Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Pay for Performance: A Reflection on How a Global Perspective Could Enhance Policy and Research 365 369 3763 10.34172/ijhpm.2020.23 EN Laura Anselmi Health, Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Service Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK 0000-0002-2499-7656 Josephine Borghi Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-0482-5451 Garrett Wallace Brown School of Politics and International Studies (POLIS), University of Leeds, Leeds, UK 0000-0002-6557-5353 Eleonora Fichera Department of Economics, University of Bath, Bath, UK 0000-0002-4729-0338 Kara Hanson Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-9928-2823 Artwell Kadungure Training and Research Support Centre (TARSC), Harare, Zimbabwe Roxanne Kovacs Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0002-4631-3227 Søren Rud Kristensen Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, UK 0000-0002-6608-7132 Neha S. Singh Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK 0000-0003-0057-121X Matt Sutton Health, Organisation, Policy and Economics (HOPE), Centre for Primary Care and Health Service Research, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK 0000-0002-6635-2127 Journal Article 2019 11 15 Pay-for-performance (P4P) is the provision of financial incentives to healthcare providers based on pre-specified performance targets. P4P has been used as a policy tool to improve healthcare provision globally. However, researchers tend to cluster into those working on high or low- and middle-income countries (LMICs), with still limited knowledge exchange, potentially constraining opportunities for learning from across income settings. We reflect here on some commonalities and differences in the design of P4P schemes, research questions, methods and data across income settings. We highlight how a global perspective on knowledge synthesis could lead to innovations and further knowledge advancement.

https://www.ijhpm.com/article_3763_7ba6d33c373fea56b7258003b16c68e5.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Integrating the Population Perspective into Health System Performance Assessment (IPHA): Study Protocol for a Cross-Sectional Study in Germany Linking Survey and Claims Data of Statutorily and Privately Insured 370 379 3741 10.15171/ijhpm.2019.141 EN Miriam Blümel Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany 0000-0002-8452-4666 Julia Röttger Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany Julia Köppen Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany Katharina Achstetter Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany 0000-0002-1436-4345 Reinhard Busse Department of Health Care Management, Berlin Centre for Health Economics Research, Technische Universität Berlin, Berlin, Germany 0000-0003-4961-9130 Journal Article 2019 01 29 Background Health system performance assessment (HSPA) is a major tool for evidence-based governance in health systems and patient/population-orientation is increasingly considered as an important aspect. The IPHA study aims (1) to undertake a comprehensive performance assessment of the German health system from a population perspective based on the intermediate and final dimensions defined by the World Health Organization (WHO) and (2) to identify differences in HSPA between (a) common user characteristics and (b) user types, which differ in their interactions and patterns of action within the health system. Methods and Analysis A cross-sectional survey was conducted between October and December 2018 with statutorily and privately health insured to assess the German health system from a population perspective related to the past 12 months. The random sample consists of 32 000 persons insured by AOK Nordost and 20 000 persons insured by Debeka. Data from the survey will subsequently be linked with health insurance claims data at the individual level for each respondent who has given consent for data linkage. Claims data covers the time period January 1, 2017 to June 30, 2018. The combination of the 2 data sources allows to identify associations between insured patient characteristics and differences in the assessment of health system performance. The survey consists of 71 items measuring all final and intermediate health system goals defined by the WHO and user characteristics like health literacy, self-efficacy, the attention an individual pays to his or her health or disease, the personal network, autonomy, compliance and sociodemographics. The claims data contains information on morbidity, care delivery, service utilization, (co)payments and sociodemography. Discussion The study represents a promising attempt to perform a holistic HSPA using a population perspective. For this purpose, a questionnaire was designed that contains both validated and new items in order to collect data on all relevant health system dimensions. In particular, linking survey data on HSPA with claims data is of high potential for assessing and analysing determinants of health system performance from the population perspective.

https://www.ijhpm.com/article_3741_63ce12dcf1ede17589befd56bb5281a5.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Independent Treatment Centres Are Not a Guarantee for High Quality and Low Healthcare Prices in The Netherlands – A Study of 5 Elective Surgeries 380 389 3734 10.15171/ijhpm.2019.144 EN Anouk Dorine Maria Tulp IQ healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands 0000-0002-0443-8494 Florien Margareth Kruse IQ healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands 0000-0003-3850-9331 Niek Waltherus Stadhouders IQ healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands 0000-0002-7296-2335 Patrick P.T. Jeurissen IQ healthcare, Radboud University and Medical Center, Nijmegen, The Netherlands Ministry of Health, Welfare and Sport, The Hague, The Netherlands 0000-0002-4198-2448 Journal Article 2019 04 02 Background Independent treatment centres (ITCs) are a growing phenomenon in many healthcare systems. Focus factory theory predicts that ITCs provide high quality healthcare with low prices, through specialisation, high-volume and routine. This study examines if ITC care outperforms general hospital (GH) care within a regulated competition system in the Netherlands, by focusing on differences in healthcare quality and price. Methods The cross-sectional study combined publicly available quality data, list prices and insurer contracts for 2017. Clinical outcomes of 5 elective surgeries (total hip and knee replacement, anterior cruciate ligament (ACL), cataract and carpal tunnel surgeries) were compared using zero-or-one inflated beta-regressions, corrected for underlying structural factors (ie, volume of care, process and structure indicators, and chain affiliation). Furthermore, price differences between ITCs and GHs were examined using ordinary least squares regressions. Lastly, we analysed quality of care in relation to the number of insurance contracts of the 4 largest Dutch insurance companies using ordered logistic regressions. Results Quality differences between ITCs and GHs were found to be inconsistent across procedures. No facility type performed better overall. There were no differences exhibited in the list prices between ITCs and GHs. No consistent relationship was found between the underlying factors and quality or price, in different procedures and time. We found no indication for selective contracting based on quality within the ITC sector. Conclusions This study found no evidence that ITCs outperform GHs on quality or price. This evidence does not support the focus factory theory. The substantial practice variation in quality of care may justify more evidence-based contracting within the market for elective surgery

https://www.ijhpm.com/article_3734_9d752cb08ef466fc480fba981cfa44a1.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Around the Tables – Contextual Factors in Healthcare Coverage Decisions Across Western Europe 390 402 3739 10.15171/ijhpm.2019.145 EN Tineke Kleinhout-Vliek Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 0000-0002-2292-8737 Antoinette De Bont Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands 0000-0002-0745-4537 Meindert Boysen National Institute for Health and Care Excellence (NICE), London, UK Matthias Perleth Federal Joint Committee (Gemeinsamer Bundesausschuss), Berlin, Germany 0000-0001-5574-8356 Romke Van Der Veen Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands Jacqueline Zwaap National Health Care Institute (Zorginstituut Nederland), Diemen, The Netherlands Bert Boer Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands Journal Article 2019 10 07 Background Across Western Europe, procedures and formalised criteria for taking decisions on the coverage (inclusion in the benefits basket or equivalent) of healthcare technologies vary substantially. In the decision documents, which display the justification of, the rationale for, these decisions, national healthcare institutes may employ ‘contextual factors,’ defined here as situation-specific considerations. Little is known about how the use of such contextual factors compares across countries. We describe and compare contextual factors as used in coverage decisions generally and 4 decision documents specifically in Belgium, England, Germany, and the Netherlands. Methods Four group interviews with 3 experts from the national healthcare institute of each country, document and web site analysis, and a workshop with 1 to 2 of these experts per country were followed by the examination of the documents of 4 specific decisions taken in each of the 4 countries, sampled to vary widely in type of technology and decision outcome. Results From the available decision documents, we conclude that in every country studied, contextual factors are established ‘around the table,’ ie, in deliberation. All documents examined feature contextual factors, with similar contextual factor patterns leading to similar decisions in different countries. The Dutch decisions employ the widest variety of factors, with the exception of the societal functioning of the patient, which is relatively common in Belgium, England, and Germany. Half of the final decisions were taken in another setting, with the consequence that no documentation was retrievable for 2 decisions. Conclusion First, we conclude that in these countries, contextual factors are actively integrated in the decision document, and that this is achieved in deliberation. Conceptualising contextual factors as both situation-specific and actively-integrated affords insight into practices of contextualisation and provides an encouragement for exchange between decision-makers on more qualitative aspects of decisions. Second, the decisions that lacked a publicly accessible justification of the final decision document raised questions on the decisions’ legitimacy. Further research could address patterning of contextual factors, elucidate why some factors may remain implicit, and how decisions without a publicly available decision document may enable or restrain decision-making practice.

https://www.ijhpm.com/article_3739_20885c72ca35d75619d6a378edea9f76.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Early Health Economic Modelling – Optimizing Development for Medical Device Developers?; Comment on “Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling” 403 405 3727 10.15171/ijhpm.2019.136 EN Conor Teljeur Health Information and Quality Authority, Dublin, Ireland Máirín Ryan Health Information and Quality Authority, Dublin, Ireland Journal Article 2019 09 25 This commentary considers the positive and negative consequences of early economic modelling and explores potential future directions. Early economic modelling offers device manufacturers an opportunity to assess the potential value of an innovation at an early stage of development. Early modelling can direct resources into potentially viable technologies and reduce investment in technologies with limited prospect of value. However, it is unclear whether early modelling is sufficiently specific to identify innovations with low value. It may be that early modelling is more useful for directing data gathering to reduce decision uncertainty. Early modelling is of primary benefit to the manufacturer and may have both positive and negative consequences for reimbursement processes that should be considered.

https://www.ijhpm.com/article_3727_d3802b1dc0d80d8a3c8ccc6ccc068e7c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 When Coproduction Is Unproductive; Comment on “Experience of Health Leadership in Partnering with University-Based Researchers in Canada: A Call to ‘Re-Imagine’ Research” 406 408 3728 10.15171/ijhpm.2019.140 EN Sara A. Kreindler Department of Community Health Sciences, Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada 0000-0001-9499-2853 Journal Article 2019 11 02 Bowen et al offer a sobering look at the reality of research partnerships from the decision-maker perspective. Health leaders who had actively engaged in such partnerships continued to describe research as irrelevant and unhelpful – just the problem that partnered research was intended to solve. This commentary further examines the many barriers that impede researchers from meeting decision-makers’ knowledge needs, and decision-makers from using knowledge that they have coproduced. It argues that not all barriers can or should be dismantled: some are legitimate and beneficial; some are harmful but deeply entrenched; some arise unpredictably. This being the case, it seems unrealistic to expect either existing or emerging strategies to create a macro-context devoid of barriers to the fruitful coproduction of knowledge. However, it may be possible to identify and support micro-contexts (configurations of participants, settings, and project characteristics) in which partnered research is most likely to achieve its aims.

https://www.ijhpm.com/article_3728_460b491b917d4185ed1f5be97229721a.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 Towards Improving Hospital Managers’ Performance in Iran: History of a Pioneer Program Among EMRO Countries 409 410 3715 10.15171/ijhpm.2019.99 EN Ali Maher Department of Health Policy, Economics and Management, School of Management and Medical Education, Shahid Beheshti University of Medical Sciences, Tehran, Iran 0000-0002-0448-284X Mohammad Hossein Salarianzadeh Advisor to Secretariat of High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran 0000-0002-6335-897X Abbas Vosoogh Moghaddam Secretariat of the High Council for Health and Food Security, Ministry of Health and Medical Education, Tehran, Iran 0000-0002-6631-2811 Mehdi Jafari School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran Rouhollah Zaboli Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran 0000-0002-6512-7278 Journal Article 2019 09 05

https://www.ijhpm.com/article_3715_d2d2c6e2445eef2bcff6bf0fdf69846c.pdf

Kerman University of Medical Sciences International Journal of Health Policy and Management 2322-5939 9 9 2020 09 01 The Proportion of Female Physician Links With Advanced Educational Opportunity for Female and by Female 411 412 3735 10.15171/ijhpm.2019.147 EN Yuki Senoo Faculty of Medicine, Comenius University, Bratislava, Slovakia Medical Governance Research Institute, Tokyo, Japan 0000-0001-7289-5016 Morihito Takita Medical Governance Research Institute, Tokyo, Japan Akihiko Ozaki Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan 0000-0003-4415-9657 Masahiro Kami Medical Governance Research Institute, Tokyo, Japan Journal Article 2019 09 25 Background The overall proportion of female physician is increasing worldwide. However, its ratio exhibits a substantial diversity among each member country of Organisation for Economic Co-operation and Development (OECD). This study aimed to reveal the social factors of countries associated with the percentage of female physicians. Methods We retrieved the percentage of female physicians and social characteristic which may affect the ratio of female physicians of 36 OECD countries in 2016 or nearest year from the World Bank Open Data. Multivariate regression analysis was performed after univariate evaluations with Spearman’s coefficient to explore correlation of social variables with the proportion of female physicians. Results The percentages of female adolescents who dropped out of school before lower secondary school, female population that attained or completed Master’s or equivalent degree, female labour force, and female academic staff in tertiary education showed statistically significant correlation with proportion of female physicians (Spearman coefficient = -0.527, 0.585, 0.501, and 0.499; P = .01, .001, .002, and .008). Female’s educational attainment at least Master’s or equivalent and that of female academic staff at tertiary education were selected after multivariate analysis. Conclusion Our study revealed the relationships between advanced education opportunity and female participation in academic positions with the percentage of female physicians. Our research is limited in the difficulty to evaluate physicians’ working hours in spite of its possible effect. Further studies with qualitative assessment are warranted to explore the detail reasons to cause gender gap in physician.

https://www.ijhpm.com/article_3735_dc0c398086fee58f9d64e1e47aa4e586.pdf