Czech public health insurer tests quality-of-care reimbursement plan

The Czech Republic's General Health Insurance Company (VZP) has introduced a new payment model designed to improve the quality and efficiency of care provided by hospitals. Under this pilot initiative, hospitals will be reimbursed based on the successful treatment of patients rather than on complications that require further interventions.

The two-year pilot program will initially focus on knee and hip replacement surgeries, as well as catheter ablations for atrial fibrillation—a common heart rhythm disorder. Each year, doctors perform nearly 50,000 joint replacements and over 10,000 catheter ablations in the Czech Republic.

The new model is inspired by similar systems in countries such as the United States, where insurers compensate healthcare providers for successfully curing patients, rather than for prolonged treatments due to complications arising from poor care.

The payment package covers both pre-operative assessments and post-operative rehabilitation, extending up to 90 days after surgery. VZP announced the pilot program earlier this year, and is already working with hospitals. Patient quality of care is evaluated through interviews conducted both before and after operations.

"The reimbursement [to hospitals] is set as a package payment - we deduct, for example, if the subjectively perceived pain after the procedure is higher than it should be on average. On the other hand, we are also able to add some bonus mechanisms," Jan Bodnár, deputy director of VZP, recently explained to Czech Television.

The two-year pilot project is being first introduced in five hospitals specializing in joint replacements and three hospitals performing catheter ablations. Healthcare providers that deliver care without complications would receive higher payments compared to the current system. Conversely, VZP will not provide additional compensation for complications deemed to be caused by substandard care.

When announcing the pilot program, VZP Director Zdeněk Kabátek expressed confidence that hospitals participating in the program would not refuse patients who are at higher risk of complications. Currently, complication rates are low, affecting only about two percent of orthopedic procedures and four percent of heart-related interventions.

Kabátek estimates that the pilot project could save VZP millions of Czech crowns. However, he emphasized that the primary goal is not cost savings, but rather finding a payment model that promotes higher-quality and more efficient healthcare.