Chapter 2

eal demand control aimed no longer only at curbing costs but at appropriate satisfaction
of needs, given the available supply structure, could result in measurement of the outcome
produced in terms of health.
Despite the presence of numerous programmes aimed at safeguarding health which
directly involve the GP, the indication of real health outcomes is still poor; the latter should
form the basis for the monitoring system to verify the real effectiveness of the actions
taken, also in relation to the costs sustained for implementing the new organizational
methods and any savings deriving from the avoidance of more serious pathologies. From
this point of view, we still seem to be a long way from forms of payment incentivating
quality, such as the one provided for by the British GP contract in April 2004 (Roland,
2004).
Rather than a correlation between incentives and health outcomes, from analysis of the
agreements a correlation can be found between incentives and predicted output of the
activity performed, quantified for example in the achievement of a certain coverage of the
population subject to screening, or using the number of meetings arranged to define shared
guidelines as indicators for verifying the contribution of GPs to the programmes
implemented, while the indicators concerning verification of their real impact on patient
health are still poor.
1.6.5 Conclusions
The analysis performed offers some useful indications for comparing the different regional
policies for demand control geared to strengthening of the role of primary care and
can, furthermore, contribute to ascertaining whether and to what extent the new organization
of primary care can be an effective and appropriate tool for supporting direction
and selection of people’s needs.
From the assessments, what undoubtedly emerges is a first positive attempt to switch
from objectives designed to ration demand to a real desire to tackle patient problems,
thus creating a new role for primary care as the guarantor of appropriate use of the
Regional Health System resources. In relation to the tools adopted, in the transition from
the regional agreements following the NCA of 2000 to those currently stipulated, there is
less emphasis on expenditure ceilings and/or limits to deliverable equipment and services
and greater attention to the planning of diagnostic-therapeutic paths. However, we
are still a long way from achieving the objective of real promotion and assessment of
health outcomes, i.e. of the real effectiveness of the policies adopted.
With regard to the methods of incentivation for GPs who contribute to achievement of the
objectives, extension of the variable service quality component is positive, but organization
in three control levels (national, regional and health authority) can be very complex
(and therefore weaken the effectiveness of the incentives), due both to the presence of
numerous objectives to be pursued simultaneously and because the part of the variable
component allocated to pursuing objectives at decentralized level (where it is easier to
measure and control the results) is still relatively low (approximately 30%).
Furthermore, the variable component does not yet represent a real result-based payment
and this is due to:
[101]
CEIS Health Report 2006