Summary Report by the WHO Research Project titled ‘Purchasing arrangements to strengthen quality health services for chronic diseases’ implemented by WHO Kobe Centre (Japan) in collaboration with the WHO Department of Health System Governance and Financing (Switzerland) OECD) and others.
The WHO report examines how different payment methods can improve the quality of care for chronic diseases. It highlights the need to move away from simply paying for activities towards rewarding providers for delivering high-quality care.
- The Challenge: Many countries struggle to deliver high-quality care for chronic diseases despite various initiatives. Traditional payment methods often don’t incentivize quality improvements.
- The Research: This study reviewed existing research and eight case studies from various countries. It explored how different payment arrangements, including blended payments and population-based methods, influence quality of care.
- Key Findings:
- Limited impact: Existing evidence suggests a weak link between current payment methods and improved quality or health outcomes.
- Balancing incentives: Blended payment methods (combining multiple payment methods) can be challenging to design, as striking a balance in incentives is crucial.
- Focus on delivery models: The report emphasizes the importance of improving healthcare delivery models alongside payment reforms. Identifying and addressing barriers to quality care is essential.
- Recommendations for policymakers:
- Quality measures: Focus on process indicators linked to improved health outcomes and patient-centeredness. Consider patient-reported outcomes as well.
- Targeted quality goals: Set relative or progressive quality targets that account for provider capacity and patient complexity.
- Equity considerations: Adjust quality metrics and payment systems to avoid penalizing providers serving vulnerable populations.
- Light reporting burdens: Minimize data collection requirements to avoid overburdening providers.
- Financial incentives: Design incentive payments carefully. Small quality payments may be ineffective, while penalties for poor performance can have unintended negative consequences.
- Transparency and certainty: Establish clear and transparent decision-making processes for payment methods, including payment schedules and how incentives are distributed.
- Phased implementation: Introduce new payment methods alongside capacity building in human resources and service delivery.
- Monitoring and evaluation: Build evaluation into payment method design to assess effectiveness and identify unintended consequences.
- Learning from experience: Share knowledge and best practices across countries to avoid repeating mistakes.
This research provides insights for countries aiming to improve chronic disease care through optimized purchasing arrangements and payment methods.