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Review
. 2022 May;126(5):398-407.
doi: 10.1016/j.healthpol.2021.09.015. Epub 2021 Oct 6.

Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

Ruth Waitzberg  1 , Sophie Gerkens  2 , Antoniya Dimova  3 , Lucie Bryndová  4 , Karsten Vrangbæk  5 , Signe Smith Jervelund  6 , Hans Okkels Birk  7 , Selina Rajan  8 , Triin Habicht  9 , Liina-Kaisa Tynkkynen  10 , Ilmo Keskimäki  11 , Zeynep Or  12 , Coralie Gandré  13 , Juliane Winkelmann  14 , Walter Ricciardi  15 , Antonio Giulio de Belvis  16 , Andrea Poscia  17 , Alisha Morsella  18 , Agnė Slapšinskaitė  19 , Laura Miščikienė  20 , Madelon Kroneman  21 , Judith de Jong  22 , Marzena Tambor  23 , Christoph Sowada  24 , Silvia Gabriela Scintee  25 , Cristian Vladescu  26 , Tit Albreht  27 , Enrique Bernal-Delgado  28 , Ester Angulo-Pueyo  29 , Francisco Estupiñán-Romero  30 , Nils Janlöv  31 , Sarah Mantwill  32 , Ewout Van Ginneken  33 , Wilm Quentin  34
Affiliations
Review

Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries

Ruth Waitzberg et al. Health Policy. 2022 May.

Abstract

Provider payment mechanisms were adjusted in many countries in response to the COVID-19 pandemic in 2020. Our objective was to review adjustments for hospitals and healthcare professionals across 20 countries. We developed an analytical framework distinguishing between payment adjustments compensating income loss and those covering extra costs related to COVID-19. Information was extracted from the Covid-19 Health System Response Monitor (HSRM) and classified according to the framework. We found that income loss was not a problem in countries where professionals were paid by salary or capitation and hospitals received global budgets. In countries where payment was based on activity, income loss was compensated through budgets and higher fees. New FFS payments were introduced to incentivize remote services. Payments for COVID-19 related costs included new fees for out- and inpatient services but also new PD and DRG tariffs for hospitals. Budgets covered the costs of adjusting wards, creating new (ICU) beds, and hiring staff. We conclude that public payers assumed most of the COVID-19-related financial risk. In view of future pandemics policymakers should work to increase resilience of payment systems by: (1) having systems in place to rapidly adjust payment systems; (2) being aware of the economic incentives created by these adjustments such as cost-containment or increasing the number of patients or services, that can result in unintended consequences such as risk selection or overprovision of care; and (3) periodically evaluating the effects of payment adjustments on access and quality of care.

Keywords: COVID-19; Compensations; Economic incentives; Payment mechanisms.

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Conflict of interest statement

The authors declare no competing interests

Figures

Fig 1
Fig. 1
A typology of COVID-19 related adaption of provider payment
Fig 2
Fig. 2
Payments to incentivize the implementation and provision of remote and e-health services.
Fig 3
Fig. 3
Changing the payment mix in England.
Fig 4
Fig. 4
. Analytical frameworks characterizing payment mechanisms and their incentives
See this image and copyright information in PMC

References

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