TY - JOUR
T1 - Healthcare payment reforms across western countries on three continents
T2 - Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients' needs
AU - Van Herck, Pieter
AU - Kessels, Roselinde
AU - Annemans, Lieven
AU - Bellou, Abdelouahab
AU - Wens, Johan
AU - Sermeus, Walter
N1 - Self-generated experimental data used
PY - 2013/6
Y1 - 2013/6
N2 - 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.
AB - 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.
KW - Care payment
KW - Incentive
KW - Care typology
KW - Country comparison
KW - Preferences
KW - Health system reform
U2 - 10.1016/j.healthpol.2013.03.013
DO - 10.1016/j.healthpol.2013.03.013
M3 - Article
C2 - 23623724
SN - 0168-8510
VL - 111
SP - 14
EP - 23
JO - Health Policy
JF - Health Policy
IS - 1
ER -