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Leveraging UHC to Achieve High Quality Care

The JLN Quality Track convenes in Bangkok, Thailand

Quality is often a forgotten component in universal health coverage (UHC) reforms. How can payers enhance the quality of health care as they move toward UHC? This is the key question under discussion in the Joint Learning Network for Universal Health Coverage (JLN) Quality Track meeting held on January 23-24, 2012, entitled “Leveraging Universal Health Initiatives to Achieve High-quality Care.”

Led by the Institute for Healthcare Improvement and NICE International, meeting brought together nearly 80 colleagues and partners from the JLN countries as part of the JLN program at the 2012 Prince Mahidol Award Conference (PMAC) in Bangkok, Thailand.

Yesterday we learned about a range of mechanisms countries are using to purchase quality health care. For example:

  • Dr. George Midiwo from Kenya’s National Hospital Insurance Fund (NHIF) described how the NHIF has trained QA officials who review every claim and work with providers to apply clinical pathways for care and establishes contracts with providers, which include requirements for accreditation, active quality assurance (QA) programs, surveillance systems, and clinical audits.

  • Dr. Nicholas Tweneboa from Ghana’s National Health Insurance Authority (NHIA) discussed the “paradox” of capitation payment methodologies, which present an inherent risk of under-provision of health care. Dr. Tweneboa shared nine different ‘control knobs’ Ghana is using for mitigating this risk in the NHIA capitation pilot in the Ashanti Region – ranging from accreditation and clinical audits to active monitoring of claims data and the power of “word of mouth.”

  • Dr. Anuwat Supachutikul from Thailand’s Healthcare Accreditation Institute shared the 30 year QA journey in Thailand’s health care system, from an early focus on structural measures, to total quality management, to mandatory accreditation for hospitals participating in the Universal Coverage Scheme. Dr. Anuwat emphasized that accreditation has primarily been an educational process through which providers receive peer support to identify opportunities for improvement, implement QA and quality improvement initiatives, and ultimately build an institutional culture of quality. He said Thailand’s next step on the QA journey will focus on tangible performance management in addition to provider education.

These examples and many more, illustrate the pivotal role that health care purchasers can play and the variety of levers they can use to improve health care quality. JLN country teams began working together to formulate specific goals and a strategy for payer-led quality improvement in each country.

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