PCN199 Testing the Potential of Performance Based Financing As a Strategy for Sustainable Health Systems in Latin America: The Case of Colombia

Abstract

Performance Based Financing (PBF) is a form of incentive where health providers are, at least partially, funded based on their performance to meet targets, being defined as fee-for-service-conditional-on-quality. Some PBF types include: Results Based Financing, Pay for Success or Health Impact Bonds. There have been some case studies in healthcare reported in developed and developing countries but none in Colombia. We conducted a rapid literature review in MEDLINE and grey literature, using a snowball technique. Our search query used PBF and its types limiting results to the last decade. Articles were selected and analyzed by 2 independent reviewers. In addition, a feasibility PBF study was conducted in Colombia to establish an operational, financial and legal framework aiming at benefiting vulnerable population by providing access to innovative oncology treatments. In total 89 articles were found in MEDLINE, identifying country case studies in all continents with predominance in Africa. PBF schemes were mainly related to public health interventions to reduce maternal mortality, increase immunization rates or address some prevalent non-communicable-diseases (e.g. Diabetes, CVD, Mental Health). The feasibility study involved 25 stakeholders from national and state governments, industry, insurers, providers, investors and civil society. The study concluded that there is willingness to invest, operating viability and a legal and regulatory pathway for implementation. Despite challenges associated with PBF, there is stakeholders’ receptivity to explore this funding option to ensure access to innovation in underserved populations, while maintaining healthcare sustainability. During the feasibility study diverse stakeholders’ interests were aligned, opening a window of opportunity to generate trust and operational synergies. A second phase is currently being deployed to detail and fully structure the mechanism, stakeholders’ roles, operation governance, metrics and funding.