WP5 Outpatient and Home care WP Leader Prof. John Hutton Dept. Health Sciences and York Health Economics Consortium

Objectives  To identify and analyse the impact of financing systems on the quality of outpatient and home care  To assess the impact of the quality of outpatient and home care on the ability of other sectors of the health system to deliver on efficiency and equity objectives

General Approach  Clarify definitions of outpatient and home care  Review published evidence  Develop in-depth case study of UK  Compare UK with other European systems  Review portability of financing mechanisms to improve quality

Methods  Concept development and debate  Structured literature review  Selected expert interviews  Case study using published and unpublished material  International information exchange and discussion

Specific Tasks

5.1 Definitions and Literature Review (1)  Agree definitions of outpatient care and home care e.g. does it include hospital outpatient care or just primary care?  Co-ordinate with WP4 and WP6  Align taxonomy of financing mechanisms and measures with WPs 1 and 2  Focus on feasible range of analyses

5.1 Definitions and Literature Review(2)  Co-ordinate literature searching with WPs 1 and 2 to avoid duplication  Concentrate on quality/finance link in primary care  Identify “grey” literature  Draw on local knowledge of partners

5.2 UK Case Study  England rather than UK  Use experience since 1983 of changes in funding mechanisms  Draw on current experience of Quality and Outcomes Framework (QOF) for GPs  Focus on impact of primary care on NHS performance

5.2 Key UK Policy Changes  General management in NHS (1983)  Purchaser/provider split  GP fund-holding  National Institute for Health and Clinical Excellence (NICE)  Payment by Results (PbR)  New GP contract  GP commissioning

5.2 UK Quality and Finance Initiatives  Quality and Outcomes Framework (QOF) for GPs  Quality accounts  Patient Reported Outcome Measures (PROMs)  CQUIN incentive payments

5.2 General Financial and Quality Policies  Efficiency savings  Activity and service delivery targets  “Best practice” tariffs  Quality, Innovation, Productivity and Prevention (QIPP) agenda  Patient choice  Shift care from hospitals to the community

5.2 New White Paper  Problem for InterQuality project  Changes already happening  New system fully in place by 2014?  No time for assessment of impact  May only show how relatively effective the old structure was?  Lay foundations for proper evaluation?

5.3 International Comparison  Comparison of UK with Germany, Denmark and Poland  Use definitions and measures developed in WPs 1 and 2  Study political context of health policies  Examine transferability of differing funding mechanisms

5.4 Feasibility of Mixed Financing Systems  Identify appropriate financing mechanisms to enhance quality in each area of outpatient care  Is there a generalisable model?  Examine home care and self-care expectations  Importance of social care/primary care/secondary care interfaces

Timetable (1)  Begin when conclusions of WPs 1 and 2 are emerging  Work in parallel with WPs 3, 4 and 6  Deliver in time for major communication activities

Timetable (2)  Task 5.1 begins Project month 13 and finishes in month 20  Task 5.2 months  Task 5.3 months  Task 5.4 months 28-31

Deliverables Series of reports on each main task:  Literature review  UK case study  International comparisons  Mixed funding systems

Partner Input  Clarification of measures and definitions (MUW and UI)  Co-ordination of scope (UniCT)  International comparisons (MHH, SPH, SDU)  Review and feedback (CPME, EPF)