Background In recent years, health care strategies have increasingly focused on pay for performance (P4P) programs designed to control costs by financially motivating physicians to render high-quality care with rewards for improving clinical outcomes, rendering preventive care, and focusing on achieving cost savings. Given the strong impact of primary care on the utilization of health care services, general practitioners are a natural target for these strategies. In Italy, implementation of P4P programs in primary care is only to a partial state: since 2005, the National Collective Agreements (NCAs) have started a reorganization process of primary care, both from an organizational point of view, through the promotion of the development of new forms of association, and the quality of care, promoting adherence to programs of clinical governance, the definition of indicators and quality objectives, and the provision of financial incentives related to their achievement. Aims The aim of this paper is twofold: 1. to understand how the indications provided in recent NCAs have been received by the Italian regions; 2. to analyze the effect of the primary care reform process on improving health population status and on reducing access to emergency health care. Methods The first aim was achieved through a documental analysis of Regional Supplementary Agreements (RSAs). The official documents were extracted from the Interregional Structure Medical Agreement website. RSAs were downloaded and analyzed in order to identify for each region: a. forms of association provided, b. regional objectives aimed at appropriateness and clinical governance; and existence of financial incentives linked to the achievement of programmed healthcare goals, d. expected impact on regional healthcare spending. To achieve the second aim, we performed a regression analysis in order to estimate the impact of the new organizational models on improving population health status and reducing the access to emergency room. Data were extracted from official databases provided by the Italian National Institute of Statistics (ISTAT) and the Italian Ministry of Health. Results Most of the Italian regions have started a process of rethinking primary care models, by providing for a transition from the classic associative forms, to new associative forms characterized by greater complexity. Despite this, the primary care reform process still appears to the early stages: despite the forecasts in the RSAs, only some regions seem to have actually started this process, with the presence of new active and functioning associative structures. Despite this, results of regression analysis showed that the activation of multi-professional and mono-professional association forms contributes to improving the overall health of the population and reducing access to the emergency room. Conclusions: The experimentation of new organizational forms in the field of primary medicine, although limited to some regions, assigns new and important health improvement objectives to Italian general practice, paving the way for a path to improvement of the entire system.
Pay for performance programs in Italian primary care: state of the art, expected impact on healthcare spending and implication for population health
Vito Pipitone;
2019
Abstract
Background In recent years, health care strategies have increasingly focused on pay for performance (P4P) programs designed to control costs by financially motivating physicians to render high-quality care with rewards for improving clinical outcomes, rendering preventive care, and focusing on achieving cost savings. Given the strong impact of primary care on the utilization of health care services, general practitioners are a natural target for these strategies. In Italy, implementation of P4P programs in primary care is only to a partial state: since 2005, the National Collective Agreements (NCAs) have started a reorganization process of primary care, both from an organizational point of view, through the promotion of the development of new forms of association, and the quality of care, promoting adherence to programs of clinical governance, the definition of indicators and quality objectives, and the provision of financial incentives related to their achievement. Aims The aim of this paper is twofold: 1. to understand how the indications provided in recent NCAs have been received by the Italian regions; 2. to analyze the effect of the primary care reform process on improving health population status and on reducing access to emergency health care. Methods The first aim was achieved through a documental analysis of Regional Supplementary Agreements (RSAs). The official documents were extracted from the Interregional Structure Medical Agreement website. RSAs were downloaded and analyzed in order to identify for each region: a. forms of association provided, b. regional objectives aimed at appropriateness and clinical governance; and existence of financial incentives linked to the achievement of programmed healthcare goals, d. expected impact on regional healthcare spending. To achieve the second aim, we performed a regression analysis in order to estimate the impact of the new organizational models on improving population health status and reducing the access to emergency room. Data were extracted from official databases provided by the Italian National Institute of Statistics (ISTAT) and the Italian Ministry of Health. Results Most of the Italian regions have started a process of rethinking primary care models, by providing for a transition from the classic associative forms, to new associative forms characterized by greater complexity. Despite this, the primary care reform process still appears to the early stages: despite the forecasts in the RSAs, only some regions seem to have actually started this process, with the presence of new active and functioning associative structures. Despite this, results of regression analysis showed that the activation of multi-professional and mono-professional association forms contributes to improving the overall health of the population and reducing access to the emergency room. Conclusions: The experimentation of new organizational forms in the field of primary medicine, although limited to some regions, assigns new and important health improvement objectives to Italian general practice, paving the way for a path to improvement of the entire system.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
