PBF?Performance Based Financing

or Population based Financing

Pieter van den HomberghChairman Dutch Society of Tropical Medicine & IH

Policy advisor Dutch Society of GPResearch assistant IQhealthcare

The symposium committee• Ton Teunissen (NVAG, SANO)

• Peter Bob Peerenboom (NVAG, Tangram zorgadviseurs)

• Wilma Meeuws (Healthnet/TPO, NVAG)

• Frank van de Looij (Cordaid)

• Anja Koornstra (GGD Nederland)

• Pieter v/d Hombergh (LHV, NVTG, IQHealthcare)

• Godelieve van Heteren (Rotterdam Global Health Initiative)

• Monique Theunissen (VVAA, host)

PBF?

Performance Based Financing

On Performance Based Financing

1. The new kid in town

2. Dutch Minister of Health Schippers likes the idea

3. In Ruanda, Burundi & Congo Kinshasa remarkable

successes

4. Integrated care evidence based (King’s fund)

5. HMO (macro), Torbay, Kinzigtal, Utrecht (meso)

PBF?

Why a symposium by the NVAG?

Why a symposium

on Performance Based Financing?

PBF

1. Requires a relevant population (denominator)

2. Possibility to compare models (innovation)

3. Visibility of performance is key for providers

4. Collaboration & competition could be a couple

Patient demandAntibiotics, antidepressives

Homeopathy

Dokters, Ziekenhuizen, andere voorzieningen

Supply

Demand

Financing so far has been in

Structure Public health, Youth care

Process Integrated care, GP-care

Performance hmmmmm? HMO?

NeedsPublic health

optimum

DMMaternal Death

Perinatal MortalityTB

CVDInfectious diseases

The population matters:

1. Pregnant women, children

2. Elderly patiënts

3. A (group of) practices, medical home

4. A community Kinzigtal, Torbay, Rovereto

PBF?

Performance Based Financing

Path Coefficients for the Effects of Income Inequality and Primary Care on Health Outcome (50 US States, 1990)

TotalMortality

NeonatalMortality

Income Inequality(GINI COEFFICIENT)

Primary CarePhysicians

Stroke Mortality

Postneonatal Mortality

-.38** -.33*

-.18

-.33*

.18.16

.39** .40**

-.38**

*p<.05; **p<.01.

Life Expectancy

Life Expectancy

-.35**

.42**

Source: Shi et al, J Fam Pract 1999; 48:275-84.

Starfield 200000-002

Starfield 11/00PC 1768

68 7

1113

18

1210

85

3 23

0

5

10

15

20

0 1 2 3 4 5 6 7 8 9 10 11 12

Aantal praktijken

uw score = 3

1. Feedback only is not enough

1. Practice visits

2. Quality circles

3. Care groups compete (pride)

2. Reward by granting autonomy

3. Shared saving

4. Competition between models (Health league)

Effectiveness of interventions

Research is needed

(Implementation research)

PBF?

Other incentives than money?

Het lijkt te werken in Kinzigtalvalue-based competition on results

Geïntegreerd initiatiefOutcome: kosten ↓↓Care ↑ & Health ↑ ?? Effect op voorschrijven, GGZ en opnamen?

Deze populatie versus

Usual health care

http://www.ekiv.org/de/pdf/Hildebrandt-et-al_2010_Gesundes-Kinzigtal-Integrated-Care.pdf

1. Insured patients? (Mathew Sutton, Diana Monissen)

Are not making the health provider enthusiastic

2. A region, demographic area (PeterBob Peereboom)

Boundaries may be vague, outcome has many variables

3. Practice population(s) (Guy Schulpen)

Needs correction for background variable, yet feels good

4. Diseases (DM, Parkinson patients)

Inclusion a problem

PBF?

Various denominators & financing

Internal Transparancy Mirror info

External TransparancyAccountibility Reward

Clinical effectiveness

1. Peter Bob Peerenboom on PBF in LICs

2. Guy Schulpen on P4P in care groups,

substitution and shared saving

3. Matthew Sutton on P4P, Commissioning,

integrated care & competition in the NHS

4. Diana Monissen on the perspective of the

insurers and their view on incentivising

PBF?

The speakers

We hope you will be servedKies straks een groep van je keuze

horend bij die spreker.