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Paying for value: options for value-based payment reform in Australia
- Source :
- Australian Health Review. 46:129-133
- Publication Year :
- 2021
- Publisher :
- CSIRO Publishing, 2021.
-
Abstract
- Value-based health care has gained increasing prominence among funders and providers in efforts to improve the outcomes important to patients relative to the resources used to deliver care. In Australia, the value-based healthcare agenda has focused on reducing the use of ‘low-value’ interventions, redesigning models of care to improve integration between providers and increasing the use of patient-reported measures to drive improvement; all have occurred within existing payment structures. In this paper we describe options for value-based payment reform and highlight two challenges critical for success: attributing financial risk fairly and organisational structures. What is known about the topic? ‘Fee for service’ is the dominant payment method in Australia and creates incentives to increase service volume, rewarding inputs rather than improvements in longer-term health outcomes. There is increasing recognition that payment reform is needed to support the shift to value-based health care in Australia. What does this paper add? This paper describes the three main options for value-based payment reform: episode-based bundled payments chronic condition bundled payments and comprehensive capitation payments. Each involves some degree of funds pooling, and the shifting of risk from the funder to provider to stimulate the more efficient use of resources. What are the implications for practitioners? We conclude that local hospital authorities in the states, private health insurers and primary health networks could implement reform as payment holders, but that capacity development in coordination and risk adjustment will be required. Successful implementation of payment reform will also require investment in data collection and information technology to track patients’ care and measure outcomes and costs.
- Subjects :
- Finance
Capitation
Health economics
business.industry
Health Policy
media_common.quotation_subject
Financial risk
Australia
Fee-for-Service Plans
Population health
1110 Nursing, 1117 Public Health and Health Services, 1605 Policy and Administration
Payment
United States
Reimbursement Mechanisms
Incentive
Health care
Costs and Cost Analysis
Humans
Public Health
Business
Fee-for-service
Delivery of Health Care
health care economics and organizations
media_common
Subjects
Details
- ISSN :
- 14498944 and 01565788
- Volume :
- 46
- Database :
- OpenAIRE
- Journal :
- Australian Health Review
- Accession number :
- edsair.doi.dedup.....909f23f5bf29a8278a65eff0da14cdd6