Healthcare payment reforms across western countries on three continents: Lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients’ needs

Abstract

Objective. To test the hypothesis that care typology -being complex and highly unpredictable versus being clear-cut and highly predictable -guides healthcare payment preferences of physicians, policy makers, healthcare executives, and researchers.Data Sources/Study Setting. We collected survey data from 942 stakeholders across Canada, Europe, Oceania, and the United States. Forty-eight international societies invited their members to participate in our study. Study Design.Cross-sectional analysis of stakeholder survey data linked to four scenarios of care typology: primary prevention, trial-and-error care, standard care and network care.Principal Findings. We identified two "extremes": (1) dominant preferences of physicians, who embraced fee for service (FFS), even when this precludes the advantages of other payment systems associated with a minimal risk of harm (OR 1.85 for primary prevention; OR 1.89 for standard care, compared to non-physicians); and (2) the dominant preferences of healthcare executives and researchers, who supported quality bonus or adjustment (OR 1.92) and capitation (OR 2.05), respectively, even when these could cause harm. Conclusions.Based on explorative findings, we can cautiously state that payment reform will prove to be difficult as long as physicians, healthcare executives, and researchers misalign payment systems with the nature of care. Replication studies are needed to (dis)confirm our findings within representative subsamples per area and stakeholder group.

How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: a discrete choice experiment

“…We observed that the total utilities between stakeholder groups become more closely aligned in the new payment system, in the sense that the differences in total utility between physicians and policy makers diminish. This result is in contrast with the result of the more direct preference enquiry of Van Herck et al [12], which revealed that care payment preferences between the stakeholder groups appear to be misaligned. There is thus a discrepancy in preferences that stakeholders directly state and those that are indirectly derived from a DCE.…”

“…In Eastern Europe and the US, this seems to be already the case. In addition, the findings confirm a closer alignment between stakeholder groups as a result of new payment structures, which is opposite to the result of the preference rating study of Van Herck et al [12], in which stakeholder preferences were directly enquired.…”

“…The DCE is part of a larger study that also includes the rating study of Van Herck et al [12] in which the same stakeholders directly stated preference ratings for seven healthcare payment systems. The DCE approach is, however, indirect, measuring stakeholder preferences for payment reform outcomes on eleven health system performance objectives.…”

Patients' Care Needs: Documentation Analysis in General Hospitals

“…The knowledge base provided by SNL in EHRs provides opportunities to discover the nature of nursing care expenses. Employing SNL can encourage hospital leaders to increase documentation quality by focusing on the procedures and content of documentation (Van Herck et al., ). Standardized nursing diagnoses, intervention, and outcome data can be used for further prevalence studies, retrospective quality analyses, safety assurance strategies, and financial controlling (Keenan & Yakel, ; Keenan et al., ; Keenan, Yakel, Yao, et al., ).…”

Does an economic incentive affect provider behavior? Evidence from a field experiment on different payment mechanisms

“…Additionally, the authors asserted that the single payment method, such as only FFS, would not result in the optimal quantity of health services. The research of Van Herck et al 32 showed that physicians preferred payment systems that increased their benefits. Thus, it would be challenging to reform a payment system that did not reward the work of physicians.…”