Better Ways to Pay for Health Care
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Payers for health care are pursuing a variety of policies as part of broader efforts to improve the quality and efficiency of care. Payment reform is but one policy tool to improve health system performance that requires supportive measures in place such as policies with well-developed stakeholder involvement, information on quality, clear criteria for tariff setting, and embedding evaluation as part of the policy process. Countries should not, however, underestimate the significant data challenges when looking at price setting processes. Data access and ways to overcome its fragmentation require well-developed infrastructures. Policy efforts highlight a trend towards aligning payer and provider incentives by using evidence-based clinical guidelines and outcomes to inform price setting. There are signs of increasing policy focus on outcomes to inform price setting. These efforts could bring about system-wide effects of using evidence along with a patient-centred focus to improve health care delivery and performance in the long-run.
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Population-based health care provider payments
This chapter discusses population-based payment to pay groups of health providers – referred to as Accountable Care Organisations (ACOs) in the United States and elsewhere. ACOs are financially accountable for the provision of all or the vast majority of health care services to a defined population. They are permitted to keep part of the savings they generate provided they meet specific quality criteria.
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