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

Payment for services changed from block contracts
to a performance based system
• Before 2003, hospitals were mainly paid using a system of annual block contracts, with an
agreed sum of money for a given amount of activity.
• Thus there was no direct relation between activity, case mix and payment.
• Instead of block contracts for activity (which are insensitive to the volume and nature of
activity), from 2002/03 hospitals were to be paid for the activity they undertook, so
called Quality Outcomes Framework (QOF).
• The government argued that this would introduce stronger incentives to ensure
improved performance.
• The QOF gives an indication of the overall achievement of a practice through a points
system.
• The QOF is almost the only area where they can make a difference to their income.
• Most practices got, and still get, a significant proportion of their income through the QOF.
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