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Better Ways to Pay for Health Care

image of Better Ways to Pay for Health Care

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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Assessment and recommendations

Most often, health care providers are paid in the same way they always have been, using the traditional, dominant payment methods common across OECD health systems. Yet, these ways of paying providers – through fee-for-service (FFS), capitation, salary, global budget or more recently diagnosis-related groups (DRG) – are often poorly aligned with contemporary health system priorities. Rather than giving incentives to providers to improve quality, or deliver care more efficiently, “traditional” payment methods come with built-in incentives leading to undesirable behaviours, for instance over-provision of services or inattention to clinical need.

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