The Impact of Payment Reforms on the Quality and Utilisation of Healthcare for Patients With Multimorbidity: A Systematic Review

International Journal of Integrated Care

Marcel Olde Rikkert¹  Simone A. van Dulmen²  Patrick P. T. Jeurissen²  Toine E. P. Remers²  Nina Nieuweweme² 

[1] Radboud University Medical Center, Radboud Institute for Health Sciences, Department of Geriatrics, Radboudumc Alzheimer Center, Nijmegen;Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Nijmegen;

关键词: multimorbidity;    payment reform;    quality of care;    healthcare utilisation;    healthcare financing;    integrated care;   

DOI  :  10.5334/ijic.5937

来源: DOAJ

【 摘 要 】

Inadequate treatment of multimorbidity is recognised as a major determinant of the effectiveness of healthcare and also of its inappropriate expenditures. However, current payment systems target, primarily, the treatment of single diseases, thus hindering integrated delivery of care for patients with multimorbidity (PwM). This review aims to assess the effects of targeted reforms of payment systems which could help attain a higher quality of care and reduce unnecessary healthcare utilisation. In June 2020, a search of Medline and EMBASE revealed 13 relevant articles. The most common payment models were the use of bundled payments (n = 4) and diagnosis-related group payments (n = 4). Except for an increase in hospital admissions (n = 3), no outcome showed unambiguous significant effects across more than one study. The two studies which focused explicitly on PwM showed a significant decrease in 30-day hospital readmissions. This, however, was not maintained after 60 days in one study. No general conclusion could be drawn on the effects of targeted payment reforms for PwM. Our findings suggest that reforms should be combined with more multifaceted healthcare delivery to address the complex patterns of healthcare use effectively. Thorough evaluations of targeted payment reforms are needed urgently to contribute to the body of evidence required.

【 授权许可】

Unknown