kim C, Lee SY, Lee W, Kim JH. Role of Primary Care and Challenges for Public-Private Cooperation during the Coronavirus Disease 2019 Pandemic: An Expert Delphi Study in South Korea. Yonsei Med J 2021; 62:660-669. [PMID: 34164964 PMCID: PMC8236345 DOI: 10.3349/ymj.2021.62.7.660] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/10/2021] [Accepted: 05/17/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim of this study was to explore the role of primary care facilities and their support measures in response to coronavirus disease 2019 (COVID-19) and to identify challenges to achieving public-private cooperation in South Korea. MATERIALS AND METHODS Twenty-four leading experts were selected and recruited to participate in this iterative web-based Delphi study. An open-ended questionnaire was administered to collect the expert panel's views in the first round. In the second round, the panel was asked to rate on a 5-point Likert scale their agreement with individual items gleaned from qualitative content analysis of views expressed in the first round. The participants were offered the opportunity to reevaluate and correct their initial responses in subsequent rounds. Responses in the second and following rounds were analyzed using quantitative descriptive statistics. RESULTS The first and second rounds were completed by 54.2% (n=13/24) and 58.3% (n=14/24) of the selected panel, respectively, while 10 out of these 14 participants completed the third round. The panel cited in-person essential medical services, telehealth for fever/respiratory symptoms, surveillance for influenzae-like illness, and minimization of spread to staff as important and appropriate roles of primary care, which are urgent and feasible during a pandemic. Regarding conditions/support for these roles, the panel indicated that institutional support and funding for separate areas, workforce, and telehealth, along with public-private collaborative governance, are urgent, but not feasible. CONCLUSION This study provides guidance on strategies for continuing the required roles of primary care and highlights a need to strengthen public-private partnerships during pandemic events in Korea.
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Affiliation(s)
- Woo Young Shin
- Department of Family Medicine, Chung-Ang University Medical Center, Seoul, Korea
| | - Changsoo Kim
- Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sei Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chung-Ang University College of Medicine, Seoul, Korea
| | - Won Lee
- Department of Nursing, Chung-Ang University, Seoul, Korea
| | - Jung Ha Kim
- Department of Family Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
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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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Ju Kim S, Han KT, Kim SJ, Park EC. Pay-for-performance reduces healthcare spending and improves quality of care: Analysis of target and non-target obstetrics and gynecology surgeries. Int J Qual Health Care 2017; 29:222-227. [PMID: 28407094 DOI: 10.1093/intqhc/mzw159] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 04/11/2017] [Indexed: 01/15/2023] Open
Abstract
Objective In Korea, the Value Incentive Program (VIP) was first applied to selected clinical conditions in 2007 to evaluate the performance of medical institutes. We examined whether the condition-specific performance of the VIP resulted in measurable improvement in quality of care and in reduced medical costs. Design Population-based retrospective observational study. Setting We used two data set including the results of quality assessment and hospitalization data from National Health Claim data from 2011 to 2014. Participants Participants who were admitted to the hospital for obstetrics and gynecology were included. A total of 535 289 hospitalizations were included in our analysis. Methods We used a generalized estimating equation (GEE) model to identify associations between the quality assessment and length of stay (LOS). A GEE model based on a gamma distribution was used to evaluate medical cost. The Poisson regression analysis was used to evaluate readmission. Main Outcome Measures The outcome variables included LOS, medical costs and readmission within 30 days. Results Higher condition-specific performance by VIP participants was associated with shorter LOSs, decreases in medical cost, and lower within 30-day readmission rates for target and non-target surgeries. LOS and readmission within 30 days were different by change in quality assessment at each medical institute. Conclusions Our findings contribute to the body of evidence used by policy-makers for expansion and development of the VIP. The study revealed the positive effects of quality assessment on quality of care. To reduce the between-institute quality gap, alternative strategies are needed for medical institutes that had low performance.
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Affiliation(s)
- Seung Ju Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Kyu-Tae Han
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sun Jung Kim
- Department of Health Administration, Soonchunhyang University, Chungnam, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Preventive Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Lee K, Kim HJ, You M, Lee JS, Eun SJ, Jeong H, Ahn HM, Lee JY. Defining the activities of publicness for Korea's public community hospitals using the Delphi method. Medicine (Baltimore) 2017; 96:e6402. [PMID: 28296785 PMCID: PMC5369940 DOI: 10.1097/md.0000000000006402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study aims to identify which activities of a public community hospital (PHC) should be included in their definition of publicness and tries to achieve a consensus among experts using the Delphi method. We conduct 2 rounds of the Delphi process with 17 panel members using a developed draft of tentative activities for publicness including 5 main categories covering 27 items. The questions remain the same in both rounds and the applicability of each of the 27 items to publicness is measured on a 9-point scale. If the participants believe government funding is needed, we ask how much they think the government should support each item on a 0% to 100% scale. After conducting 2 rounds of the Delphi process, 22 out of the 27 items reached a consensus as activities defining the publicness of the PHCs. Among the 5 major categories, in category C, activities preventing market failure, all 10 items were considered activities of publicness. Nine of these were evaluated as items that should be compensated at 100% of total financial loss by the Korean government. Throughout results, we were able to define the activities of the PCH that encompassed its publicness and confirm that there are "good deficits" in the context of the PCHs. Thus, some PCH deficits are unavoidable and not wasted as these monies support a necessary role and function in providing public health. The Korean government should therefore consider taking actions such as exempting such "good deficits" or providing additional financial aid to reimburse the PHCs for "good deficits."
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Affiliation(s)
- Kunsei Lee
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul
| | - Hyun Joo Kim
- Department of Nursing Science, Shinsung University, Dangjin
| | - Myoungsoon You
- Department of Public Health, the Graduate School of Public Health
| | - Jin-Seok Lee
- Institute of Health Policy and Management, Medical Research Center, Seoul National University
- Department of Health Policy and Management, Seoul National University College of Medicine, Seoul
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon
| | - Hyoseon Jeong
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul
| | - Hye Mi Ahn
- Department of Preventive Medicine, Konkuk University School of Medicine, Seoul
| | - Jin Yong Lee
- Institute of Health Policy and Management, Medical Research Center, Seoul National University
- Public Health Medical Service, Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
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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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Milstein R, Schreyoegg J. Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries. Health Policy 2016; 120:1125-1140. [DOI: 10.1016/j.healthpol.2016.08.009] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 08/21/2016] [Accepted: 08/25/2016] [Indexed: 11/26/2022]
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Tchoe B, Lee S. The Possibility of Expanding Pay-for-Performance Program as a Provider Payment System. HEALTH POLICY AND MANAGEMENT 2013. [DOI: 10.4332/kjhpa.2013.23.1.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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