Quality Bonus System in Latvia Inga Inkina Senior

Quality Bonus System in Latvia Inga Inkina Senior expert of Outpatient Service Division of Health Services Department

History of Quality Bonus System in PHC • First quality bonus system was introduced in 2004 • mandatory for all GPs • 8 indicators for regular practice, 6 indicators for pediatric practice • introduced together with capitation payment system • funding: 9% of capitation money • incentives for all indicators which are met 2

History of Quality Bonus System in PHC • In addition to mandatory system, a voluntary quality bonus system was introduced in 2011 • On voluntary basis • Additional funding • 36 process, outcome and resource indicators • to receive money, GPs were required to meet five compulsory indicators 3

Current Quality Bonus System • United Quality Bonus System was introduced in 2013 • mandatory for all GPs • 13 indicators for prevention, management of chronic conditions, improvement of cost effectiveness, increase of comprehensiveness of PHC • no compulsory indicators – incentives for all indicators which are met 4

Objectives of Quality Bonus system in Latvia for PHC To strengthen organization of PHC practice To increase accessibility of GP To promote the GP active involvement in disease prevention To ensure more effective management of patients with chronic diseases To tackle the spread of infectious diseases To motivate GP-s to provide broad range of health services to patients

Organization of Primary Health Care in Latvia §General practitioner (family doctor) has a gatekeeping role § 94. 3% inhabitants have chosen a GP §An average number of patients per one GP: 1584 §Access: up to 5 days, if acute situation: at the same day §Reimbursement system for the purchase of medicines (Pharmaceuticals reimbursed in whole or in part ) 6

QBS indicators: Routine health checks Indicator definition Percentage of new patients with routine health check-up within 3 months of registration Percentage of adult patients who have had check-up per annum Threshold 75 -90% 65 -75% 7

Child health Indicator definition Threshold Percentage of children who have been vaccinated according to vaccination calendar 92 - 98% Percentage of patients who have had check-up per annum, age 2 -18 years 75 - 95% 8

Cancer screening indicators Indicator definition Threshold Target population screened in defined period (CCS, women aged 25 -70) 36 -50% Target population screened in defined period (BCS, women aged 50 -69) 36 -50% Target population screened in defined period (Col. CS, men and women aged 50 -74) 11 -25% 9

Diabetes Mellitus: monitoring processes Indicator definition Threshold Percentage of patients with type II diabetes who have had measured glycated haemoglobin tests (except in an inpatient setting) in the previous year and the result of test is below 7, 5% Percentage of patients with type II diabetes who have had a record of micro-albuminuria testing 75 -90% 50 -75% 10

Arterial hypertension and Coronary Heart Disease monitoring processes Indicator definition Threshold Cardiovascular disease risk assessment (SCORE) 60 -90% Percentage of arterial hypertension patients who have had a low-density cholesterol test 70 -90% Percentage of CHD patients who have had a lowdensity cholesterol test 70 -90% 11

Short description Indicator definition Threshold Asthma monitoring processes Percentage of asthma patients who have had at least one measurement of peak expiratory 75 -90% Cost efficiency of SEMS calls Number of SEMS visits to patients with definite diagnosis, who had not been hospitalized Quantity of GP provides various range of additional services procedures, interventions and services performed by GP 25 -50% 12

Results of QBS in 2015 Percentage of Fulfilment (%) 2015 80 74. 6 70 63. 3 60 50. 3 50 45. 2 42. 6 37. 8 40 35. 3 31. 5 30 23. 7 18. 7 20 17. 6 17 13. 1 10 0 1 2 3 4 5 6 7 8 9 10 11 12 13 No of Indicator 13

Results of QBS 2014 -2015 250 228 222 195 200 170 168 Number of GP 156 147 150 142 137 128 9492 93 88 100 90 82 64 57 50 42 34 34 27 31 17 Quantity of indicators fulfiled 0 2015 2014 0 27 34 1 88 93 2 147 170 3 228 195 4 156 222 5 168 142 6 137 128 7 94 92 8 90 82 9 57 64 10 42 34 11 17 31 17 9 8 6 12 17 9 13 8 6 14

Cesu Str. 31 k-3 Riga, Latvia, LV-1012 Phone. E-mail: nvd@vmnvd. gov. lv Homepage: www. vmnvd. gov. lv Twitter: www. twitter. com/vmnvd