Design and effects of outcome-based payment models in healthcare: a systematic review

F. P. Vlaanderen (), M. A. Tanke, B. R. Bloem, M. J. Faber, F. Eijkenaar, F. T. Schut and P. P. T. Jeurissen
Additional contact information
F. P. Vlaanderen: Radboudumc
M. A. Tanke: Radboudumc
B. R. Bloem: Radboudumc
M. J. Faber: Radboudumc
F. Eijkenaar: Radboudumc
F. T. Schut: Radboudumc
P. P. T. Jeurissen: Radboudumc

The European Journal of Health Economics, 2019, vol. 20, issue 2, No 5, 217-232

Abstract: Abstract Introduction Outcome-based payment models (OBPMs) might solve the shortcomings of fee-for-service or diagnostic-related group (DRG) models using financial incentives based on outcome indicators of the provided care. This review provides an analysis of the characteristics and effectiveness of OBPMs, to determine which models lead to favourable effects. Methods We first developed a definition for OBPMs. Next, we searched four data sources to identify the models: (1) scientific literature databases; (2) websites of relevant governmental and scientific agencies; (3) the reference lists of included articles; (4) experts in the field. We only selected studies that examined the impact of the payment model on quality and/or costs. A narrative evidence synthesis was used to link specific design features to effects on quality of care or healthcare costs. Results We included 88 articles, describing 12 OBPMs. We identified two groups of models based on differences in design features: narrow OBPMs (financial incentives based on quality indicators) and broad OBPMs (combination of global budgets, risk sharing, and financial incentives based on quality indicators). Most (5 out of 9) of the narrow OBPMs showed positive effects on quality; the others had mixed (2) or negative (2) effects. The effects of narrow OBPMs on healthcare utilization or costs, however, were unfavourable (3) or unknown (6). All broad OBPMs (3) showed positive effects on quality of care, while reducing healthcare cost growth. Discussion Although strong empirical evidence on the effects of OBPMs on healthcare quality, utilization, and costs is limited, our findings suggest that broad OBPMs may be preferred over narrow OBPMs.

Keywords: Outcome-based payment models; Health reform; Payment models in healthcare; Health outcomes; Healthcare costs; Quality of care; I180 (search for similar items in EconPapers)
Date: 2019
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Citations: View citations in EconPapers (8)

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DOI: 10.1007/s10198-018-0989-8

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