Abstract
The effectiveness in population health management relies on employing multiple strategies in the improvement of the delivery system, particularly in the implementation of integrated care and continuity of care to avoid any drawbacks or ill side effects. Every nation has to refine outcome-based measurements and payment schemes to develop innovative and equitable rewards for key players or stakeholders in the health-care delivery system, to incentivize patients who are in tune to lifestyle changes (e.g., cessation of smoking, prevention and treatment of substance abuses, encouragement of patient participation in nutritional and dietary changes), and to facilitate patient engagement in the self-care practice of chronic disease management and prevention. This chapter offers an international perspective to examination of the prospective payment system, pay-for-performance evaluation, and value-based payment system.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Altman, S. H. (2012). The lessons of Medicare’s prospective payment system show that the bundled payment program faces challenges. Health Affairs, 31(9), 1923–1930. https://doi.org/10.1377/hlthaff.2012.0323.
Anell, A. (2005). Swedish healthcare under pressure. Health Economics, 14(S1), S237–S254.
Barros, P. P., Machado, S. R., & Simões, A. S. (2011). Portugal. Health system review. Health Systems in Transition, 12(4), 1–156. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0019/150463/e95712.pdf.
Beaulieu, N. D., & Horrigan, D. R. (2005). Putting smart money to work for quality improvement. Health Services Research, 40, 1318–1334. https://doi.org/10.1111/j.1475-6773.2005.00414.x.
Bodenheimer, T., Chen, E., & Bennett, H. D. (2009). Confronting the growing burden of chronic disease: Can the U.S. health care workforce do the job? Health Affairs, 28(1), 64–74. https://doi.org/10.1377/hlthaff.28.1.64.
Borden, J. P. (1988). An assessment of the impact of diagnosis-related group (DRG)-based reimbursement on the technical efficiency of New Jersey hospitals using data envelopment analysis. Journal of Accounting and Public Policy, 7(2), 77–96. https://doi.org/10.1016/0278-4254(88)90012-9.
Busse, R., Geissler, A., Quentin, W., & Wiley, M. (Eds.). (2011). Diagnosis-related groups in Europe. Berkshire: McGraw Hill.
Cacace, M., & Schmid, A. (2009). The role of diagnosis related groups (DRGs) in healthcare system convergence. BMC Health Services Research, 9(Suppl 1), A5. https://doi.org/10.1186/1472-6963-9-S1-A5.
Cashin, C. (2011). United Kingdom: Quality and Outcomes Framework (QOF). Washington, DC: The World Bank.
Cashin, C., Chi, Y., Smith, P., Borowitz, M., & Thomson, S. (Eds.). (2014). Paying for performance in health care: Implications for health system performance and accountability. Berkshire: Open University Press.
Centers for Medicare & Medicaid Services. (2015). Fact sheet: Computation of the 2016 value modifier. Retrieved from https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/PhysicianFeedbackProgram/Downloads/2016-VM-Fact-Sheet.pdf.
Centers for Medicare & Medicaid Services. (2016a). Physician quality reporting system. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS
Centers for Medicare & Medicaid Services. (2016b). Readmissions reduction program. Retrieved from https://www.cms.gov/medicare/medicare-fee-for-service-payment/acuteinpatientpps/readmissions-reduction-program.html
Centers for Medicare & Medicaid Services. (n.d.). The hospital value-based purchasing (HVBP) program. Retrieved from https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/HVBP/Hospital-Value-Based-Purchasing.html.
Chang, R., Lin, S., & Aron, D. C. (2012). A pay-for-performance program in Taiwan improved care for some diabetes patients, but doctors may have excluded sicker ones. Health Affairs, 31(1), 93–102. https://doi.org/10.1377/hlthaff.2010.0402.
Chen, T., & Chung, K. (2010). The unintended consequence of diabetes mellitus pay-for performance (P4P) program in Taiwan: Are patients with more comorbidities or more severe conditions likely to be excluded from the P4P program? Health Services Research, 46(1), 46–60. https://doi.org/10.1111/j.1475-6773.2010.01182.x.
Cheng, S., Lee, T., & Chen, C. (2012). A longitudinal examination of a pay-for-performance program for diabetes care: Evidence from a natural experiment. Medical Care, 50(2), 109–116. https://doi.org/10.1097/MLR.0b013e31822d5d36.
Chern, J. Y., & Wan, T. T. (2000). The impact of the prospective payment system on the technical efficiency of hospitals. Journal of Medical Systems, 24(3), 159–172. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10984870.
Chipman, A. (2015). Value-based health care in Portugal: Necessity of the mother of invention. The Economist Intelligence Unit Report.
Chiu, H. C., Hsieh, H. M., Lin, Y. C., Kuo, S. J., Kao, H. Y., Yeh, S. C. J., … Wang, C. F. (2016). Patient assessment of diabetes care in a pay-for-performance program. International Journal for Quality in Health Care, 28(2), 183–190 doi: https://doi.org/10.1093/intqhc/mzv120.
Chiu, H.C., Lin, Y.C., Hsieh, H.M., Chen, H.P., Wang, H.L., Wang, J.Y. (2017).The impact of complications on prolonged length of hospital stay after resection in colorectal cancer: A retrospective study of Taiwanese patients. The Journal of International Medical Research. 300060516684087. PMID 28173723 doi: https://doi.org/10.1177/0300060516684087.
Cohen, S. & Meyers, D. (2012). Trends in health care costs and the concentration of medical expenditures. A powerpoint presentation to the National Advisory Council. Agency for Healthcare Research and Quality.
Damberg, C. L., Shortell, S. M., Raube, K., Gillies, R. R., Rittenhouse, D., McCurdy, R. K., … Adams, J. (2010). Relationship between quality improvement processes and clinical performance. American Journal of Managed Care, 16(8), 601-606. Retrieved from http://www.ajmc.com/journals/issue/2010/2010-08-vol16-n08/AJMC_10aug_Damberg_601to606.
de Bruin, S. R., Baan, C. A., & Struijs, J. N. (2011). Pay-for-performance in disease management: A systematic review of the literature. MC. Health Services Research, 11(272), 36. https://doi.org/10.1186/1472-6963-11-272.
Doran, T., Fullwood, C., Gravelle, H., Reeves, D., Kontopantellis, E., Hiroeh, U., & Roland, M. (2006). Pay-for-performance programs in family practices in the United Kingdom. The New England Journal of Medicine, 355, 375–384. https://doi.org/10.1056/NEJMsa055505.
Eijkenaar, F. (2012). Pay for performance in health care: An international overview of initiatives. Medical Care Research and Review, 69(3), 251–276. https://doi.org/10.1177/1077558711432891.
Ellis, R. P. (2001). Hospital payment in the United States: An overview and discussion of current policy issues. Paper presented at Colloque International La tarification à la pathologie: les leçons de l’expérience étrangère, Paris, France. Retrieved from http://people.bu.edu/ellisrp/EllisPapers/2001_Ellis_HospPayment_English.pdf.
EuroDRG. (2013, October 28). Retrieved June 09, 2017, from http://eurodrg.projects.tu-berlin.de/wiki/doku.php.
Fialho, A. S., Oliveira, M. D., & Sá, A. B. (2011). Using discrete event simulation to compare the performance of family health unit and primary health care centre organizational models in Portugal. BMC Health Services Research, 11, 274. https://doi.org/10.1186/1472-6963-11-274.
Forgione, D. A., & D'annunzio, C. M. (1999). The use of DRGs in health care payment systems around the world. Journal of Health Care Finance, 26(2), 66.
Gillam, S. J., Siriwardena, A. N., & Steel, N. (2012). Pay-for-performance in the United Kingdom: Impact of the quality and outcomes framework – A systematic review. Annals of Family Medicine, 10(5), 461–468. https://doi.org/10.1370/afm.1377.
Griffiths, R., & Hindle, D. (1999). The effectiveness of AN-DRGs in classification of acute admitted patients with diabetes. Health Information Management, 29(2), 77–83. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/10977181.
Guterman, S., Eggers, P. W., Riley, G., Greene, T. F., & Terrell, S. A. (1988). The first 3 years of Medicare prospective payment: An overview. Health Care Financing Review, 9, 67–77. Retrieved from https://www.cms.gov/Research-Statistics-Data-and-Systems/Research/HealthCareFinancingReview/Downloads/CMS1192039dl.pdf.
Healthcare Intelligence Network. (2016). Social determinants and population health: Moving beyond clinical data in a value-based healthcare system [Press release]. Retrieved from http://www.pr.com/press-release/696363.
Hsieh, H. M., Tsai, S. L., Mau, L. W., & Chiu, H. C. (2015a). Effects of changes in diabetes pay-for performance incentive designs on patient risk selection. Health Services Research, 51(2), 667–686. https://doi.org/10.1111/1475-6773.1233.
Hsieh, H. M., Gu, S. M., Shin, S. J., Kao, H. Y., Lin, Y. C., & Chen, H. C. (2015b). Cost-effectiveness of a diabetes pay-for-performance program in diabetes patients with multiple chronic conditions. PloS One, 10(7), 0133163. https://doi.org/10.1371/journal.pone.0133163.
Hsieh, H. M., Shin, S. J., Tsai, S. L., & Chiu, H. C. (2016a). Effectiveness of pay-for-performance incentive designs on diabetes care. Medical Care, 54(12), 1063–1069.
Hsieh, H. M., Lin, T. H., Lee, I. C., Huang, C. J., Shin, S. J., & Chiu, H. C. (2016b). The association between participation in a pay-for-performance program and macrovascular complications in patients with type 2 diabetes in Taiwan: A nationwide population-based cohort study. Preventive Medicine, 85, 53–59. https://doi.org/10.1016/.ypmed.2015.
Hsieh, H. M., Chiu, H. C., Lin, Y. T., & Shin, S. J. (2017). A diabetes pay-for-performance program and the competing causes of death among cancer survivors with type 2 diabetes in Taiwan. International Journal for Quality in Health Care, 1–9. PMID 28531317 doi: https://doi.org/10.1093/intqhc/mzx057.
Huang, Y. C., Lee, M. C., Chou, Y. L., & Huang, N. (2016). Disease-specific pay-for-performance programs: Do the P4P effects differ between diabetic patients with and without multiple chronic conditions? Medical Care, 54(11), 977–983.
Johnson, J. A., & Stoskopf, C. H. (2010). Comparative health systems: Global perspectives. Sudbury: Jones and Bartlett Publishers.
Kastberg, G., & Siverbo, S. (2007). Activity-based financing of health care––Experiences from Sweden. The International Journal of Health Planning and Management, 22(1), 25–44.
Knickman, J. R., & Kovner, A. R. (2015). Health care delivery in the United States (11th ed.). New York: Springer Publishing Company.
L’Assurance Maladie. (2016). La remuneration sur objectifs de Sante Publique: Une amelioration continue en faveur la qualite et de la pertience des soins (Report). Retrieved from http://www.fmfpro.org/IMG/point-hebdo/Bilan%20ROSP_2015-160415_vdef.pdf
Lee, T. T., Cheng, S. H., Chen, C. C., & Lai, M. S. (2010). A pay-for-performance program for diabetes care in Taiwan: A preliminary assessment. The American Journal of Managed Care, 16(1), 65–69. Retrieved from http://www.ajmc.com/journals/issue/2010/2010-01-vol16-n01/AJMC_2010Jan_Lee_p65to69.
McAlearney, A. S. (2003). Population health management. Chicago: Health Administration Press.
Mendelson, A., Kondo, K., Damberg, C., Low, A., Makalapua, M, Freeman, M., … Kandagara, D. (2017). The effects of pay-for-performance programs on health, health care use, and processes of care: A systematic review. Annals of Internal Medicine [Epub ahead of print 10 January 2017]. doi: https://doi.org/10.7326/M16-1881.
Moreno-Serra, R., & Wagstaff, A. (2010). System-wide impacts of hospital payment reforms: Evidence from Central and Eastern Europe and Central Asia. Journal of Health Economics, 29(4), 585–602.
NHS Employers. (2016a). 2016/17 General medical services (GMS) contract quality and outcomes framework (QOF): Guidance for GMS contract 2016/17. Retrieved from http://www.nhsemployers.org/~/media/Employers/Documents/Primary%20care%20contracts/QOF/2016-17/2016-17%20QOF%20guidance%20documents.pdf.
NHS Employers. (2016b). Changes to QOF 2015/16. Retrieved from http://www.nhsemployers.org/changestoQOF201516
Pomp, M. (2010). Pay for performance and health outcomes: A next step in Dutch health care reform. A report to the Netherlands’ Council for Public Health and Health Care.
Pordata. (2016a). Despesas do Estado em saúde: Execução orçamental [data file]. Retrieved from http://www.pordata.pt/Portugal/Despesas+do+Estado+em+saúde+execução+orçamental-854
Pordata. (2016b). Despesas do Estado em saúde: Execução orçamental em % do PIB [data file]. Retrieved from http://www.pordata.pt/Portugal/Despesas+do+Estado+em+saúde+execução+orçamental+em+percentagem+do+PIB-855
Pordata. (2016c). Despesas do Estado em saúde: Execução orçamental per capita [data file]. Retrieved from http://www.pordata.pt/Portugal/Despesas+do+Estado+em+saúde+execução+orçamental+per+capita-856
Prazeres, F., & Santiago, L. (2015). Prevalence of multimorbidity in the adult population attending primary care in Portugal: A cross-sectional study. BMJ Open, 5(9), e009287. https://doi.org/10.1136/bmjopen-2015-009287.
Prazeres, F., & Santiago, L. (2016). Relationship between health-related quality of life, perceived family support and unmet health needs in adult patients with multimorbidity attending primary care in Portugal: A multicentre cross-sectional study. Health and Quality of Life Outcomes, 2016(14), 156. https://doi.org/10.1186/s12955-016-0559-7.
Rice, T. H. (1996). Changing the U.S. health care system. San Francisco: Jossey-Bass Publishers.
Saint-Lary, O., Bernard, E., Sicsic, J., Plu, I., François-Purssell, I., & Franc, C. (2013). Why did most French GPs choose not to join the voluntary national pay-for-performance program? PloS One, 8(9), e72684. https://doi.org/10.1371/journal.pone.0072684.
Squires, D., & Anderson, C. (2015). Health care from a global perspective: Spending, use of services, prices, and health in 13 countries. The Commonwealth Fund. Retrieved from http://www.commonwealthfund.org/publications/issue-briefs/2015/oct/us-health-care-from-a-global-perspective.
Struijs. (2015, October). How bundled health care payments are working in the Netherlands. Harvard Business Review. Retrieved from https://hbr.org/2015/10/how-bundled-health-care-payments-are-working-in-the-netherlands
Struijs, J. N., & Baan, C. A. (2011). Integrating care through bundled payments – Lessons from the Netherlands. The New England Journal of Medicine, 364, 990–991. https://doi.org/10.1056/NEJMp1011849.
Struijs, J. N., de Jon-van Til, J. T., Lemmens, L. C., Drewes, H. W., de Bruin, S. R., & Baan, C. A. (2012). Three years of bundled payment for diabetes care in the Netherlands: Impact on health care delivery process and the quality of care. Bilthoven: National Institute for Public Health and the Environment.
Sturgeon, J. (2009). DRGs: Still frustrating after all these years. For The Record, 21(11), 14. Retrieved from http://www.fortherecordmag.com/archives/052509p14.shtml.
Tsiachristas, A., Dikkers, C., Boland, M. R. S., & Rutten-van Mölken, M. P. (2012). PHP78 System-wide impact of payment schemes for integrated care of chronic diseases in Europe: Evidence from an empirical analysis. Value in Health, 15(7), A302–A302. Retrieved from https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1098301512023339?returnurl=null&referrer=null.
U.S. Department of Health and Human Services. (2015). Hospital value-based purchasing (ICN 907664). Retrieved from https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/Hospital_VBPurchasing_Fact_Sheet_ICN907664.pdf
Walker, S., Mason, A. R., Claxton, K., Cokson, R., Fenwick, E., Fleetcroft, R., & Scupher, M. (2010). Value for money and the quality and outcomes framework in primary care in the UK NHS. The British Journal of General Practice, 60(574), e213–e220. https://doi.org/10.3399/bjgp10X501859.
Wan, T. T. H. (1995). Analysis and evaluation of health care systems: An integrated approach to managerial decision making. Baltimore: Health Professions Press.
World Health Organization. (2005). Preventing chronic diseases: A vital investment (WHO global report). Retrieved from http://apps.who.int/iris/bitstream/10665/43314/1/9241563001_eng.pdf
Author information
Authors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG
About this chapter
Cite this chapter
Wan, T.T.H. (2018). Cost-Containment Strategies for Population Health Management and How They Relate to Poly Chronic Conditions. In: Population Health Management for Poly Chronic Conditions. Springer, Cham. https://doi.org/10.1007/978-3-319-68056-9_2
Download citation
DOI: https://doi.org/10.1007/978-3-319-68056-9_2
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-68055-2
Online ISBN: 978-3-319-68056-9
eBook Packages: Business and ManagementBusiness and Management (R0)