Up to 42% of adults with non-communicable diseases (NCDs) die prematurely because of poor quality care. One way of improving quality is to link some of the healthcare provider payment to the quality of care or patient outcomes.
To explore this, the WHO Centre for Health Development (WHO Kobe Centre/WKC) jointly with OECD produced a book on Purchasing for quality chronic care. From this, authors from WHO, OECD, China, Chile, Indonesia, and South Africa produced a paper focusing on Purchasing primary care services for quality chronic care: Capitation with performance payments in four countries, which features in the latest edition of International Journal of Health Planning and Management.
The paper describes country case studies of health care purchasing arrangements in the four countries where primary care service providers were paid using capitation with performance pay to improve service quality and health outcomes for chronic conditions.
The countries introduced enabling interventions with the changes in payment methods, such as non-financial incentives and training, to deliver better health services. However, the research found these were not enough to change provider behaviour to improve quality. Design and implementation challenges highlighted the importance of adjusting quality measures for patient health risk and complexity to avoid penalising providers for accepting patients with higher health risks.
The researchers suggest that progressive quality targets may be more appropriate when there is a wide range in providers’ capacities, particularly in national programmes. This could encourage gradual quality improvements over time. A tactic of withholding performance payments to penalize poor performers was seen as counter-productive and could reduce resources for quality improvements in these settings.
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. The four studies of capitation with performance pay were part of a larger study on purchasing arrangements to strengthen quality health services for chronic diseases. Read more about this project.