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Yet, the evidences of success with P4P schemes are inconclusive. Rewarding incentives for good performance sounds like common sense.
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Similarly, financial incentives are rewarded for good performance. Among doctors, UBH rolled out the pay-for-chronic disease management that tries to improve compliance with clinical guidelines and reduce avoidable hospitalization for cases such as diabetes, asthma, gyncaecology, etc. Accredited hospitals accounted for 65 percent of all UBH hospital admissions in 2008. Hospitals receive an increase in per diem rate in joining and meeting targets in the accreditation process. Together with the Diagnosis-Related Group (DRG) method, these allow comparison of performance across hospitals. A hospital accreditation program, known as the Service Network Qualification Project, was instituted in 2004, aiming to standardize the provision of quality care among hospitals in the city of Belo Horizonte. On the other hand, Unimed-Belo Horizonte’s (UBH) program catered to both hospitals and doctors.
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Meeting the scores result in a percentage increases in consultation fees, which are shouldered by Unimed Franca. While there are no set absolute targets, there is a benchmark interval scoring, based on the average performance of all doctors. The scheme rewards doctors depending on how they compare to their colleagues, looking into performance domain such as utilization, cost, effectiveness, healthcare and patient satisfaction. Its aim is to control costs and improve doctor’s remuneration while still ensuring the quality of healthcare delivery. Unimed-Franca implemented its FFS+P4P (fee-for-service + payment-for-performance) in 2009. While there is yet no clear evidence of the effectiveness of the scheme, pay-for-performance has steadily becoming popular in both private healthcare providers and cooperatives in countries including the United States, United Kingdom, New Zealand, Australia and Korea. The OECD acknowledges the potential of P4P scheme to go beyond mere encouragement and actually improve the quality of health care. The scheme may also include disincentives for poor performance where hospitals, for instance, are fined for failing to meet reduction targets or physicians are not reimbursed for the cost of treating medical errors. The P4P scheme rewards healthcare providers with financial incentives in meeting certain quality or efficiency targets. In line with this mission, cooperatives in the Unimed network have undertaken initiatives to improve health care delivery one of which, is the pay-for-performance (P4P) scheme which has been piloted by cooperatives like Unimed-Franca and Unimed-Belo Horizonte. True to the cooperative values, Unimed launched its National Policy on Social Responsibility in 2001, with the aim of practicing social responsibility in managing business. It currently covers more than a third of the Brazilian market for health plans. The entire system consists of 370 medical cooperatives, 109,000 doctors and 3,029 accredited hospitals, providing care to more than 18 million customers. Serving since 1967, Unimed do Brasil is the biggest private healthcare operator in Braziland has the largest network of medical cooperatives in the world. While there were doubts on the extent on the capabilities of cooperatives, there are already successful cases of healthcare cooperatives that deliver affordable prices and maintain quality delivery in other parts of the world.Ĭooperatives have long been at the forefront of the Brazilian health care system.
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Cooperatives are able to control the high cost of prescription medicines, help community-owned hospitals remain independent, and improve the quality of healthcare and assisted living. In the ensuing debate, cooperatives emerged as a key strategy for keeping healthcare costs and insurance premiums affordable. When hospitals, doctors or insurers receive less remuneration than what they previously received, they may, as rational agents, exercise lesser effort and commitment in return. Yet, from a cost-and-benefit viewpoint, lowering the cost and price of healthcare may prove problematic as it may inadvertently decrease the quality of service delivery.
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Cooperatives in Healthcare: Unimed do Brasil and P4PĪt the height of the debate on American health care reforms, the primary issue revolves around how to lower the cost of healthcare services.