Quality indicators and their role in contractual relations between health care providers and health insurance companies Janka Jančovičová Health Care Surveillance Authority, Bratislava

Quality of provided health care From the view of WHO the highest possible level of expertise effective usage of resources minimal risk for patient high level of patient satisfaction patness of health care provision

„Quality“ of provided health care Quality is a category, describing in quantitative and qualitative terms the level of provided health care or provided services quality thus consists of two parts - the quantitative, measurable, and the qualitative, based on the system of values, Quality is a relative, not an absolute category (Dr. Marx, JCR/JCI, WHO, Bratislava 2005)

Quality indicators internal – monitoring and evaluation of results of provided health care (unveiling the problems, proposing solutions, permanently increasing of quality) external – assessment of the quality of health care providers, comparison with other providers

Legislative framework of quality indicators §7, Law No. 581/2004 Z. z. issued by the government directive for the purpose of assessment of selected areas of health care provision accessibility of health care effective usage of resources effectiveness and adequacy perception of provided health care by the patient results of provided health care

Legislative framework of quality indicators §7, Law No. 581/2004 Z. z. Obligations of health insurance company to publish criterions of conclusion of contracts related to 1.material and technical equipment and human resources of the providers 2.quality indicators to create a list of providers according to criterions fulfillment to conclude contracts with providers on the grounds of their position in the list

Criterions for conclusion of contracts on health care provision and coverage

Number of contracts between health insurance companies and health care providers Total :50 925

Percentage assessment of levels of quality indicators

Role of quality indicators assessment in contractual relations in relation to legislative framework in force in relation to actual demand of health insurance companies In relation to actual demand of health care providers

Role of quality indicators assessment in contractual relations selection of appropriate quality indicators??? methodology of quality indicators collection and assessment ??? validity of data??? competition or motivation???

Problem areas of assessment of external quality indicators from the view of health insurance companies Universal set of quality indicators (not influenced by specifics of insurance base) Methodology of collection and assessment (error of little numbers) Setting of clear criterions of conclusion of contracts considering quality indicator level (effectivity and quality )

Problem areas of assessment of external quality indicators from the view of health care providers Validity of data in relation to increasing administrative burden of health care providers Assessment of „non-measurable“ part of selected forms of health care Feedback by assessment of results in relation to increasing level of quality of provided health care

Quality indicators in contractual relations – future vision Assessment of quality of provided health care aimed at: Creation of differential treatment system by conclusion of contractual relation between health insurance companies and health care providers according to appropriately selected and targeted criterions of quality and effectivity of provided health care.