Provider Payment Reforms for Improved Primary Health Care in Romania

Publication:
Provider Payment Reforms for Improved Primary Health Care in Romania

dc.contributor.author	Comsa, Radu
dc.contributor.author	Chukwuma, Adanna
dc.contributor.author	Chen, Dorothee
dc.contributor.author	Gong, Estelle
dc.date.accessioned	2021-08-24T14:19:28Z
dc.date.available	2021-08-24T14:19:28Z
dc.date.issued	2021-08
dc.description.abstract	Romania faces high levels of amenable mortality reflecting, in part, the relatively low utilization rates of high-quality primary health care (PHC), particularly for non-communicable disease (NCD) prevention and treatment. Provider payment mechanisms do not reward the high-quality care provision and may incentivize bypassing of PHC for hospitals, exacerbating challenges presented by physical, financial, and social barriers to accessing essential care. This paper assesses provider payment mechanisms at the PHC level, by examining their design features and implementation arrangements, and exploring their implications for PHC performance in terms of access and quality of care. The authors conclude with policy recommendations to address the constraints identified. To increase the supply of preventative care and case management, the authors recommend that volume thresholds for fee-for-service payments reflect both the number of enrollees and physicians in a practice; laboratory tests required for case management be reduced in scope and their costs be reimbursed; and the law on health care reform be amended to enable the introduction of new payment mechanisms, such as performance-based payments. To expand the scope of PHC and strengthen care coordination with hospitals, periodic reviews by physician commissions should aim to expand the scope of PHC care in line with provisions in other European Union (EU) countries for ambulatory-care sensitive conditions; capitation payments should be adjusted for gender and historical service use to reduce incentive for over-referrals; and payment mechanisms that reward coordination of care, including bundled payments, should be introduced. To establish an enabling environment for provider payment reforms, health information systems should be strengthened by unifying diagnosis coding, establishing quality standards, and ensuring referral module functionality; payment reforms should be informed by extensive consultations with providers at all service delivery levels; and PHC spending should be increased to support higher reimbursement levels for providers and match expenditure levels in high-performing EU health systems.	en
dc.identifier	http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania
dc.identifier.doi	10.1596/36189
dc.identifier.uri	https://hdl.handle.net/10986/36189
dc.language	English
dc.publisher	World Bank, Washington, DC
dc.relation.ispartofseries	Health, Nutrition and Population Discussion Paper;
dc.rights	CC BY 3.0 IGO
dc.rights.holder	World Bank
dc.rights.uri	http://creativecommons.org/licenses/by/3.0/igo
dc.subject	UNIVERSAL HEALTH CARE
dc.subject	UNIVERSAL HEALTH COVERAGE
dc.subject	CARE COORDINATION
dc.subject	PROVIDER PAYMENT
dc.subject	PRIMARY HEALTH CARE
dc.title	Provider Payment Reforms for Improved Primary Health Care in Romania	en
dc.type	Working Paper	en
dc.type	Document de travail	fr
dc.type	Documento de trabajo	es
dspace.entity.type	Publication
okr.crossref.title	Provider Payment Reforms for Improved Primary Health Care in Romania
okr.date.disclosure	2021-08-11
okr.date.doiregistration	2025-05-05T12:46:21.768234Z
okr.doctype	Publications & Research
okr.doctype	Publications & Research::Working Paper
okr.docurl	http://documents.worldbank.org/curated/en/936221628662346557/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania
okr.guid	936221628662346557
okr.identifier.externaldocumentum	090224b08889bef0_1_0
okr.identifier.internaldocumentum	33334127
okr.identifier.report	162755
okr.imported	true	en
okr.language.supported	en
okr.pdfurl	http://documents.worldbank.org/curated/en/936221628662346557/pdf/Provider-Payment-Reforms-for-Improved-Primary-Health-Care-in-Romania.pdf	en
okr.region.administrative	Europe and Central Asia
okr.region.country	Romania
okr.topic	Health, Nutrition and Population::Health Economics & Finance
okr.topic	Health, Nutrition and Population::Health Insurance
okr.topic	Health, Nutrition and Population::Health Systems Development & Reform
okr.topic	Industry::Health Care Services Industry
okr.unit	Health Nutrition &Population ECA (HECHN)
relation.isAuthorOfPublication	41aa479e-8677-5046-8dc0-ceca0dc1aa7f
relation.isAuthorOfPublication.latestForDiscovery	41aa479e-8677-5046-8dc0-ceca0dc1aa7f