Evolution of healthcare provider payment mechanisms
https://doi.org/10.17749/2070-4909.2019.12.4.318-326
Abstract
Methods of payment to care providers constitute an essential part of the healthcare financing system; these mechanisms determine the motivation of service providers. Throughout the history of public health care, the payment methods have been gradually improved so to stimulate the providers to best match the societal demands (greater access to health services, cost reduction, and better quality) and prevent “moral hazards”. As a result, the most advanced healthcare systems have stopped paying simply for service volume and rigorously restraining the costs. Instead, the updated system is based on the integrated payments combining the elements of cost control with the stimuli that promote a high quality and better access to healthcare service. At present, the new payment mechanisms aiming at improving the long-term treatment outcomes (life expectancy and quality of life) are available. The care provider payment system existing in Russia, by large, corresponds to the best international practices as far as the hospital care is concerned. However, the payment arrangements in the primary care network still lag behind the international standards. To improve the situation, quality indicators should be included in payments for primary care services.
About the Authors
V. V. Omelyanovskiy
Financial Research Institute of the Ministry of Finance of the Russian Federation; Russian Presidential Academy of National Economy and Public Administration
Russian Federation
Russian Federation
Vitaly V. Omelyanovskiy – MD, PhD, Professor, Head of the Center for Healthcare Funding, Financial Research Institute of the Ministry of Finance of Russia; Head of the Laboratory for Health Technology Assessment at the Institute of Applied Economic Research, Russian Presidential Academy of National Economy and Public Administration (RANEPA)
Researcher ID: P-6911-2018
Scopus Author ID: 6507287753
3-2 Nastasyinsky pereulok, Moscow 127006
82 Vernadskogo prospect, Moscow 119571
N. N. Sisigina
Financial Research Institute of the Ministry of Finance of the Russian Federation; Russian Presidential Academy of National Economy and Public Administration
Russian Federation
Russian Federation
Natalya N. Sisigina – Researcher at the Institute for Social Analysis and Forecast, Russian Presidential Academy of National Economy and Public Administration; Junior Researcher at the Tax Policy Center, Financial Research Institute
Scopus Author ID: 57205304532
Researcher ID: X-4298-2019
3-2 Nastasyinsky pereulok, Moscow 127006
82 Vernadskogo prospect, Moscow 119571
V. K. Fedyaeva
Financial Research Institute of the Ministry of Finance of the Russian Federation; Center for Healthcare Quality Assessment and Control of the Ministry of Healthcare of the Russian Federation
Russian Federation
Russian Federation
Vlada K. Fedyaeva – Researcher at the Institute for Applied Economic Studies, Russian Presidential Academy of National Economy and Public Administration; Junior Researcher at the Health Care Finance Center, Financial Research Institute; Deputy Head of the Department of Medical Support and Standardization, Center for Healthcare Quality Assessment and Control, Ministry of Health of the Russian Federation
Scopus Author ID: 57189502826
3-2 Nastasyinsky pereulok, Moscow 127006
10-5 Khokhlovskii pereulok, Moscow
N. Z. Musina
Center for Healthcare Quality Assessment and Control of the Ministry of Healthcare of the Russian Federation; Sechenov University
Russian Federation
Russian Federation
Nuriya Z. Musina – PhD, Associate Professor at the Department of Pharmacology, Faculty of Pharmacy, Sechenov First Moscow State Medical University; Head of the Development and Communications Department, Center of Healthcare Quality Assessment and Control, Ministry of Healthcare of the Russian Federation, Senior Researcher at the Center for Healthcare Funding, Financial Research Institute
Researcher ID: C-8075-2018
10-5 Khokhlovskii pereulok, Moscow 109028
8-2 Trubetskaya Str., Moscow 119048
References
1. World Health Organization. The world health report 2000 – Health systems: improving performance. [Electronic resource] URL: https://www.who.int/whr/2000/en/whr00_en.pdf. Accessed: 14.10.2019.
2. Langebrunner J.C., Cachin C., O’Dougherty S. (eds.) Designing and implementing health care provider payment systems: how-to manuals. Washington DC: The World Bank, 2009; 321 p. https://doi.org/10.1596/978-0-8213-7815-1.
3. Shrivastava D., Mueller M., Hewlett E. Better Ways to Pay for Health Care. Paris: OECD Publishing, 2016; 165 p. https://doi.org/10.1787/9789264258211-en.
4. Gosden T., Forland F., Kristiansen I., Sutton M., Leese B., Giuffrida A., Sergison M., Pedersen L. Capitation, salary, fee-forservice and mixed systems of payment: effects on the behaviour of primary care physicians (Review). The Cochrane Database of Systematic Reviews. 2000; Issue 3. Art. No.: CD002215. https://doi.org/10.1002/14651858.CD002215.
5. Shen J. The Effects of Payment Method on Clinical Decisionmaking: Physician Responses to Clinical Scenarios. Medical Care. 2004; 42 (3): 297-302. https://doi.org/10.1097/01.mlr.0000114918.50088.1c.
6. Hofmann S.M., Muhlenweg A.M. Gatekeeping in German primary health care – impacts on coordination of care, quality indicators and ambulatory costs. CINCH Working Paper Series 1605, Universitaet Duisburg-Essen, 2016. [Electronic resource] URL: https://cinch.unidue.de/fileadmin/content/research/workingpaper/1605_CINCHSeries_Hofmann_Muehlenweg.pdf. Accessed: 15.10.2019.
7. Olejaz M., Juul Nielsen A., Rudkjobing A., Okkels Birk H., Krasnik A., Hernandez-Quevedo C. Denmark: Health system review. Health Systems in Transition. 2012; 14 (2): 1-192.
8. Krasnik A. et al. Changing remuneration systems: effects on activity in general practice. British Medical Journal. 1990; (300): 16981701. https://doi.org/10.1136/bmj.300.6741.1698.
9. Kringos D.S., Boerma W.G.W., Hutchinson A., Saltman R.B. (eds), Building primary care in a changing Europe – Case studies. Copenhagen, World Health Organization, 2015; 304 p.
10. Vahidi R.G., Mojahed F., Jafarabadi M.A., Gholipour K., Rasi V. A systematic review of the effect of payment mechanisms on family physician service provision and referral rate behavior. Journal of Pakistan Medical Students. 2013; (3): 54-60.
11. Iversen, T., Hilde L. The Effect of Capitation on GPs’ Referral Decisions. Health Economics. 2000; (9): 199-210. https://doi.org/10.1002/(SICI)1099-1050(200004)9:3<199::AID-HEC514>3.0.CO;2-2.
12. Sorensen R.J., Grytten J. Service production and contract choice in primary physician services. Health Policy. 2003; (66): 73-93. https://doi.org/10.1016/s0168-8510(03)00026-5.
13. Busse R., Geissler A., Quentin W. Diagnosis-Related Groups in Europe. NY: Open University Press, 2011; 458 p.
14. Annear P.L., Huntington D. (eds.) Case-based payment systems for hospital funding in Asia: an investigation of current status and future directions. Comparative Country Studies. 2015; 1(2): 132. https://doi.org/10.1787/9789290617327-en.
15. Milstein R., Schreyogg J. A review of pay-for-performance programs in the inpatient sector in OECD countries. University of Hamburg, Hamburg Center for Health Economics (HCHE), 2015. https://doi.org/10.1016/j.healthpol.2016.08.009.
16. Feldhaus I., Mathauer I. Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature. BMC Health Services Research. 2018; (18): 996-1010. https://doi.org/10.1186/s12913-018-3779-1.
17. Porter M. E., Teisberg E. O. Redefining health care: creating value-based competition on results. Harvard Business Press, 2006; 528 p.
18. Saitgareyev R. R. The Indicators of Efficiency in Capitation Payments for Outpatient Care. Medical Technologies. Assessment and Choice. 2016; 4 (26): 26-31. (In Russ.).
19. Kuzminov Y. I., Popova S.A., Jakobson L.I. (eds.). Effective contract for professional in social sphere. Expert report. Moscow. 2017; 141 p. (In Russ.).
Review
For citations:
Omelyanovskiy V.V., Sisigina N.N., Fedyaeva V.K., Musina N.Z. Evolution of healthcare provider payment mechanisms. FARMAKOEKONOMIKA. Modern Pharmacoeconomics and Pharmacoepidemiology. 2019;12(4):318-326. (In Russ.) https://doi.org/10.17749/2070-4909.2019.12.4.318-326
Views:
1580
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Email this article 