Publications IPH Magazine IPH Magazine 13th: Annals International experience on the compensation models
- Editorial - 13th
- HEALTH MANAGEMENT: Efficiency, Innovation and Sustainability
- Health Management Focused on Efficiency, Innovation and Sustainability!
- CONGRESS FOR COST AND FINANCIAL MANAGEMENT
- Hospitals, networks and sustainability
- Cost Reduction through Process Review
- Integrating Business Management to the Assistance Management
- International experience on the compensation models
- The Future of Hospital System - The Sustainability Challenge of Small Hospitals
- Advances in Patient Safety: Indicators and Impact on Cost Assistance
- Prospects for Public Private Partnerships and the Partnership Arrangements with Health Social - Critical Analysis of the PPP Brazilian Experiences in Health
- ENGINEERING, ARCHITECTURE AND LOGISTICS CONGRESS
- Hospital Logistics: Intelligence at Service for the Health Manager
- PEOPLE MANAGEMENT AND LEADERSHIP CONGRESS
- Illusionist Performance: Transformation and Innovation in Tough Times
- Implementation Careers & Salaries: New Paradigms and Opportunities
- The Art of Leading Generations X, Y and Z - How to retain talent?
- Giving Back Over the Organizational Climate - Talent Retention Strategies
- Creative Practices to Innovate in HR
- HEALTH MANAGMENT CONGRESS
- Efficiency
- Efficiency (2)
- The Process of Change in Bolivia "Hospital Arco Iris" from Solid Hospital to Liquid Hospital
- PATIENT'S QUALITY AND SAFETY CONGRESS
- Impact of External Assessment in Brazil
- Impact of External Assessment in Brazil (2)
- Quality and impact of patient safety in the hospital financial result - Santa Casa de Misericordia de Maceió
- Quality and Safety Integration on Education Process
- Management
- The Apthapi as Innovation Strategy in the Humanization of Healthcare Hospitality
- The experience of the State Hospital Sumaré / Unicamp in management by care
- HOSPITAL HOTEL CONGRESS
- Hospitality in Patient Perspective
- Hospitality at the Service of Humanization
- Hospitality and Humanization
- Hospitals Infrastructure Trends aimed at Physical and Mental Comfort for Patients and Families
- The Multidisciplinary Integration of Beds Management as a Way to Seek Effectiveness
- Spirituality in Hospitals Focusing on Healthcare Hospitality
International experience on the compensation models
Joan Castillejo Peña
There are several compensation models existing at international level, however, the different existing compensation models stand out as main purposes to promote the efficient production of services by providers, minimizing administrative costs by donors / buyers of services.
Before defining what better model to be used, it is necessary to reflect on some important points on compensation models on how to use them.
The search for efficient services production by providers and the minimization of administrative costs is the starting point for consideration of the compensation models, then we should be confident that the service providers have economic, financial and administrative conditions to manage hospital costs, providing quality service to users.
Through information systems adapted to hospital reality all information is obtained and recorded enabling the funder/ buyer to accomplish the budget forecast of the service provider in the allocation of financial resources. The funder can not use an information system where the remuneration model can not be controlled. This information system should support the budget forecast for strategic planning, where can be established what is expected for the year, both in terms of budget and in terms of hospital productivity. The budget planning and productivity is important for both the service provider as for the funder to purchase the services.
We can define the product/unit services purchase through structure, processes (intermediate products) and outcomes, where issues related to structure are directly related to certification and accreditation processes, we can mention for example, human resources, material resources, economic resources and the information system. Intermediate products refer to internal work processes and may be related to compensation for process systems, such as the amount of consultations and examinations, length of stay, surgery, among others. The results are related to the fulfillment of end-health goals, such as reducing the incidence of certain pathology, satisfaction index, adjusted life years for quality of life (Quality-adjusted life-year), conditions diagnosed (through DRG, PMC, ACG).
The actual cost of the hospital should be analyzed so that the funder/buyer get subsidies to define the most appropriate remuneration model and the amount to be paid to the service provider. In a brief analysis of the costs, we can say that when the paid prices are higher than the actual cost there is a tendency to induce unnecessary services and weakness of the viability of the health system and when the paid prices are lower than the actual cost there is a tendency to induce sub-benefits, discouraging offer from providers and encouraging unnecessary super-activity.
The most suitable is that the remuneration paid to the provider must be adjusted as close as possible to the actual costs of the hospital. Each compensation model has different specific incentives and risks, let's look at some examples of the different compensation models in the world:
- Compensation for history of service model
- Per capita remuneration model
- Adjusted per capita remuneration model
- Aggregate activity remuneration model
- Compensation for itemized activity/processes model
- Length of stay compensation model
- Intermediary products compensation
Financially, the compensation models are related to levels of aggregation of the budget, so in a brief analysis we can say that an important premise to be considered in relation to the risks is that the more added the compensation model of the budget, the greater the risk to the service provider and the less aggregate, the greater the risk for the funder/buyer.
Therefore, there is not a payment unit that can be valid whatever time, place and type of service; the choice of compensation model depends, among other things, of the funder objectives and also the development of appropriate information systems.
There are some desirable features in remuneration models that should be considered, such as: balance between performance and compensation, ease of understanding of the payment system, quality improvement of the promotion, adaptability to industry changes and incentives generation for desired capacity.
Citing international models used, the experience shows that:
- The per capita compensation adjusted by combined risk with compensation based on treated cases are the best alternative for compensation in cases of service integration between different levels of health care.
- The mixed remuneration, considering the structure and according to the complexity of cases treated, are the best alternative to pay hospitals. This remuneration is characterized by measuring the cases treated by applying DRGs, adapted to their own countries and modulated by comparison systems between hospitals (benchmarking).
- The per capita compensation adjusted by risks, which converges with the model using morbidity (ACG, DCG CRG) are the best alternative for the remuneration in primary care.
- The special mixed remuneration, are the best alternative to other areas or services, such as emergency, remote areas, special treatments etc.
In addition to all the aforementioned topics, we conclude that to introduce changes in hospital payment system, you must create a compensation model where the relationship between funder and provider must be based on mutual trust and agreeing on risk levels between them, where the remuneration model is based on legally and technically robust contracts supported by strong information systems that can be audited and verified by both parties. The model shall be in accordance with the strategic objectives of both the funder as the service provider to minimize the risks in incentives. We conclude that each country implements compensation models adapted to their reality, but with tools internationally validated.
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