Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients' needs

Pieter Van Herck*, Roselinde Kessels, Lieven Annemans, Abdelouahab Bellou, Johan Wens, Walter Sermeus

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


To test the hypothesis that care typology-being complex and highly unpredictable versus being clear-cut and highly predictable-guides healthcare payment preferences of physicians, policy makers, healthcare executives, and researchers. We collected survey data from 942 stakeholders across Canada, Europe, Oceania, and the United States. A total of 48 international societies invited their members to participate in our study. Cross-sectional analysis of stakeholder survey data linked to four scenarios of care typology: primary prevention, trial-and-error care, standard care and network care. We identified two "extremes": (1) dominant preferences of physicians, who embraced fee for service (FFS), even when this precludes the advantages of other payment systems associated with a minimal risk of harm (OR 1.85 for primary prevention; OR 1.89 for standard care, compared to non-physicians); and (2) the dominant preferences of healthcare executives and researchers, who supported quality bonus or adjustment (OR 1.92) and capitation (OR 2.05), respectively, even when these could cause harm. Based on exploratory findings, we can cautiously state that payment reform will prove to be difficult as long as physicians, healthcare executives, and researchers misalign payment systems with the nature of care. Replication studies are needed to (dis)confirm our findings within representative subsamples per area and stakeholder group. Copyright (c) 2013 Elsevier Ireland Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)14-23
Number of pages10
JournalHealth Policy
Issue number1
Publication statusPublished - Jun 2013
Externally publishedYes


  • Care payment
  • Incentive
  • Care typology
  • Country comparison
  • Preferences
  • Health system reform

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