Balancing financial incentives during COVID-19: A comparison of provider payment adjustments across 20 countries |
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| Institution: | 1. Department of Health Care Management, Faculty of Economics & Management, Technische Universität Berlin, Germany;2. The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Jerusalem, Israel;3. Belgian Health Care Knowledge Centre, Belgium;4. Faculty of Public Health, Medical University – Varna, Bulgaria;5. Center for Social and Economic Strategies, Faculty of Social Science, Charles University, Czechia;6. University of Copenhagen, Department of Public Health, Section for Health Services Research, Copenhagen, Denmark;7. London School of Hygiene and Tropical Medicine, London, UK;8. WHO Barcelona Office for Health Systems Financing, Spain;9. Tampere University, Faculty of Social Sciences, Finland;10. Finnish Institute for Health and Welfare and Tampere University, Faculty of Social Sciences, Finland;11. Institute for Research and Information in Health Economics, France;12. Section of Hygiene, University Department of Life Sciences and Public Health-Università Cattolica del Sacro Cuore, Italy;13. UOC ISP Prevention and Surveillance of Infectious and Chronic Diseases-Department of Prevention-Local Health Authority (ASUR-AV2), Jesi, Italy;14. Faculty of Public Health, Health Research Institute, Medical Academy, Lithuanian University of Health Sciences, Lithuania;15. Netherlands Institute of Health Services Research, Utrecht, the Netherlands;p. Department of Health Economics and Social Security, Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Cracow, Poland;q. National School of Public Health, Management and Professional Development Bucharest, Romania;r. National School of Public Health, Management and Professional Development Bucharest, Faculty of Medicine, University Titu Maiorescu, Romania;s. National Institute of Public Health of Slovenia, Department of Public Health, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia;t. Data Sciences for Health Services and Policy Research. Institute for Health Sciences in Aragon (IACS), Spain;u. University of Lucerne Department of Health Sciences and Medicine, Switzerland;v. European Observatory on Health Systems and Policies, Belgium;w. Swedish Agency for Health and Care Services Analysis |
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| 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. |
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