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How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: a discrete choice experiment.

Kessels R, Van Herck P, Dancet E, Annemans L, Sermeus W - BMC Health Serv Res (2015)

Bottom Line: Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe.Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders favor in some health systems, but not in others.C90, C99, E61, I11, I18, O57.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Applied Economics, Department of Economics & StatUa Center for Statistics, University of Antwerp, Prinsstraat 13, B-2000, Antwerpen, Belgium. roselinde.kessels@uantwerpen.be.

ABSTRACT

Background: Many developed countries are reforming healthcare payment systems in order to limit costs and improve clinical outcomes. Knowledge on how different groups of professional stakeholders trade off the merits and downsides of healthcare payment systems is limited.

Methods: Using a discrete choice experiment we asked a sample of physicians, policy makers, healthcare executives and researchers from Canada, Europe, Oceania, and the United States to choose between profiles of hypothetical outcomes on eleven healthcare performance objectives which may arise from a healthcare payment system reform. We used a Bayesian D-optimal design with partial profiles, which enables studying a large number of attributes, i.e. the eleven performance objectives, in the experiment.

Results: Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe. Finally, (c) such payment reform more closely aligns the overall fulfillment of objectives between stakeholders such as physicians versus healthcare executives.

Conclusions: Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders favor in some health systems, but not in others. Future studies, including the use of random samples, should examine the contextual factors that explain such differences in values and buy-in.

Jel classification: C90, C99, E61, I11, I18, O57.

No MeSH data available.


Marginal utility values (main effects) of the positive, negative and status quo outcomes related to the eleven healthcare performance objectives.
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Fig3: Marginal utility values (main effects) of the positive, negative and status quo outcomes related to the eleven healthcare performance objectives.

Mentions: Figure 3 shows the marginal utility values attached to the positive, negative and status quo outcomes in each performance domain. These marginal utility values are significant main effects (p < 0.0001) expressed relatively to the golden standard of no harm to effectiveness, the main effect of which is set to -1. The values do not fully align with the importance ranking of the performance domains shown in Figure 2, which is due to the presence of a number of significant interaction effects. Especially for the less important domains (such as ‘timeliness’ and ‘care equity’), interactions co-determine the impact on total utility (see Impact of stakeholder role and Impact of geographical area).Figure 3


How to reform western care payment systems according to physicians, policy makers, healthcare executives and researchers: a discrete choice experiment.

Kessels R, Van Herck P, Dancet E, Annemans L, Sermeus W - BMC Health Serv Res (2015)

Marginal utility values (main effects) of the positive, negative and status quo outcomes related to the eleven healthcare performance objectives.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4465730&req=5

Fig3: Marginal utility values (main effects) of the positive, negative and status quo outcomes related to the eleven healthcare performance objectives.
Mentions: Figure 3 shows the marginal utility values attached to the positive, negative and status quo outcomes in each performance domain. These marginal utility values are significant main effects (p < 0.0001) expressed relatively to the golden standard of no harm to effectiveness, the main effect of which is set to -1. The values do not fully align with the importance ranking of the performance domains shown in Figure 2, which is due to the presence of a number of significant interaction effects. Especially for the less important domains (such as ‘timeliness’ and ‘care equity’), interactions co-determine the impact on total utility (see Impact of stakeholder role and Impact of geographical area).Figure 3

Bottom Line: Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe.Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders favor in some health systems, but not in others.C90, C99, E61, I11, I18, O57.

View Article: PubMed Central - PubMed

Affiliation: Faculty of Applied Economics, Department of Economics & StatUa Center for Statistics, University of Antwerp, Prinsstraat 13, B-2000, Antwerpen, Belgium. roselinde.kessels@uantwerpen.be.

ABSTRACT

Background: Many developed countries are reforming healthcare payment systems in order to limit costs and improve clinical outcomes. Knowledge on how different groups of professional stakeholders trade off the merits and downsides of healthcare payment systems is limited.

Methods: Using a discrete choice experiment we asked a sample of physicians, policy makers, healthcare executives and researchers from Canada, Europe, Oceania, and the United States to choose between profiles of hypothetical outcomes on eleven healthcare performance objectives which may arise from a healthcare payment system reform. We used a Bayesian D-optimal design with partial profiles, which enables studying a large number of attributes, i.e. the eleven performance objectives, in the experiment.

Results: Our findings suggest that (a) moving from current payment systems to a value-based system is supported by physicians, despite an income trade-off, if effectiveness and long term cost containment improve. (b) Physicians would gain in terms of overall objective fulfillment in Eastern Europe and the US, but not in Canada, Oceania and Western Europe. Finally, (c) such payment reform more closely aligns the overall fulfillment of objectives between stakeholders such as physicians versus healthcare executives.

Conclusions: Although the findings should be interpreted with caution due to the potential selection effects of participants, it seems that the value driven nature of newly proposed and/or introduced care payment reforms is more closely aligned with what stakeholders favor in some health systems, but not in others. Future studies, including the use of random samples, should examine the contextual factors that explain such differences in values and buy-in.

Jel classification: C90, C99, E61, I11, I18, O57.

No MeSH data available.