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Design and effects of outcome-based payment models in healthcare: a systematic review

Author

Listed:
  • F. P. Vlaanderen

    (Radboudumc
    Radboudumc)

  • M. A. Tanke

    (Radboudumc
    Radboudumc)

  • B. R. Bloem

    (Radboudumc
    Radboudumc)

  • M. J. Faber

    (Radboudumc
    Radboudumc)

  • F. Eijkenaar

    (Radboudumc
    Erasmus University)

  • F. T. Schut

    (Radboudumc
    Erasmus University)

  • P. P. T. Jeurissen

    (Radboudumc
    Radboudumc)

Abstract

Introduction Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. Methods We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. Results We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. Discussion Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.

Suggested Citation

  • F. P. Vlaanderen & M. A. Tanke & B. R. Bloem & M. J. Faber & F. Eijkenaar & F. T. Schut & P. P. T. Jeurissen, 2019. "Design and effects of outcome-based payment models in healthcare: a systematic review," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 20(2), pages 217-232, March.
    • Handle: RePEc:spr:eujhec:v:20:y:2019:i:2:d:10.1007_s10198-018-0989-8
    DOI: 10.1007/s10198-018-0989-8
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    References listed on IDEAS

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    1. Hugh Gravelle & Matt Sutton & Ada Ma, 2010. "Doctor Behaviour under a Pay for Performance Contract: Treating, Cheating and Case Finding?," Economic Journal, Royal Economic Society, vol. 120(542), pages 129-156, February.
    2. Lee, Jin Yong & Lee, Sang-Il & Kim, Nam-Soon & Kim, Seon-Ha & Son, Woo-Seung & Jo, Min-Woo, 2012. "Healthcare organizations’ attitudes toward pay-for-performance in Korea," Health Policy, Elsevier, vol. 108(2), pages 277-285.
    3. Milstein, Ricarda & Schreyoegg, Jonas, 2016. "Pay for performance in the inpatient sector: A review of 34 P4P programs in 14 OECD countries," Health Policy, Elsevier, vol. 120(10), pages 1125-1140.
    4. Frank Eijkenaar, 2013. "Key issues in the design of pay for performance programs," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 14(1), pages 117-131, February.
    5. Eijkenaar, Frank & Emmert, Martin & Scheppach, Manfred & Schöffski, Oliver, 2013. "Effects of pay for performance in health care: A systematic review of systematic reviews," Health Policy, Elsevier, vol. 110(2), pages 115-130.
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    3. Fernández Coves, Andrea & Yeung, Karene Hoi Ting & van der Putten, Ingeborg M & Nelson, E. Anthony S, 2022. "Teleconsultation adoption since COVID-19: Comparison of barriers and facilitators in primary care settings in Hong Kong and the Netherlands," Health Policy, Elsevier, vol. 126(10), pages 933-944.
    4. Feng, Yan & Kristensen, Søren Rud & Lorgelly, Paula & Meacock, Rachel & Sanchez, Marina Rodes & Siciliani, Luigi & Sutton, Matt, 2019. "Pay for performance for specialised care in England: Strengths and weaknesses," Health Policy, Elsevier, vol. 123(11), pages 1036-1041.
    5. Dimitrovová, Klára & Perelman, Julian & Serrano-Alarcón, Manuel, 2020. "Effect of a national primary care reform on avoidable hospital admissions (2000–2015): A difference-in-difference analysis," Social Science & Medicine, Elsevier, vol. 252(C).
    6. Tsai, Wen-Chen & Huang, Kuang-Hua & Chen, Pei-Chun & Chang, Yu-Chia & Chen, Michael S. & Lee, Chiachi Bonnie, 2023. "Effects of individual and neighborhood social risks on diabetes pay-for-performance program under a single-payer health system," Social Science & Medicine, Elsevier, vol. 326(C).

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