“Up to 58% of preventable deaths in low-and middle-income countries are attributable to poor quality medical care, and about 15% of hospital expenses in high-income countries are due to addressing poor quality care, including correcting mistakes and treating hospital-acquired infections that together affect up to 10% of inpatients.”
On 7 November 2024, the Director for WHO’s Centre for Health Development (WKC), Dr Sarah Barber, shared research findings on purchasing to strengthen quality care for chronic illnesses at the 30th Health Promoting Hospitals and Health Services (HPH) conference in Hiroshima to highlight whether quality can be incentivised through care standards.
“While many countries are addressing this by moving away from payments to health care providers based on volumes of services delivered towards ways of paying that are linked to the quality of care received or patients’ health outcomes, research was needed to validate this,” said Dr Barber.
In 2023, WKC managed a flagship project on purchasing to strengthen quality care for chronic illnesses in collaboration with the Organisation for Economic Co-operation and Development. Using evidence reviews and eight country case studies which explored different payment mechanisms, the researchers described how different payment methods had been used to incentivise better quality and health outcomes for chronic conditions.
They found that payment methods, including capitation with performance payments and bundled payments for specific procedures, had potential to contribute to improving quality in chronic care, but this was not realized due to design features and implementation. Facilitating factors such as health information and quality assurance systems, service delivery and governance played an important role.
Lessons learned included that changes in payment methods alone cannot improve quality, and financial incentives for quality improvements rely heavily on other quality assurance mechanisms. It is important to build monitoring and evaluation into the design of a payment method. The series of publications on “Purchasing for quality chronic care” can be found here.
WKC conducts research about innovations in service delivery models and sustainable financing to accelerate progress towards Universal Health Coverage in the context of population ageing.