2014-04-02 Report on reimbursement in health care

2 April 2014

There are no neutral compensation models. Each offers incentives and thus it is important to determine what you want to achieve, explained researcher Peter Lindgren, author of the report Reimbursement in health care - models, effects and recommendations, at a workshop on Wednesday. He asserted that different models suits different categories of care. The report is included in the IFN and SNS joint project Från välfärdsstat till välfärdssamhälle (From welfare state to a welfare society).

In the picture from left: Peter Lindgren, Stefan Kallstrom-Jansson and Erik Wahlberg.

Erik Wahlberg, Praktikertjänst and Stefan Kallström-Jansson, Stockholm health care region, were two of several panelists. They argued that the report is valuable for determining the compensation to health care providers. Also Lars Kolmodin, Region Halland and Jan Steen, Region Skåne, gave their views on the topic, as well as Anna Glenngård, doctor of Economics at Lund University, who commented on the report. She meant, among other things that “nowadays we focus a lot on quality, but we have to define the right goals to secure better quality."

Anna Glenngård, Lund University, commented on the report.

"Over the past 30 years, the governance of health care in Sweden has changed. Caregivers are increasingly guided by economic incentives. Given that county councils decide how compensation should be designed, there are considerable variations between different parts of the country," writes Ilinka Benson, SNS and Henrik Jordahl, IFN, in the introduction to the report. The two of them operates the IFN/SNS project Från välfärdsstat till välfärdssamhälle (From welfare state to a welfare society).

The report explains the advantages and disadvantages of different types of compensation - often used in various combinations. Basically, fixed compensation is given regardless of how much is done and flexible compensation is based on how much was delivered. "Variable compensation gives an incentive to perform as much as possible, which is not the case with fixed compensation," explains report author.

In the picture from left Jan Steen, Region Skåne, Lars Kolmodin, Region Halland and Anna Glenngård listening to Peter Lindgren.

The main reimbursement model in Swedish primary care is called capitation, i.e., the amount of compensation is based on the number of patients in the care of the caregiver. This compensation model is frequently combined with, for example, any type of compensation for targets met or "fines" if the waiting time for an operation is too long, and so on. In specialist care applies instead appropriation; I.e., the compensation is based on a predetermined budget.

Published April 2