Pay-for-performance in resource-constrained settings: Lessons learned from Thailand’s Quality and Outcomes Framework

Abstract

Many countries have introduced pay-for-performance (P4P) Introduction. models to encourage health providers and institutions to provide good quality of care. In 2013, the National Health Security Office of Thailand introduced P4P, based on the UK Quality and Outcomes Framework (QOF), as a mandatory programme for primary care providers. This study aims to review the first year of the Thai QOF policy, focusing on the key features of its formulation and implementation stages.This study used a mix of data collection Methods. approaches, such as literature review, in-depth interviews with QOF managers, and focus-group discussions with health officers and practitioners. Data were collected between June and August 2015 and transcribed and analysed using qualitative content analysis (interpretation of the content of text data through the systematic classification process of identifying themes or patterns). Two consultation meetings were organised to verify the preliminary findings.Based on the UK model, the Thai QOF was formulated without formal Results. consultation with key stakeholders. Additionally, programme managers adopted a 'learning by doing' approach, since Thai authorities were already aware of health system limitations, such as insufficient human and financial resources and unreliable databases. There were also problems with QOF implementation, as follows: 1) deducting the budget from the annual payment for ambulatory care made the policy unjustified because providers did not receive full subsidisation of their service delivery; 2) lack of key stakeholder engagement resulted in miscommunication, and subsequently misunderstanding and inadequate coordination, for the translation of QOF policy into action; and 3)

Developing and testing quality indicators for the Thai Quality and Outcomes Framework

“…However, early evaluation of the program identified that the quality measures in use were perceived to have poor validity which negatively impacted upon the acceptability of the scheme, with resulting variation in uptake and financing at the local level [5]. In response, an independent research unit in the Ministry of Health-the Health Intervention and Technology Assessment Program (HITAP) was commissioned to develop and pilot potential quality indicators to be implemented in fiscal year 2017.…”