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Pay-for-performance in cataract surgery: the first quality-based payment system in Europe

Session Details

Session Title: Special Issues

Session Date/Time: Friday 15/02/2013 | 08:30-10:00

Paper Time: 09:11

Venue: Hall 2

First Author: : J.Förster GERMANY

Co Author(s): :    T. Herbst   D. Uthoff           

Abstract Details


The aim of this study is to present the first pay-for-performance approach for cataract surgery in Germany. Furthermore, possible effects of quality-based payments on quality of supply will be presented.


“Quality Network Bellvue“ (QNB) and “Quality Index Bellevue” (QiB) as foundation for quality measurement will be characterized. A description of the developed quality-based payment system will be made and first results will be presented.


The presentation of the pay-for-performance approach will occur in a descriptive way. Statistical methods will be used for identifying significant effects, which may be explained by quality-based payments. Therefore, we will compare first findings after introducing quality-based payments with corresponding findings before introduction. For comparisons of single QiB findings, we will use Mann-Whitney-Test and Kruskal-Wallis tests. For examinations on aggregate levels, ANOVA test as well as ordinary t-test will be used.


We identified significant improvements by introducing quality-based payments in the following aspects: reduced total time of hospital stay (p=0,032) and increased overall patient satisfaction (p=0,002). Since medical care is independent of health insurance, we did not find any differences in peri- and postoperative medical findings. Since the introduction of quality-based payments in cataract surgery took place on 1st of October, our empirical results are just a midterm conclusion, which base on 117 quality-based cataract cases. Further analyses will be undertaken three months after introduction of the quality-based payment system.


The long-run goal of every healthcare system is to develop a payment system, in which the amount of payments are geared not only to incurred costs but also to rendered quality of care. The Eye Hospital Bellevue has made the first step towards the realization of this vision together with a German health insurance. Payments per patient receiving cataract treatment depend on reached quality level of medical outcome, which is captured by Quality Index Bellevue system (QiB system). The individual QiB of every single cataract case is compared to a predefined value, which represents the overall mean QiB of the past year. This comparison decides about a financial bonus (in case of higher quality level) or malus (lower quality level). First results support our hypotheses of significant reduced time of hospital stay as well as increased patient satisfaction. Structural model supports causality between introduced payment system and explanatory variables (total time of hospital stay, patient satisfaction). Further analyses will follow 3 months after introduction of the quality-based payment system.

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