Abstract
Background: The benefits of prevention are widely recognized; ranging from avoiding disease onset to substantially reducing disease burden, which is especially relevant considering the increasing prevalence of chronic diseases. However, its delivery has encountered numerous obstacles in healthcare. While healthcare professionals play an important role in stimulating prevention, their behaviors can be influenced by incentives related to reimbursement schemes. Purpose: The purpose of this research is to obtain a detailed description and explanation of how reimbursement schemes specifically impact primary, secondary, tertiary, and quaternary prevention. Methods: Our study takes a mixed-methods approach. Based on a rapid review of the literature, we include and assess 27 studies. Moreover, we conducted semi-structured interviews with eight Dutch healthcare professionals and two representatives of insurance companies, to obtain a deeper understanding of healthcare professionals' behaviors in response to incentives. Results: Nor fee-for-service (FFS) nor salary can be unambiguously linked to higher or lower provision of preventive services. However, results suggest that FFS's widely reported incentive to increase production might work in favor of preventive services such as immunizations but provide less incentives for chronic disease management. Salary's incentive toward prevention will be (partially) determined by provider-organization's characteristics and reimbursement. Pay-for-performance (P4P) is not always necessarily translated into better health outcomes, effective prevention, or adequate chronic disease management. P4P is considered disruptive by professionals and our results expose how it can lead professionals to resort to (over)medicalization in order to achieve targets. Relatively new forms of reimbursement such as population-based payment may incentivize professionals to adapt the delivery of care to facilitate the delivery of some forms of prevention. Conclusion: There is not one reimbursement scheme that will stimulate all levels of prevention. Certain types of reimbursement work well for certain types of preventive care services. A volume incentive could be beneficial for prevention activities that are easy to specify. Population-based capitation can help promote preventive activities that require efforts that are not incentivized under other reimbursements, for instance activities that are not easily specified, such as providing education on lifestyle factors related to a patient's (chronic) disease.
Original language | English |
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Article number | 750122 |
Number of pages | 21 |
Journal | Frontiers in Public Health |
Volume | 9 |
DOIs | |
Publication status | Published - 27 Oct 2021 |
Bibliographical note
ACKNOWLEDGMENTSWe thank all the participants in this study. An earlier version
of this paper has been presented at the HSMO ScienceClub at
Erasmus University Rotterdam. We thank the participants for
their constructive comments. We would especially like to thank
Dr. Jeroen van Wijngaarden, Pieter Vandekerckhove, and Dr.
Sandra Sülz for their constructive and insightful feedback on the
manuscript leading to the improvement of our work.
Publisher Copyright:
© Copyright © 2021 Zwaagstra Salvado, van Elten and van Raaij.
Copyright © 2021 Zwaagstra Salvado, van Elten and van Raaij.
Funding Information:
We thank all the participants in this study. An earlier version of this paper has been presented at the HSMO ScienceClub at Erasmus University Rotterdam. We thank the participants for their constructive comments. We would especially like to thank Dr. Jeroen van Wijngaarden, Pieter Vandekerckhove, and Dr. Sandra Sülz for their constructive and insightful feedback on the manuscript leading to the improvement of our work.
Publisher Copyright:
© Copyright © 2021 Zwaagstra Salvado, van Elten and van Raaij.