Primary care reform: a three country comparison of `budget holding'

Wilton, Paula; Smith, Richard

doi:10.1016/s0168-8510(98)00020-7

Cited by 17 publications

(12 citation statements)

References 40 publications

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“…In a research by Barnum et al in 1995, payment level and unit and the time of payment as well as different payment systems (fee-for-service and capitation) and their strong and weak points were implied. Capitation payment method in national medicine system of England (Robinson & Grand, 1994), Argentina (World Bank Report, 1998), New Zealand (Wilton & Smith, 1998), and the United States (Feachem, 2000) has become operational. According to the World Health Organization Report in 2000, buyers must shift from payment mechanisms based on fee-for-service payment to those mechanisms covering risk; it is in accordance with the results of the present study.…”

Section: Resultsmentioning

confidence: 99%

“…Due to the advantages of capitation system in controlling costs, capitation method is used in some organizations purchasing services in the world. This method has become operational in England National Medicine (Robinson & Grand, 1994), and the network of service providers in Social Security Organization of Argentina (World Bank Report, 1998), non-affiliated organizations in New Zealand (Wilton & Smith, 1998) and the organizations of health care providers in the United States (Feachem, 2000).…”

Section: Appropriate Payment Methodsmentioning

confidence: 99%

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Variables Affecting the Payment Mechanism for Strategic Purchasing in the Indirect Health Section of Iranian Social Security Organization

Nasiripour¹,

Raeissi²,

Tabibi³

et al. 2011

IBR

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The present study was conducted to define the variables affecting payment mechanism for strategic purchasing in the indirect health section of Iranian Social Security Organization of Iran, by which the Organization can provide the insured with better services while controlling the cost. 13 variables affecting payment mechanism for strategic purchasing were determined. A questionnaire was prepared based on above variables and completed by experts. The data was analyzed by SPSS and LISREL through confirmatory and exploratory analysis factors. The results indicate that payments mechanism is important in the process of strategic purchasing and three partial dimensions including performance-based payment mechanism, time-based payment system and risk coverage should be considered: 1-Performance-based payment system includes variables such as financial incentives for health service providers, prospective payment system and performance-based motives for health service employees. 2-Time-based payment system includes variables such as the time of receiving service. 3. Risk coverage includes variables such as justice and financial protection against disease risk.

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Section: Resultsmentioning

confidence: 99%

Section: Appropriate Payment Methodsmentioning

confidence: 99%

Variables Affecting the Payment Mechanism for Strategic Purchasing in the Indirect Health Section of Iranian Social Security Organization

Nasiripour¹,

Raeissi²,

Tabibi³

et al. 2011

IBR

View full text Add to dashboard Cite

show abstract

“…While MCO structures differ quite significantly [20], they share a number of common characteristics, including budgetary arrangements through which care for the designated (frequently enrolled) population is to be provided, and risk-sharing arrangements with the physician as 'gatekeeper' to the MCO. Although the method of remuneration differs across MCOs, the key underlying incentives remain; that efficiency is encouraged through budgetary arrangements which ensure physicians stand to 'gain/lose' from the resource implications of care prescribed [22]. For instance, physicians in MCOs may: (a) have budget-holding responsibilities (i.e.…”

Section: United States Of Americamentioning

confidence: 99%

Devolved budgetary responsibility in primary care

Wilton

Smith

2002

Eur J Health Econom

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General Practitioners and primary care physicians have a pivotal role in the allocation of health care resources in most countries. With increasing costs of care, they have therefore become a significant focus for healthcare reform in the pursuit of increased efficiency. For example, the United Kingdom (UK), United States of America (USA), New Zealand (NZ), Germany and The Netherlands, have all pursued reforms introducing explicit budgetary responsibilities for primary care. While there is a common set of objectives underlying such budgetary responsibilities, different versions have been introduced to reflect specific health environments. As most of these reforms were introduced in the early to middle 1990s, it is timely to examine their impact on efficiency. This paper therefore provides an econometric assessment of the effect of budgetary arrangements in the UK, USA, NZ, Germany and The Netherlands on the growth of primary care expenditure and flow-on costs (as proxied by pharmaceutical expenditure), as proxy indicators for efficiency. The results suggest that for all countries there is some support for efficiency improvements through the implementation of budgets for primary care.

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“…Over the last decade health restructuring in New Zealand has promoted 'managed' competition amongst providers and suppliers in the sector [7]. Of particular importance has been the establishment of 'budget holding' by IPAs within an incentive framework of retained savings for new services [8].…”

Section: Premec and The New Zealand Health Care Environment 1990-2000mentioning

confidence: 99%

A New Zealand prescribing quality initiative, PreMeC – the first 10 years

Maling

Bishop

2001

International Journal Of Pharmaceutical Medicine

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The National Preferred Medicines Centre (PreMeC) was established in 1991 as the first nationally funded prescribing quality assurance initiative in New Zealand. PreMeC services include: (1) individualized prescription analysis and feedback, with selected face to face facilitation, (2) medicines information bulletins targeted to therapeutic controversies and the results from prescription and case study analyses, (3) analysis of responses to case studies of common conditions in general practice with individualized feedback, and (4) software development to facilitate analysis of practice variation in prescribing.From 1991, New Zealand has undergone unprecedented health reform with increasing fiscal constraint in a rationed health care environment. The maintenance of nationally funded quality programmes remains a priority in the current environment. The lessons learned from sustaining PreMeC through this period are germane to most countries confronting the challenges of health care rationing.National pharmaceutical purchasing agencies such as New Zealand's PHARMAC, should not be accountable for pharmaceutical demand management in general practice. PHARMAC's modus operandi is inevitably and primarily through fiscal supply strategies rather than through informed facilitation of prescribing behavioural change. It may be argued that involvement of these agencies in demand-side management represents a potential conflict of interest.The inherent difficulty in demonstrating effectiveness of prescribing quality initiatives, in the face of natural prescribing variation, continues to challenge existing drug utilization methodology. There is a clear priority for ring-fenced funding to ensure a sustained national focus on quality management of pharmaceutical expenditure, particularly in general practice.

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Primary care reform: a three country comparison of `budget holding'

Cited by 17 publications

References 40 publications

Variables Affecting the Payment Mechanism for Strategic Purchasing in the Indirect Health Section of Iranian Social Security Organization

Variables Affecting the Payment Mechanism for Strategic Purchasing in the Indirect Health Section of Iranian Social Security Organization

Devolved budgetary responsibility in primary care

A New Zealand prescribing quality initiative, PreMeC – the first 10 years

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