Abstract
Background: Pay for Quality (P4Q) is being discussed as an incentive to ensure high quality standards despite cost pressure in healthcare. However, P4Q can also have adverse effects, and the evidence for its effectiveness is limited, especially regarding chronic conditions and multimorbidity. For the treatment of the latter, specific evaluation criteria were defined. Whether these are feasible in the context of costs and remunerations is analyzed in this study using the German DRG system as an example. The aim is to show conditions under which P4Q can be effective. Methods and Results: Costs and remuneration for hospitals were compared for an exemplary geriatric indication, with and without complex treatment. Doing so, cost weights were shown to be more than triple for the latter. The results are applicable to health care systems with P4Q or similar approaches. Conclusion: Introducing complex treatments poses higher and costly demands regarding structure, processes, and interdisciplinary cooperation in organizations. Additional average costs can be calculated by comparison to regular treatment. Covering the extra costs creates the necessary conditions for P4Q and makes the implementation of complex treatments more likely. As high standards have to be guaranteed for complex treatments and patient satisfaction rises when these are introduced, quality improvements can be assumed. This study can inform Health policy (incentive models) medical societies, give impulses for quality management, and healthcare research (patient-oriented health, e.g. consumer-driven health care, shared decision-making). Future studies should report patient-related outcomes and investigate further diagnoses.
Highlights
The demand for health care services is rising due to demographic changes and an increase in patients with chronic conditions and multimorbidity
The introduction of complex multimodal treatment codes in the G-DRG system has a high probability of improving the quality of care
Summary
The demand for health care services is rising due to demographic changes and an increase in patients with chronic conditions and multimorbidity. In the case of complex treatments, these indicators are vital, especially concerning chronically ill or multimorbid patients for whom [1] outcome quality criteria are limited and [2] treatment needs to be given by a highly qualified, multidisciplinary team, over a longer period and high intensity of care. First impulses for developing innovative care systems that ensure quality and patient safety, as well as incentives for care providers, came from reports of the Institute of Medicine (IOM) in 1999 aus (IOM, 2001) In this context, various incentivization models (P4Q, P4P) are being discussed on a global level. This issue can be addressed by specifying criteria for patients and, remunerations to provide clarity for service providers and payers [7]
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