assuming evenness in quality across providers. More recently, with better information, countries have initiated payment with quality indicators and outcomes. France, Germany, the United Kingdom (Busse et al. 2011) and the USA have focused on indicators related to quality, such as readmissions and hospitalacquired infections. The USA has initiated a 2% withhold to hospitals across the board, followed by a reallocation to the top 20% of hospitals, based on a complicated mix of severityadjusted performance measures. It has also revised the DRG algorithm to exclude certain complications of care from affecting DRG assignment, thus effectively creating a “nonpayment for non-performance” policy. A number of countries, including Germany, the Netherlands, the United Kingdom and the USA, have initiated payment pilots and programmes that share savings for bundled payments or “integrated care” based on costs, quality, outcomes and patient satisfaction (Busse & Stahl, 2014). This volume showcases several countries in the Asia Pacific region that routinely monitor along multiple dimensions and are already linking payment and quality outcomes. Emergent practices in Indonesia and the Philippines can learn from good practices in countries such as Japan and the Republic of Korea. A simpler approach to incorporating quality considerations into case-based payments is to provide an incentive for hospitals to participate in a hospital accreditation programme, or to require participation in such a programme as part of the conditions of funding.
Preconditions for Success From these 10 issues, a few clear patterns emerge in terms of institutional “preconditions” for success, which need to be met by countries considering moving to this new approach. Payment design: Is there one best design? Neither the global evidence (presented in Chapter 4) nor the volume allows us to unequivocally determine the best model or design. Countries start from a current system, with unique sets of policy challenges and policy objectives, but clearly design details vary. Perhaps the more important issue is how models are
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