23.08.12
Paying NHS for performance can deliver better care – Nuffield Trust
A payment system that covers the whole patient care pathway rather than individual providers and rewards for performance can deliver high-quality, affordable care, a new report suggests.
But authors from the Nuffield Trust accept that there are significant practical difficulties involved in this approach.
The report considers different forms of payment reform in the health sector in Europe, where providers are paid in a variety of different ways. Payment systems can be used to encourage collaboration and deliver care in the most appropriate settings, the Nuffield Trust found.
It also warned that current systems may be rewarding fragmented care, duplication of services and a focus on quantity rather than quality.
There are multiple challenges in implementing a single payment system, such as the need for shared IT systems, data on cost and quality, aligned clinical governance and a shared organisational culture.
Other issues to consider include technical difficulties measuring quality across a complex pathway, groups being too small to accept the financial risk of large payments for a set population and the risk that provider collaboration may reduce patient choice.
Lead author of the report and Nuffield Trust chief economist Anita Charlesworth said: “The question of how best to pay healthcare providers to encourage value for money is an under-researched area and our review has found variation in practice across Europe.
“Two important trends are worth noting. Early experiments are occurring in some countries to supplement DRG [diagnosis-related group] payment with incentives for the achievement of specific quality goals; and other countries are introducing volume caps and differential payment above a cap to contain total costs.
“It is important that countries strike the right balance between cost control and efficiency. A return to block budgets may help deliver short-term financial targets but it risks undermining the incentives for hospitals and other providers to improve their efficiency.
“However given the wide range of services with different attributes that constitute health care, policy makers are likely to need to deploy a range of different payment methods, with the optimal blend evolving in ways specific to individual countries.”
The report is at: www.nuffieldtrust.org.uk./sites/files/nuffield/publication/120823_reforming-payment-for-health-care-in-europev2.pdf
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