Paying the hospitals by performance and the health care insurance systems :an incentive to change

1
Paying the hospitals by performance and the
health care insurance systems an incentive to
change?
  JM Rodrigues University of Saint Etienne
France. rodrigues_at_univ-st-etienne.fr
2
Is there a gold standard for funding the
hospitals?

• 1 Introduction
• 2 The different health care systems fundings
• 3 How to pay the hospitals by performance
• 4 Conclusion

3
The specific or weared nature of the health care
system

• The nature of the good health care
• Good unclearhealth status/ health delivery
• Non-homogeneous
• Multiple explaining variable (In /Out)?
• Uncertainty
• Unpredictability of the disease
• Unpredictability of the production results
• Asymetric Informationtop role of physicians
• Imperfect Market
• barriers to entry, not for profit sector,
  interdependence between demand and supply

4
Implications for health policy

• Equality of access to health care
• Public funding and individual payment
• Health insurance (Risk)or Bismarckian
  insurance(Social)?
• Prices are not important at the moment of
  consumption
• Payment through fees, salary or capitation
• Intervention of the State

5
Is there a gold standard for funding the
hospitals?

• 1 Introduction
• 2 The different health care systems fundings
• 3 How to pay the hospitals by performance
• 4 Conclusion

6
CLASSIFYING THE HEALTHCARE SYSTEMS 1
- The health insurance system based on
contracting between partnershealth care
professionals, insurers-funding risk
management within market and a restricted role
for state government - The integrated healthcare
system associating the partners based under the
management of the state government to satisfy
health care needs to support the demand side of
the Keynes model
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CLASSIFYING THE HEALTHCARE SYSTEMS 2
- The health insurance system .1 compulsory
health insurance -social insurance -Bismarc
k system -Germany,Austria,France (1/2),Japan
,Belgium , The Netherlands and Switzerland .2
competing health insurance -USA
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CLASSIFYING THE HEALTHCARE SYSTEMS 3
- The integrated healthcare system -national
level NHS Beveridge -UK,Ireland,
-Portugal, -France (hospitals)? -Singa
pore
9
Health Care SystemsinEurope
10
Is there a gold standard for funding the
hospitals?

• 1 Introduction
• 2 The different health care systems funding
• 3 How to pay the hospitals by performance
• 4 Conclusion

11
Financing health care 2 ways

• Command and control
• The paying entity (State) decides on the level of
  financial resources, it regulates the behaviour
  of providers.
• Creating incentives
• The paying entity creates incentives for the
  providers in order that they behave in a socially
  acceptable way, through the imposition of a risk.

12
Sharing risks
13
The Odyssey of Case mix(over time and space)?

• 1 Transparency of the product of careYale
• 2 P.P.S U.S .A Medicare
• 3 Globalisation of the tool with localisation of
  the use Europe ,Australia,world
• 4 Localisation of the tool and of the use
• 5 Globalisation of the use with localisation of
  the tool?

14
The Odyssey of Case mix(over time and space)?

• 1 Transparency of the product of careYale
• 2 P.P.S U.S .A Medicare
• 3 Globalisation of the tool with localisation of
  the use Europe ,Australia,world
• 4 Localisation of the tool and of the use
• 5 Globalisation of the use with localisation of
  the tool?

15
The Odyssey of Case mix

• 2 Prospective Payment System US Federal
  Government Medicare (1983-
• 21 Prospective price setting
• 22 Transferring the risk from the payers to the
  hospitals (but without the physicians fees)?
• 23 efficiency by market competition

16
The Odyssey of Case mix(over time and space)?

• 1 Transparency of the product of careYale
• 2 P.P.S U.S .A Medicare
• 3 Globalisation of the tool with localisation of
  the use Europe ,Australia,world
• 4 Localisation of the tool and of the use
• 5 Globalisation of the use with localisation of
  the tool?

17
Patient Classification Systems/Europe PCS/E(PCS
int)?

• 5 continents 35 countries 2002

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Penetration of DRG/Casemix-Type Applications
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• Localisation of useshift to equity
• The most common use of DRG or Case mix outside
  the US until recently has been a pursuit of the
  global budgeting approach with the application of
  an adjustment based on the case mix of the
  hospital.
• To increase efficiency by benchmarking within
• a framework of cost control throughout
• the growth economic cycles.But as well equity
• To support health planning and strategic planning
• towards ambulatory care
• -To reduce inequities across supply
• -To facilitate health economics and
• epidemiology studies

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• Globalisation of use?
• In contradiction with the previous phase there
  is a recent trend in several countries
  (France,Germany,The Netherlands and UK)
• to announce and to start to implement quick and
  radical PPS to change the health care systems by
  creating market competition
• This new trend uses different and not very clear
  names as payment by results ,patient choice,
  payment by disease or by activity or by
  performance

21
THE FRENCH DRG/GHM USE 97-03 Equity more than
efficiency
22
THE FRENCH PPS USE 2004- Efficiency more than
equity
23
Is there a gold standard for funding the
hospitals?

• 1 Introduction
• 2 The different health care systems fundings
• 3 How to pay the hospitals by performance
• 4 Conclusion

24
Conclusion

• 1 The Case mix information tool to measure
  performance has moved from a common global DRG
  system to several local case mix systems in the
  different countries
• 2 The situation for utilisation is still
  challenged by localisation of the usage on one
  hand (different designs of the relative weight of
  equity and efficiency ) and global PPS use on the
  other ( distorted to the efficiency angle).
• 3 The migration of a technology innovation
  measuring hospital performance to different types
  of health care systems provides a zoom on how
  the socio-economic factors challenge the changes
  within the health care systems.

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END

• THANK YOU
• Vielen Dank für Ihre Aufmerksamkeit
• Merci
• Gracie
• Gracias
• Obrigado
• Efcharisto
• Kessenem
• Tag
• Arigato Gozaimasu
• Multimesc

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• PATIENT CLASSIFICATION SYSTEMS
• INTERNATIONAL
• and
• University of Saint Etienne
• Service de Santé Publique et d'Information
  Médicale
•  
• present
•  
• THE 2008 INTERNATIONAL
• CASEMIX SUMMER SCHOOL
•  
•  
• Avignon, France
• 9th 13th June 2008
•   
• www.pcsinternational.org
•