Payment and reimbursement

Payment and reimbursement systems in publicly financed services receive a lot of attention in the policy debate. Pros and cons of different solutions hade been debated at length by both academic scholars and practitioners. Not surprisingly, payers and providers often have different views about what constitute an optimal solution.

The outcome of the debate, at least so far, is that no optimal solutions that can meet all requirements and objectives seem to exist. Therefore, the most common recommendation put forward in the literature is to combine different principles. In Swedish primary care, for example, a fixed payment for each registered individual is usually combined with fee-per-visits and pay-for-performance on the top. Internationally, there is a tendency at least in health care services to “move towards the middle”. In countries with predominantly fixed payment, existing payment systems are combined with at least some payment based on volume of activities. In countries with payment based volume of activities, existing systems is rather developed towards the other end.

Although researchers have studied different alternatives at length there is still room for more studies. Little is still known about the effects of combined solutions and when combinations are used in different contexts. Moreover, the design and outcome of new and popular solutions like pay-for-performance is another topic that need to be more researched. Development of pay-for-performance using outcome indicators also opens up for studies of how the internal motivation of professions (and maybe professions more generally) may change as a result of external economic incentives.

Studies of payment and reimbursement systems within PUMAR focus developments of new solutions, as well as the effect of new solutions on services and for professions.

Senast uppdaterad: 2016-03-22