Two-thirds of health leaders, including government and private payers from 20 different countries, see problems with their current payment system, and they are exploring new payment models that use incentives to better balance access, quality, efficiency, and demand, according to a report published June 23 by PricewaterhouseCoopers’ Health Research Institute. The report, entitled You Get What You Pay For: A Global Look at Balancing Demand, Quality and Efficiency in Healthcare Payment Reform, provides a comprehensive overview of how payment models are changing in different countries, lessons learned from the experiences of other health systems, and findings of a survey of 200 health industry executives including government payers, private payers, hospital executives, and physicians.
Among other findings in the report, case-based prospective payment that groups reimbursement rates into diagnosis-related groups is the emerging standard for hospital payment, having proven to improve efficiencies. This type of hospital reimbursement already has been adopted by 70 percent of countries within the Organisation for Economic Cooperation and Development. Also, reimbursement to general practitioners and primary care physicians is far more varied among different countries and regions than reimbursement to hospitals. Models that integrate hospital and physician payment have proven best at creating mutually aligned incentives. Download the report.
