Quality-enhancing incentive initiatives for hospital care: policy implications and management requirements.

During the last decades, in many countries retrospective payment systems for hospital care have beenreplaced by prospective payment methods, mainly DRG-based ones. The latter, though encouraginga more efficient use of hospital resources, present several undesired effects, some of which are likelyto jeopardize the quality of care. The aim of the paper is to examine the main issues in designing andimplementing an effective scheme of financial incentives for enhancing quality of hospital care. Themain international experiences regarding the adoption of hospital performance-based incentives aswell as the existing empirical evidence on their capacity to effectively boost quality of care are alsocritically analysed. Finally, some managerial remarks are considered in order to provide indicationsfor the concrete implementation process and to contribute to the definition of a quality-enhancingincentive scheme well suited to the peculiarities of each organization system.