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International Research Project on Financing Quality in Healthcare InterQuality

International Research Project on Financing Quality in Healthcare InterQuality. Prof. dr hab. Tomasz Hermanowski Medical University of Warsaw. Incentives Effect in Complex Social Systems.

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International Research Project on Financing Quality in Healthcare InterQuality

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  1. International Research Project on Financing Quality in HealthcareInterQuality Prof. dr hab. Tomasz Hermanowski Medical University of Warsaw

  2. Incentives Effect in Complex Social Systems • There are two fundamentally different ways of thinking about complex social systems: the economic approach and the engineering approach • The social engineer sees society as disorganized, unplanned and inefficient. He wants experts to study the problem, discover what should be produced and plan how to do it

  3. Incentives Effect in Complex Social Systems • Social engineers believe that a plan devised by people at the top can work, even though everyone at the bottom has a self interest in defeating it • Implicitly, they assume that incentives don’t matter. Or, if they do matter, they don’t matter very much

  4. Incentives Effect in Complex Social Systems • To the economist, by contrast, incentives are everything • To have the best chance of good social outcomes, people at the bottom must find that when they pursue their own interests they are meeting the needs of others • Perverse incentives almost always lead to perverse outcomes

  5. Incentives Effect in Complex Social Systems • In the 20th century, country after country tried to impose an engineering model on society as a whole. Most of those experiments have thankfully come to a close • Yet there are two fields that are still completely dominated by people who steadfastly resist the economic way of thinking. They are health care and education

  6. Incentives Effect in Complex Social Systems • Healthcare can be described as a sea of mediocrity, punctuated by islands of excellence • The islands of excelence always spring from the bottom up, never from the top down; they are the result of enthusiasm, leadership and entrepreneurial skills of a small number of people; and they are almost always penalized by the payment system John Goodman

  7. Scope of InterQuality Research Project • to investigate the effects of different financing models and incentives on the quality, effectiveness and equity of acess to: • Outpatient care • Hospital care • Pharmaceutical care • To establish the feasibility of collaborative practice models, involving physicians, hospitals and pharmacy-service providers in the context of implementing integrated care and innovative P4P financig models

  8. WP1 Incentives WP2 Value/benefits WP4 Hospital Care WP5 Outpatient, Home Care WP6 Integrated Care WP3 Pharmaceutical Care WP 7 Dissemination WP8,9 Scientific Coordination, Management

  9. WP1 – 2; Incentives, Values/Benefits • The first two work packages will provide detailed theoretical background • WP 1 will discuss into the effects of financial and non-financial incentives of reimbursement systems based on the neoclassical economics principal agent theory • WP 2 will assess the benefits of reimbursement incentives in the light of their effects on the quality of care

  10. WP 3 – 6; Empirical Experiences • The results of these theoretical considerations will flow into Work Packages 3-6. Based on the findings from the theoretical considerations, concrete projects from different sectors of different countries will be assessed and lessons to learn elaborated • These work packages are formulated to provide results on empirical experiences with incentives programs in pharmaceutical care, the hospital sector, the outpatient/home care sector and within integrated care

  11. Methods • New Institutional Economics (Olivier Williamson, Nobel prize 2009) • Agency (Principal-Agent) Theory • Transaction costs analysis • Use of Patient Reported Oucomes data to assess healthcare quality and efficiency: • English NHS PROMs programme, • Reimbursement for providers linked to PROMs performance, via local incentive contracts (‘CQUIN’ payments) • If the purpose of a health system is to improve health, not just to produce healthcare services- than PROMs are essential!

  12. The Consortium • Medical University of Warsaw (WUM) – project coordinator • Hannover Medical School (MHH) • Università degli Studi di Catania (UniCT) • University of Southern Denmark (SDU)

  13. The Consortium • Urban Institute Washington (UI) • Sopharm Warsaw (SPH) • Standing Committee of European Doctors (CPME) • European Patients Forum (EPF)

  14. Time-frame and Budget • June 2009 – call for proposals • November 2009 – submission deadline • March 2010 – evalution by EU experts • June- October 2010 – contract negotiations • December 2010 – project beginning, • January 2011 - kick-of meeting • December 2013 – project termination • Total budget- 3 766 972,80 €

  15. Credits • Excellent Consortium Partners • Dedicated Project Team • Support by MUW Rector , prof. Marek Krawczyk, Deputy Rector, prof. Sławomir Majewski and Chancellor, Mrs. Małgorzata Kozłowska • Advice from National Contact Point experts • Proposal development subsidy granted by the Ministry of Science and Higer Education

  16. Thank you for your attention! Tomasz.hermanowski@wum.edu.pl

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