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Outcome-based reimbursement models can effectively reduce the financial risk to health care payers in cases when there is important uncertainty or heterogeneity regarding the clinical value of health technologies. Still, health care payers in lower income countries rely mainly on financial based agreements to manage uncertainties associated with new therapies. We performed a survey, an exploratory literature review and an iterative brainstorming in parallel about potential barriers and solutions to outcome-based agreements in Central and Eastern Europe (CEE) and in the Middle East (ME). A draft list of recommendations deriving from these steps was validated in a follow-up workshop with payer experts from these regions. 20 different barriers were identified in five groups, including transaction costs and administrative burden, measurement issues, information technology and data infrastructure, governance, and perverse policy outcomes. Though implementing outcome-based reimbursement models is challenging, especially in lower income countries, those challenges can be mitigated by conducting pilot agreements and preparing for predictable barriers. Our guidance paper provides an initial step in this process. The generalizability of our recommendations can be improved by monitoring experiences from pilot reimbursement models in CEE and ME countries and continuing the multistakeholder dialogue at national levels.

We explore the alternative explanation for barriers and facilitators for implementation of PCC evolving from human resources through the lenses of institutional theory. We have deepened the explanation by adding the perspective of different institutional logics, which shows that the physician's resistance or nurses’ support may originate from the differences in institutional logics. Working with patients by applying person-centered principles places new demands on health professionals. It is widely agreed that education and training are very important for the clarification on the roles of professionals in the person-centred care. PCC education programs were designed to be delivered through informal training, continued medical education, leadership development and training through mentors’ system. Managers, on the other hand, may support the implementation of PCC, but their motivation may be less oriented to increase of service quality, than gaining higher external legitimacy of the organization and increase organizational access to external resources. Therefore, managers may not implement sufficient control and motivational mechanisms for healthcare professionals for following PCC routines and make them slip back into ‘usual care’ or lose interest, knowledge or commitment. As the psychological state of medical staff can determine the duration and success of the treatment and care, therefore they should be properly motivated. In this chapter we show comparative research study in Ukraine and Poland. The methodology of this study selected a list of motivators for medical staff in both countries. The results of this study brought the main findings that may be useful for reforming inefficient healthcare systems.

The Gothenburg model of Person-Centred Care (PCC) is an evidence-based intervention shown to improve care and health outcomes while maintaining cost. Other health systems could benefit from its sustainable implementation. The WE-CARE implementation framework, adapted by COSTCares, provides a base set of enablers and outcomes recommended for the design and evaluation of PCC. The methodology is extended using implementation science to systematically address contextual factors at different levels. Evidence-based frameworks, such as the Consolidated Framework for Implementation Research (CFIR), for example, and hybrid effectiveness-implementation study designs can be used. Additional enablers to consider when designing and evaluating PCC implementation strategies are discussed. The outcomes of quality of care and cost can be addressed using a Value for Money (VfM) framework. Various VfM methods and analysis models can be incorporated into PCC implementation research design in order to influence policy makers and health system decision makers towards the sustainable uptake of PCC.

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