Abstract
Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes.Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention.Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives.Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention.Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.
Highlights
Healthcare prevention, ranging from regular dental cleaning to collective initiatives to promote a healthier lifestyle, is one of the most important pillars of public health (1)
It is argued that reimbursement schemes play an important role in both hindering and stimulating the provision of healthcare services (13)
We distinguish between four levels of prevention, ranging from avoiding disease onset, allowing early diagnose and reducing disease impact to protecting patients from receiving redundant, unnecessary care
Summary
Healthcare prevention, ranging from regular dental cleaning to collective initiatives to promote a healthier lifestyle, is one of the most important pillars of public health (1). Prevention has the potential to substantially reduce disease’s economic burden (3), especially in the current environment of growing chronic illness (4). Healthcare prevention focuses on promoting and protecting people’s health by ensuring they receive care that conforms to their needs and stage of disease (5). Secondary, and tertiary prevention focus on delivering care to avoid disease onset, allow early diagnose and reduce disease impact, respectively (6), quaternary prevention aims to protect patients from receiving redundant, unnecessary care (7). The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes impact primary, secondary, tertiary, and quaternary prevention
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