GHC Conference, May 30 - June 2, 2005
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Transcript of GHC Conference, May 30 - June 2, 2005
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TESTING PERFORMANCE-BASED TESTING PERFORMANCE-BASED REMUNERATION FOR PRIMARY CAREREMUNERATION FOR PRIMARY CARE
PPROVIDERS IN ARMENIAROVIDERS IN ARMENIA
Tatyana MakarovaTatyana MakarovaMark McEuenMark McEuen
Abt Associates Inc.Abt Associates Inc.
GHC Conference, May 30 - June 2, 2005
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CURRENT PHC PAYMENT SYSTEMCURRENT PHC PAYMENT SYSTEM
1. PHC Benefits Package source of funding: general taxes
2. Contract based budget funds allocations
3. Payment model: prospective
4. Basic payment method: capitation
5. Differentiated per capita rates: children and adults
6. Fees for selected services
7. Fees for selected diseases treatment
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CURRENT PHC REMUNERATION CURRENT PHC REMUNERATION SYSTEMSYSTEM
• Ministry of Health regulated salary rates• Rate estimates defined on per capita basis for
physicians and nurses • Total base salary per provider assumes assigned
population rather than actually enrolled• Salaries are fixed and do not differ across providers
in regard to service volume and quality, even in cases when they provide paid services
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GOALS OF INCENTIVE REMUNERATION SYSTEM
• Introduce differentiated remuneration system to:
• Bring incentives and reward for improved quality and increased utilization of PHC services
• Reward additional work as participation in reform related activities and assignments
• Increase PHC personnel’s earnings and motivation
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IMPLEMENTATION APPROACH
• Define PHC financing and remuneration indicators (volume and quality type) for rewarding performance
• Introduce performance based PHC financing in combination with capitation payments
• Collect performance data from new PHC information system and generate required reports
• Provide feedback on performance to individual providers in comparison with minimal, average and maximum indicators’ values achieved by the PHC staff
• Introduce a simple electronic tool for remuneration estimates to be easily used by facility accountants
• Quality indicators for remuneration were offered only to 3 pilots out of 13 as they already had functional CQI programs
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PERFORMANCE INDICATORS
• Year 2004– for PHC financing – enrolment performance only – for remuneration – 28 volume and quality indicators were
offered for facility choice with the possibility to change them from month to month. Different pilots chose from 2 to 11 indicators.
• Year 2005: – seven PHC incentive financing indicators directly linked with
13 PHC remuneration indicators– all 13 remuneration indicators are to be used universally by
pilots
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COMPARISON OF 2004 AND 2005 INCENTIVE REMUNERATION SYSTEMS
1. 4 months in 2004 vs. whole year in 2005
2. 28 indicators in 2004 vs. 13 indicators in 2005
3. Elective indicators in 2004 vs. fixed list in 2005
4. Relation of incentive remuneration indicators to facility financing indicators
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INCENTIVE REMUNERATION SYSTEM
Base fund Variable fund
Remuneration Fund
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PHC FACILITIES PERFORMANCE PHC FACILITIES PERFORMANCE INDICATORSINDICATORS
1. Indicator of population open enrollment
2. Indicator of all types of visits to PHC physicians (separately for children and adults)
3. Indicator of early detection of hypertension
4. Indicator of early detection of diseases in 0-1 year old children
5. Indicator of immunization
6. Indicator of participation of PHC physicians in Peer Chart Review process
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REMUNERATION BASE FUND
• Source – state budget per capita financing
• Fixed salary
• Based on the optimal number of served population
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REMUNERATION VARIABLE FUND
• Source – state budget incentive financing - established performance pool at the purchaser organization - State Health Agency
• Variable remuneration• Based on reform related additional work and
performance results
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ASSESSMENT OF PHC PERSONNEL’S PERFORMANCE
PHC personnel’s performance
indicators
Automated calculation of incentive
remuneration
PHC facilities’ performance indicators
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CORRELATION BETWEEN BASE FUND AND INCENTIVE REMUNERATION IN 2004
1.4%
61.1%
17.6%
0.0%
72.7%
14.3%
0.7%
73.3%
11.9%
0%
20%
40%
60%
80%
FP Therapevt Pediatrician
Physicians
Minimum
Maximum
Average
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1.4%
52.8%
16.5%
0.0%
79.5%
20.0%
0.3%
79.6%
18.2%
0%
20%
40%
60%
80%
FN Therapevt's nurse Pediatrician'snurse
Nurses
Minimum
Maximum
Average
CORRELATION BETWEEN BASE FUND AND INCENTIVE REMUNERATION IN 2004
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PILOT PHYSICIANS’ TOTAL SALARY VS. AVERAGE ARMENIA WAGE IN 2004
34000
35000
36000
37000
38000
39000
40000
41000
42000
September October November December
Av. Salary inArmenia in 2004
Pilot physicianssalary
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PILOT NURSES’ TOTAL SALARY VS. AVERAGE ARMENIA WAGE IN 2004
0
5000
10000
15000
20000
25000
30000
35000
40000
45000
September October November December
Av. Salary inArmenia in 2004
Pilot nurses salary
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CONCLUSIONS1. Performance based PHC remuneration system has
proved to be working
2. Sufficient time (not less than a year) is needed to assess measurable impact and draw sound conclusions on performance improvement
3. Continuous monitoring and improvement of the methodology of the system is required
4. Positive impact of incentives payment system is increased when combined with regular feedback to providers on their individual performance