The WHO Centre for Health Development (WHO Kobe Centre – WKC), WHO’s Health Financing and Economics (HFE) Unit in Geneva and the Organisation for Economic Co-operation and Development (OECD) convened international experts to discuss “Blending capitation with performance-based payment: does it improve the quality of chronic care?” in a webinar on Tuesday, 10 September 2024.
The webinar was based on research by WKC, HFE and the Organisation for Economic Cooperation and Development (OECD) which explored experiences with purchasing arrangements and payment methods for improving quality and better health outcomes for people with chronic conditions. Around 41 million people around the world die annually from noncommunicable diseases, increasingly in low- and middle-income countries (LMICs), where about 60% of deaths are due to poor quality care. This is more than those who die due to lack of access to care. A core objective to purchasing arrangements and provider payment options is to improve quality.
Nearly 170 people joined to hear inputs from Dr Inke Mathauer, HFE Senior Health Financing Specialist who chaired the session, Dr Kalipso Chalkidou, HFE Unit Director, and Dr Sarah Barber, WKC Director, who described the research project, with country experiences from Dr Qian Long, Associate Professor of Global Health at Duke-Kunshan University in China, and Mr Stevie Ardianto Nappoe, a Research Fellow at the Center for Health Policy and Management at Gadjah Mada University in Indonesia. Dr Prastuti Soewondo, expert staff for public health services to the Minister in the Ministry of Public Health, Indonesia, and Mr Luca Lorenzoni, health economist and policy analyst at the OECD provided expert commentary.
Case studies from China and Indonesia were selected since they use capitation[1] and performance payments to pay healthcare providers. While capitation discourages over-servicing of patients, it can encourage providers to under-service, skimp on quality and unnecessarily refer patients with more severe conditions. In China, the performance payments were a small share of the total payments to providers and were regressive in that rural and remote areas had lower performance. In Indonesia, absolute rather than progressive targets meant that providers felt the targets were unattainable particularly in areas with fewer resources for quality.
Participants responded very positively to the webinar which highlighted the complex nature of using blended payment methods for improved quality of chronic care. The discussions stressed the importance of design and implementation processes, and the importance of embedding monitoring and evaluation into the design of purchasing models. Leadership and sequenced implementation can help in identifying obstacles, working with healthcare professionals and patient groups, and plan for the necessary infrastructure when introducing new purchasing and delivery systems.
WKC conducts research about innovations in service delivery models and sustainable financing to accelerate progress towards access and quality in the context of population ageing.
[1] Capitation is a way of paying healthcare providers/organizations a fixed payment per patient for a defined period, usually a year, paid upfront regardless of the actual services provided.