The health system must evolve towards an activity and outcome-based funding model, says study by Esade-URL
The study analyses funding models for health services (health centers and hospitals) and outlines the differences between payment systems in Spain and most European countries
Thursday, June 30, 2022. Spain’s national health service must move towards a funding system based on the activity and complex healthcare services of hospitals and also outcomes. Likewise, it would be advisable to generalize the funding system per capita in health centers, taking into account socio-demographic and health factors in the catchment areas of each health center. These are some of the findings of the report "Activity- and outcome-based funding for health services. Towards a healthcare policy based on evidence and value", by the Esade Institute for Healthcare Management and Antares Consulting, with help from Gilead. The study analyses hospital funding models and outlines the differences between payment systems in Spain and most European countries.
The most usual payment system in Spain is budgetary (particularly in public hospitals) and Catalonia is the only autonomous region to have moved towards pay-per-process or diagnosis- related groups. The latter system, in which Spain was a pioneer, has not taken root in Spain. This makes it different from most European countries which have evolved over the last thirty years towards payment per activity in health centers and hospitals, with the addition of payment systems based on value and outcome criteria.
Spain has gone the opposite way compared to European health systems”, say the authors of the report, Manel Peiró, professor at Esade and director of the EsadeGov Institute for Healthcare Management, and Joan Barrubés, partner at Antares Consulting. This is why they recommend moving from budget-based healthcare funding to a model in which funding is based on activity, care complexity and outcomes at all levels: health centers, and medium-stay and acute hospitals.
Strong points: transparency and equality
This change in model is based, according to the authors of the study, on bolstering and enhancing citizens’ perception of transparency and accountability, on the need to accompany the development of a healthcare model based on value, and on the need to ensure an equitable allocation of resources amongst all the healthcare entities in the national health system. “In each autonomous region, it is essential for the health services provided by all healthcare organizations to be funded according to the same finance model to ensure an equitable allocation of public resources,” the report explained.
To complete the change, a very robust technical base is needed to be able to compare and analyze good practices, together with robust leadership, sustained and shared by the health authority, and better governance and management transparency in public-sector health entities. The last point is in keeping with the Congress of Deputies’ findings about social and economic reconstruction, which advocated the professionalization of the management of healthcare organizations and the strengthening of the participatory framework of professionals. Lastly, the authors of the report champion the importance of lead time, a crucial factor if the gap between Spain and European countries is not to widen due to delays in the new funding model.
Iniciativa SanEV
The report is part of the SanEV initiative aimed at creating a space for reflection to help define and implement evidence-based health policies. The SanEv project stems from collaboration between the EsadeGov Institute for Healthcare Management and Antares Consulting, who, with help from Gilead, will work each year on a topic of interest to analyze existing overhauls and changes in healthcare policies. Another of its goals is to help improve the quality of the measures and decisions taken when sharing, discussing and disseminating successful experiences and their impact on citizens. Finally, its purpose is to have a positive impact on the skills and knowledge of managers and professionals working in regional health services.
More information
Judith Mangrané
Assoc. Director
Esade Communications Unit
Tel. 93 495 20 99
judith.mangrane@esade.edu
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