Dagens FSV-oversigt: Quality check: does it matter for quality how you organize and pay for health care? A review of the international evidence.
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Dagens #fsvoversigt:
Quality check: does it matter for quality how you organize and pay for health
care? A review of the international evidence.
Int J Health Serv. 2014;44(3):479-505
Authors: Footman K, Garthwaite K, Bambra C, McKee M
Abstract
Health systems in high-income countries have experienced significant
organizational and financial reforms over the last 25 years. The implications
of these changes for the effectiveness of health care systems need to be
examined, particularly in relation to their effects on the quality of health
services (a pertinent issue in the United Kingdom in light of the Francis
Report). Systematic review methodology was used to locate and evaluate
published systematic reviews of quantitative intervention studies (experimental
and observational) on the effects of health system organizational and financial
reforms (system financing, funding allocations, direct purchasing arrangements,
organization of service provision, and service integration) on quality of care
in high-income countries. Nineteen systematic reviews were identified. The
evidence on the payment of providers and purchaser-provider splits was
inconclusive. In contrast, there is some evidence that greater integration of
servi
ces can benefit patients. There were no relevant studies located relating to
funding allocation reforms or direct purchasing arrangements. The systematic
review-level evidence base suggests that the privatization and marketization of
health care systems does not improve quality, with most financial and
organizational reforms having either inconclusive or negative effects.
PMID: 25618986 [PubMed - indexed for MEDLINE]
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