Provider Payment Reforms for Improved Primary Health Care in Romania
Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanisms do not reward the high-quality care provision and may incentivize bypassing of PHC for hospitals, exacerbating challenges presented by physical, financial, and social barriers to accessing essential care. This paper assesses provider payment mechanisms at the PHC level, by examining their design features and implementation arrangements, and exploring their implications for PHC performance in terms of access and quality of care. The authors conclude with policy recommendations to address the constraints identified. To increase the supply of preventative care and case management, the authors recommend that volume thresholds for fee-for-service payments reflect both the number of enrollees and physicians in a practice; laboratory tests required for case management be reduced in scope and their costs be reimbursed; and the law on health care reform be amended to enable the introduction of new payment mechanisms, such as performance-based payments. To expand the scope of PHC and strengthen care coordination with hospitals, periodic reviews by physician commissions should aim to expand the scope of PHC care in line with provisions in other European Union (EU) countries for ambulatory-care sensitive conditions; capitation payments should be adjusted for gender and historical service use to reduce incentive for over-referrals; and payment mechanisms that reward coordination of care, including bundled payments, should be introduced. To establish an enabling environment for provider payment reforms, health information systems should be strengthened by unifying diagnosis coding, establishing quality standards, and ensuring referral module functionality; payment reforms should be informed by extensive consultations with providers at all service delivery levels; and PHC spending should be increased to support higher reimbursement levels for providers and match expenditure levels in high-performing EU health systems.
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| Format: | Working Paper biblioteca |
| Language: | English |
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World Bank, Washington, DC
2021-08
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| Subjects: | UNIVERSAL HEALTH CARE, UNIVERSAL HEALTH COVERAGE, CARE COORDINATION, PROVIDER PAYMENT, PRIMARY HEALTH CARE, |
| Online Access: | http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania http://hdl.handle.net/10986/36189 |
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dig-okr-10986361892021-08-25T05:10:33Z Provider Payment Reforms for Improved Primary Health Care in Romania Chukwuma, Adanna Comsa, Radu Chen, Dorothee Gong, Estelle UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanisms do not reward the high-quality care provision and may incentivize bypassing of PHC for hospitals, exacerbating challenges presented by physical, financial, and social barriers to accessing essential care. This paper assesses provider payment mechanisms at the PHC level, by examining their design features and implementation arrangements, and exploring their implications for PHC performance in terms of access and quality of care. The authors conclude with policy recommendations to address the constraints identified. To increase the supply of preventative care and case management, the authors recommend that volume thresholds for fee-for-service payments reflect both the number of enrollees and physicians in a practice; laboratory tests required for case management be reduced in scope and their costs be reimbursed; and the law on health care reform be amended to enable the introduction of new payment mechanisms, such as performance-based payments. To expand the scope of PHC and strengthen care coordination with hospitals, periodic reviews by physician commissions should aim to expand the scope of PHC care in line with provisions in other European Union (EU) countries for ambulatory-care sensitive conditions; capitation payments should be adjusted for gender and historical service use to reduce incentive for over-referrals; and payment mechanisms that reward coordination of care, including bundled payments, should be introduced. To establish an enabling environment for provider payment reforms, health information systems should be strengthened by unifying diagnosis coding, establishing quality standards, and ensuring referral module functionality; payment reforms should be informed by extensive consultations with providers at all service delivery levels; and PHC spending should be increased to support higher reimbursement levels for providers and match expenditure levels in high-performing EU health systems. 2021-08-24T14:19:28Z 2021-08-24T14:19:28Z 2021-08 Working Paper http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania http://hdl.handle.net/10986/36189 English Health, Nutrition and Population Discussion Paper; CC BY 3.0 IGO http://creativecommons.org/licenses/by/3.0/igo World Bank World Bank, Washington, DC Publications & Research Publications & Research :: Working Paper Europe and Central Asia Romania |
| institution |
Banco Mundial |
| collection |
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| country |
Estados Unidos |
| countrycode |
US |
| component |
Bibliográfico |
| access |
En linea |
| databasecode |
dig-okr |
| tag |
biblioteca |
| region |
America del Norte |
| libraryname |
Biblioteca del Banco Mundial |
| language |
English |
| topic |
UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE |
| spellingShingle |
UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE Chukwuma, Adanna Comsa, Radu Chen, Dorothee Gong, Estelle Provider Payment Reforms for Improved Primary Health Care in Romania |
| description |
Romania faces high levels of amenable
mortality reflecting, in part, the relatively low
utilization rates of high-quality primary health care (PHC),
particularly for non-communicable disease (NCD) prevention
and treatment. Provider payment mechanisms do not reward the
high-quality care provision and may incentivize bypassing of
PHC for hospitals, exacerbating challenges presented by
physical, financial, and social barriers to accessing
essential care. This paper assesses provider payment
mechanisms at the PHC level, by examining their design
features and implementation arrangements, and exploring
their implications for PHC performance in terms of access
and quality of care. The authors conclude with policy
recommendations to address the constraints identified. To
increase the supply of preventative care and case
management, the authors recommend that volume thresholds for
fee-for-service payments reflect both the number of
enrollees and physicians in a practice; laboratory tests
required for case management be reduced in scope and their
costs be reimbursed; and the law on health care reform be
amended to enable the introduction of new payment
mechanisms, such as performance-based payments. To expand
the scope of PHC and strengthen care coordination with
hospitals, periodic reviews by physician commissions should
aim to expand the scope of PHC care in line with provisions
in other European Union (EU) countries for ambulatory-care
sensitive conditions; capitation payments should be adjusted
for gender and historical service use to reduce incentive
for over-referrals; and payment mechanisms that reward
coordination of care, including bundled payments, should be
introduced. To establish an enabling environment for
provider payment reforms, health information systems should
be strengthened by unifying diagnosis coding, establishing
quality standards, and ensuring referral module
functionality; payment reforms should be informed by
extensive consultations with providers at all service
delivery levels; and PHC spending should be increased to
support higher reimbursement levels for providers and match
expenditure levels in high-performing EU health systems. |
| format |
Working Paper |
| topic_facet |
UNIVERSAL HEALTH CARE UNIVERSAL HEALTH COVERAGE CARE COORDINATION PROVIDER PAYMENT PRIMARY HEALTH CARE |
| author |
Chukwuma, Adanna Comsa, Radu Chen, Dorothee Gong, Estelle |
| author_facet |
Chukwuma, Adanna Comsa, Radu Chen, Dorothee Gong, Estelle |
| author_sort |
Chukwuma, Adanna |
| title |
Provider Payment Reforms for Improved Primary Health Care in Romania |
| title_short |
Provider Payment Reforms for Improved Primary Health Care in Romania |
| title_full |
Provider Payment Reforms for Improved Primary Health Care in Romania |
| title_fullStr |
Provider Payment Reforms for Improved Primary Health Care in Romania |
| title_full_unstemmed |
Provider Payment Reforms for Improved Primary Health Care in Romania |
| title_sort |
provider payment reforms for improved primary health care in romania |
| publisher |
World Bank, Washington, DC |
| publishDate |
2021-08 |
| url |
http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania http://hdl.handle.net/10986/36189 |
| work_keys_str_mv |
AT chukwumaadanna providerpaymentreformsforimprovedprimaryhealthcareinromania AT comsaradu providerpaymentreformsforimprovedprimaryhealthcareinromania AT chendorothee providerpaymentreformsforimprovedprimaryhealthcareinromania AT gongestelle providerpaymentreformsforimprovedprimaryhealthcareinromania |
| _version_ |
1756575948860293120 |