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Janka Jančovičová Health Care Surveillance Authority , Bratislava

Quality indicators and their role in contractual relations between health care providers and health insurance companies. Janka Jančovičová Health Care Surveillance Authority , Bratislava. Quality of provided health care. From the view of WHO the highest possible level of expertise

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Janka Jančovičová Health Care Surveillance Authority , Bratislava

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  1. Quality indicators and their role in contractual relations between health care providers and health insurance companies Janka Jančovičová Health Care Surveillance Authority,Bratislava

  2. Quality of provided health care • From the view of WHO • the highest possible level of expertise • effective usage of resources • minimal risk for patient • high level of patient satisfaction • patness of health care provision

  3. „Quality“ of provided health care • Quality is a category, describing in quantitative and qualitative terms the level of provided health care or provided services • quality thus consists of two parts - the quantitative, measurable, and the qualitative, based on the system of values, • Quality is a relative, not an absolute category (Dr. Marx, JCR/JCI, WHO, Bratislava 2005)

  4. Quality indicators • internal – monitoring and evaluation of results of provided health care (unveiling the problems, proposing solutions, permanently increasing of quality) • external – assessment of the quality of health care providers, comparison with other providers

  5. Legislative framework of quality indicators §7, LawNo. 581/2004 Z. z. issued by the government directivefor the purpose of assessment of selectedareas of health care provision • accessibility of health care • effective usage of resources • effectiveness and adequacy • perception of providedhealth care by the patient • results of provided health care

  6. Legislative framework of quality indicators §7, LawNo. 581/2004 Z. z. Obligations of health insurance company • to publish criterions of conclusion of contracts related to 1.material and technical equipment and human resources of the providers 2.quality indicators • to create a list of providers according to criterions fulfillment • to conclude contracts with providers on the grounds of their position in the list

  7. Criterions for conclusion of contracts on health careprovision andcoverage

  8. Number of contracts between health insurance companies and health care providers- 31.12.2006 Total :50 925

  9. Percentage assessmentof levels of quality indicators

  10. Role of quality indicators assessment in contractual relations • in relation to legislative framework in force • in relation to actual demand of health insurance companies • In relation to actual demand of health care providers

  11. Role of quality indicators assessment in contractual relations • selection of appropriate quality indicators??? • methodology of quality indicators collection and assessment??? • validity of data??? • competition or motivation???

  12. Problem areas of assessment of external quality indicators from the view of health insurance companies • Universal set of quality indicators (not influenced by specifics of insurance base) • Methodology of collection and assessment (error of little numbers) • Setting of clear criterions of conclusion of contracts considering quality indicator level • (effectivity and quality )

  13. Problem areas of assessment of external quality indicators from the view of health care providers • Validity of data in relation to increasing administrative burden of health care providers • Assessment of „non-measurable“ partof selected forms of health care • Feedback by assessment of results in relation to increasing level of qualityof provided health care

  14. Quality indicators in contractual relations – future vision • Assessment of quality of provided health care aimed at: Creation of differential treatment system by conclusion of contractual relation between health insurance companies and health care providers according to appropriately selected and targeted criterions of quality and effectivity of provided health care.

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