TY - JOUR
T1 - Balancing financial incentives during COVID-19
T2 - A comparison of provider payment adjustments across 20 countries
AU - Waitzberg, Ruth
AU - Gerkens, Sophie
AU - Dimova, Antoniya
AU - Bryndová, Lucie
AU - Vrangbæk, Karsten
AU - Jervelund, Signe Smith
AU - Birk, Hans Okkels
AU - Rajan, Selina
AU - Habicht, Triin
AU - Tynkkynen, Liina Kaisa
AU - Keskimäki, Ilmo
AU - Or, Zeynep
AU - Gandré, Coralie
AU - Winkelmann, Juliane
AU - Ricciardi, Walter
AU - de Belvis, Antonio Giulio
AU - Poscia, Andrea
AU - Morsella, Alisha
AU - Slapšinskaitė, Agnė
AU - Miščikienė, Laura
AU - Kroneman, Madelon
AU - de Jong, Judith
AU - Tambor, Marzena
AU - Sowada, Christoph
AU - Scintee, Silvia Gabriela
AU - Vladescu, Cristian
AU - Albreht, Tit
AU - Bernal-Delgado, Enrique
AU - Angulo-Pueyo, Ester
AU - Estupiñán-Romero, Francisco
AU - Janlöv, Nils
AU - Mantwill, Sarah
AU - Van Ginneken, Ewout
AU - Quentin, Wilm
N1 - Funding Information:
The manuscript benefitted from comments received at the HSRM webinar on November, 10, 2020. We thank Nadav Ben Yossef from the Israeli Ministry of Health for the data about Israel, Christoph Reichebner and Nathan Shuftan for their contribution to HSRM German country-page.
Publisher Copyright:
© 2021
PY - 2021/10/6
Y1 - 2021/10/6
N2 - Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.
AB - Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.
KW - Compensations
KW - COVID-19
KW - Economic incentives
KW - Payment mechanisms
U2 - 10.1016/j.healthpol.2021.09.015
DO - 10.1016/j.healthpol.2021.09.015
M3 - Article
AN - SCOPUS:85117955833
JO - HEALTH POLICY
JF - HEALTH POLICY
SN - 0168-8510
ER -