Innovation in European healthcare – what can Sweden learn? - LIF

PbR is being incrementally reformed to incentivise
quality care through Best Practice Tariffs (BPTs)
• Although tariffs are based on national average costs, they are not exactly reflective of them. The DH
reinforces the cost-reducing incentive of a tariff fixed at average cost by annually reducing all tariffs to
encourage efficient use of NHS resources.
• PbR system does not contain any safeguards to balance the risk of losing clinical quality when cost-cutting
is prioritised.
• Best Practice Tariffs (BPTs) were introduced in 2010/11 to incentivise reimbursement based on clinical
quality and shift away from costing mechanisms based on average costs.
• BPTs have been introduced where the costs are below the national average costs for a given procedure, or
where there is significant unexplained variation in current practice, or where the evidence base defining
good practice is strong.
• BPTs have their scope expanded on an annual basis. The revisions are prioritising an initiative to shift
hospital activity and its costs to other care settings. It will expand the number of procedures covered by the
BPTs and aim to incentivise day case and outpatient activity
• Similarly, a ‘pay for performance’ component is introduced in the form of the Commissioning for Quality
and Innovation (CQUIN) payment framework.
• CQUIN was first introduced in 2009/10. It acts as a further incentive for providers by allowing them to
potentially earn an additional 2.5% of their income depending on how well they meet specific standards of
quality improvement.
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