Provider Payment Reforms for Improved Primary Health Care in Romania
Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanis...
| Main Authors: | , , , |
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| Format: | Working Paper |
| Language: | English |
| Published: |
World Bank, Washington, DC
2021
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| Subjects: | |
| Online Access: | http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania http://hdl.handle.net/10986/36189 |
| Summary: | Romania faces high levels of amenable
mortality reflecting, in part, the relatively low
utilization rates of high-quality primary health care (PHC),
particularly for non-communicable disease (NCD) prevention
and treatment. Provider payment mechanisms do not reward the
high-quality care provision and may incentivize bypassing of
PHC for hospitals, exacerbating challenges presented by
physical, financial, and social barriers to accessing
essential care. This paper assesses provider payment
mechanisms at the PHC level, by examining their design
features and implementation arrangements, and exploring
their implications for PHC performance in terms of access
and quality of care. The authors conclude with policy
recommendations to address the constraints identified. To
increase the supply of preventative care and case
management, the authors recommend that volume thresholds for
fee-for-service payments reflect both the number of
enrollees and physicians in a practice; laboratory tests
required for case management be reduced in scope and their
costs be reimbursed; and the law on health care reform be
amended to enable the introduction of new payment
mechanisms, such as performance-based payments. To expand
the scope of PHC and strengthen care coordination with
hospitals, periodic reviews by physician commissions should
aim to expand the scope of PHC care in line with provisions
in other European Union (EU) countries for ambulatory-care
sensitive conditions; capitation payments should be adjusted
for gender and historical service use to reduce incentive
for over-referrals; and payment mechanisms that reward
coordination of care, including bundled payments, should be
introduced. To establish an enabling environment for
provider payment reforms, health information systems should
be strengthened by unifying diagnosis coding, establishing
quality standards, and ensuring referral module
functionality; payment reforms should be informed by
extensive consultations with providers at all service
delivery levels; and PHC spending should be increased to
support higher reimbursement levels for providers and match
expenditure levels in high-performing EU health systems. |
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