PBF? Performance Based Financing or Population based Financing Pieter van den Hombergh Chairman...
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Transcript of PBF? Performance Based Financing or Population based Financing Pieter van den Hombergh Chairman...
PBF?Performance Based Financing
or Population based Financing
Pieter van den HomberghChairman Dutch Society of Tropical Medicine & IH
Policy advisor Dutch Society of GPResearch assistant IQhealthcare
The symposium committee• Ton Teunissen (NVAG, SANO)
• Peter Bob Peerenboom (NVAG, Tangram zorgadviseurs)
• Wilma Meeuws (Healthnet/TPO, NVAG)
• Frank van de Looij (Cordaid)
• Anja Koornstra (GGD Nederland)
• Pieter v/d Hombergh (LHV, NVTG, IQHealthcare)
• Godelieve van Heteren (Rotterdam Global Health Initiative)
• Monique Theunissen (VVAA, host)
PBF?
Performance Based Financing
On Performance Based Financing
1. The new kid in town
2. Dutch Minister of Health Schippers likes the idea
3. In Ruanda, Burundi & Congo Kinshasa remarkable
successes
4. Integrated care evidence based (King’s fund)
5. HMO (macro), Torbay, Kinzigtal, Utrecht (meso)
PBF?
Why a symposium by the NVAG?
Why a symposium
on Performance Based Financing?
PBF
1. Requires a relevant population (denominator)
2. Possibility to compare models (innovation)
3. Visibility of performance is key for providers
4. Collaboration & competition could be a couple
Patient demandAntibiotics, antidepressives
Homeopathy
Dokters, Ziekenhuizen, andere voorzieningen
Supply
Demand
Financing so far has been in
Structure Public health, Youth care
Process Integrated care, GP-care
Performance hmmmmm? HMO?
NeedsPublic health
optimum
DMMaternal Death
Perinatal MortalityTB
CVDInfectious diseases
The population matters:
1. Pregnant women, children
2. Elderly patiënts
3. A (group of) practices, medical home
4. A community Kinzigtal, Torbay, Rovereto
PBF?
Performance Based Financing
Path Coefficients for the Effects of Income Inequality and Primary Care on Health Outcome (50 US States, 1990)
TotalMortality
NeonatalMortality
Income Inequality(GINI COEFFICIENT)
Primary CarePhysicians
Stroke Mortality
Postneonatal Mortality
-.38** -.33*
-.18
-.33*
.18.16
.39** .40**
-.38**
*p<.05; **p<.01.
Life Expectancy
Life Expectancy
-.35**
.42**
Source: Shi et al, J Fam Pract 1999; 48:275-84.
Starfield 200000-002
Starfield 11/00PC 1768
68 7
1113
18
1210
85
3 23
0
5
10
15
20
0 1 2 3 4 5 6 7 8 9 10 11 12
Aantal praktijken
uw score = 3
1. Feedback only is not enough
1. Practice visits
2. Quality circles
3. Care groups compete (pride)
2. Reward by granting autonomy
3. Shared saving
4. Competition between models (Health league)
Effectiveness of interventions
Research is needed
(Implementation research)
PBF?
Other incentives than money?
Het lijkt te werken in Kinzigtalvalue-based competition on results
Geïntegreerd initiatiefOutcome: kosten ↓↓Care ↑ & Health ↑ ?? Effect op voorschrijven, GGZ en opnamen?
Deze populatie versus
Usual health care
http://www.ekiv.org/de/pdf/Hildebrandt-et-al_2010_Gesundes-Kinzigtal-Integrated-Care.pdf
1. Insured patients? (Mathew Sutton, Diana Monissen)
Are not making the health provider enthusiastic
2. A region, demographic area (PeterBob Peereboom)
Boundaries may be vague, outcome has many variables
3. Practice population(s) (Guy Schulpen)
Needs correction for background variable, yet feels good
4. Diseases (DM, Parkinson patients)
Inclusion a problem
PBF?
Various denominators & financing
Internal Transparancy Mirror info
External TransparancyAccountibility Reward
Clinical effectiveness
1. Peter Bob Peerenboom on PBF in LICs
2. Guy Schulpen on P4P in care groups,
substitution and shared saving
3. Matthew Sutton on P4P, Commissioning,
integrated care & competition in the NHS
4. Diana Monissen on the perspective of the
insurers and their view on incentivising
PBF?
The speakers
We hope you will be servedKies straks een groep van je keuze
horend bij die spreker.