Presentation on theme: "PBF? Performance Based Financing or Population based Financing Pieter van den Hombergh Chairman Dutch Society of Tropical Medicine & IH Policy advisor."— Presentation transcript:
PBF? Performance Based Financing or Population based Financing Pieter van den Hombergh Chairman Dutch Society of Tropical Medicine & IH Policy advisor Dutch Society of GP Research 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 demand Antibiotics, antidepressives Homeopathy Dokters, Ziekenhuizen, andere voorzieningen Supply Demand Financing so far has been in Structure Public health, Youth care Process Integrated care, GP-care Performancehmmmmm? HMO? Needs Public health optimum DM Maternal Death Perinatal Mortality TB CVD Infectious 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) Total Mortality Neonatal Mortality Income Inequality (GINI COEFFICIENT) Primary Care Physicians Stroke Mortality Postneonatal Mortality -.38**-.33* * **.40** -.38** *p<.05; **p<.01. Life Expectancy -.35**.42** Source: Shi et al, J Fam Pract 1999; 48: Starfield Starfield 11/00 PC 1768
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 Kinzigtal value-based competition on results Geïntegreerd initiatief Outcome: kosten ↓↓ Care ↑ & Health ↑ ?? Effect op voorschrijven, GGZ en opnamen? Deze populatie versus Usual health care
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
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
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