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AN OVERVIEW OF PAYMENT
SYSTEMS IN OECD
COUNTRIES USING THE OECD HEALTH SYSTEM
CHARACTERISTICS SURVEY
Expert Group Meeting on Payment Systems, 7th – 8th April 2014
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Health System Characteristics Survey
2012
• HSC survey complements existing OECD data questionnaires with detailed information on the institutional features of health systems: – (i) Governance
– (ii) Organisation and delivery
– (iii) Financing
• First wave of HSC survey carried in 2008-09
• 2008-09 survey results released in OECD Health Working Paper No 50.
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Health System Characteristics Survey
2012
• Second HSC survey carried out in 2012-13, following the same structure but with some updates:
– Updating 2008 information where necessary
– Enhanced information on key areas: health financing and health coverage, health care delivery (providers’ payment and regulation of prices and supply)
– Included questions for specific OECD projects (including on workforce and primary care)
• Surveys sent out second half of 2012 – almost 100% response rate!
• For the ‘Organisation Section’ of the survey, which this background paper used, all but one country submitted a response
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USING THE HSC SURVEY DATA TO LOOK AT
PROVIDER PAYMENT
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Using the HSC Survey responses
• Background paper provides an overview of the predominant modes of payment of health care services in OECD member countries (DELSAHEA(2014)2)
• Based on data collected through the 2012 wave of the OECD Health Systems Characteristics (HSC) Survey
• Paper covers 14 questions related to paying providers
• An in-depth phase of validation and completion of missing data took place at the end of 2013 and beginning of 2014
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Using the HSC Survey responses
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BACKGROUND PAPER: AN OVERVIEW OF PAYMENT
SYSTEMS IN OECD COUNTRIES
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• High level of heterogeneity
• Delivery is predominantly in the private setting either in solo or group practices
• Main modes of provider payment are FFS or capitation which may include additional components such as P4P
• FFS is the main mode of physician payment in private practices while salary is the main payment in public clinics
Overview of payment systems in OECD
countries: Primary care
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Overview of payment systems in OECD
countries: Outpatient specialist care
• More similarity across countries in delivery modes and payment
• Delivery is mainly carried out in outpatient departments of public hospitals where reimbursement is typically FFS
• Many countries also include other components such as global budget and P4P
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Overview of payment systems in OECD
countries: Inpatient acute care
• Payment of inpatient acute care is either DRG or global budget
• DRG payment is most common in social health insurance (SHI)-based systems
• Global budget is mainly used in general taxation (NHS)-based systems
• Salary is the main payment model for inpatient specialists.
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• For FFS prices are typically set through negotiation
• Global budget in all settings is typically set by key purchasers (central or local level) rather than negotiated.
Overview of payment systems in OECD
countries: Reimbursement setting
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Overview of payment systems in OECD
countries: P4P
• Most common in primary care (14 countries)
• Focus is on prevention (primary care), management of chronic disease (primary care and outpatient specialist) and improvement of patient experience (inpatient acute care)
• Participation of providers in P4P schemes can be voluntary or mandatory
• In most countries of the share of total reimbursement represented by P4P was below 10%
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