Effect on hospital incentive payments and quality performance of a hospital pay for performance (P4P) programme in Belgium

Background

Belgium initiated a hospital pay for performance (P4P) programme after a decade of fixed bonus budgets for “quality and safety contracts”. This study examined the effect of P4P on hospital incentive payments, performance on quality measures, and the association between changes in quality performance and incentive payments over time.

Methods

The Belgian government provided information on fixed bonus budgets in 2013–2017 and hospital incentive payments as well as hospital performance on quality measures for the P4P programmes in 2018–2020. Descriptive analyses were conducted to map the financial repercussion between the two systems. A difference-in-difference analysis evaluated the association between quality indicator performance and received incentive payments over time.

Results

Data from 87 acute-care hospitals were analyzed. In the transition to a P4P programme, 29% of hospitals received lower incentive payments per bed. During the P4P years, quality performance scores increased yearly for 55% of hospitals and decreased yearly for 5% of hospitals. There was a significant larger drop in incentive payments for hospitals that scored above median with the start of the P4P programme.

Conclusions

The transition from fixed bonus budgets for quality efforts to a new incentive payment in a P4P programme has led to more hospitals being financially impacted, although the effect is marginal given the small P4P budget. Quality indicators seem to improve over the years, but this does not correlate with an increase in reward per bed for all hospitals due to the closed nature of the budget.