AN OVERVIEW OF PAYMENT SYSTEMS IN OECD · PDF fileAN OVERVIEW OF PAYMENT SYSTEMS IN OECD COUNTRIES USING THE OECD HEALTH SYSTEM CHARACTERISTICS SURVEY Expert Group Meeting on Payment

AN OVERVIEW OF PAYMENT

SYSTEMS IN OECD

COUNTRIES USING THE OECD HEALTH SYSTEM

CHARACTERISTICS SURVEY

Expert Group Meeting on Payment Systems, 7th – 8th April 2014

Health System Characteristics Survey

2012

• HSC survey complements existing OECD data questionnaires with detailed information on the institutional features of health systems: – (i) Governance

– (ii) Organisation and delivery

– (iii) Financing

• First wave of HSC survey carried in 2008-09

• 2008-09 survey results released in OECD Health Working Paper No 50.

Health System Characteristics Survey

2012

• Second HSC survey carried out in 2012-13, following the same structure but with some updates:

– Updating 2008 information where necessary

– Enhanced information on key areas: health financing and health coverage, health care delivery (providers’ payment and regulation of prices and supply)

– Included questions for specific OECD projects (including on workforce and primary care)

• Surveys sent out second half of 2012 – almost 100% response rate!

• For the ‘Organisation Section’ of the survey, which this background paper used, all but one country submitted a response

USING THE HSC SURVEY DATA TO LOOK AT

PROVIDER PAYMENT

Using the HSC Survey responses

• Background paper provides an overview of the predominant modes of payment of health care services in OECD member countries (DELSAHEA(2014)2)

• Based on data collected through the 2012 wave of the OECD Health Systems Characteristics (HSC) Survey

• Paper covers 14 questions related to paying providers

• An in-depth phase of validation and completion of missing data took place at the end of 2013 and beginning of 2014

Using the HSC Survey responses

BACKGROUND PAPER: AN OVERVIEW OF PAYMENT

SYSTEMS IN OECD COUNTRIES

• High level of heterogeneity

• Delivery is predominantly in the private setting either in solo or group practices

• Main modes of provider payment are FFS or capitation which may include additional components such as P4P

• FFS is the main mode of physician payment in private practices while salary is the main payment in public clinics

Overview of payment systems in OECD

countries: Primary care

Overview of payment systems in OECD

countries: Outpatient specialist care

• More similarity across countries in delivery modes and payment

• Delivery is mainly carried out in outpatient departments of public hospitals where reimbursement is typically FFS

• Many countries also include other components such as global budget and P4P

Overview of payment systems in OECD

countries: Inpatient acute care

• Payment of inpatient acute care is either DRG or global budget

• DRG payment is most common in social health insurance (SHI)-based systems

• Global budget is mainly used in general taxation (NHS)-based systems

• Salary is the main payment model for inpatient specialists.

• For FFS prices are typically set through negotiation

• Global budget in all settings is typically set by key purchasers (central or local level) rather than negotiated.

Overview of payment systems in OECD

countries: Reimbursement setting

Overview of payment systems in OECD

countries: P4P

• Most common in primary care (14 countries)

• Focus is on prevention (primary care), management of chronic disease (primary care and outpatient specialist) and improvement of patient experience (inpatient acute care)

• Participation of providers in P4P schemes can be voluntary or mandatory

• In most countries of the share of total reimbursement represented by P4P was below 10%

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