The Open Public Health Journal

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Incentives for Multimodal Treatment-first Step Towards Pay for Quality (P4Q) for Chronic Care: Health Services Research from Germany

Tobias Romeyke1, 2, *, Elisabeth Noehammer2, Harald Stummer2, 3
1 Institute for Management and Economics in Health Care,UMIT- University for Health Sciences, Medical Informatics and Technology, Hall , Austria
2 Waldhausklinik, Acute Hospital for Internal Medicine, Pain Therapy, Complementary and Individualized PatientCentred Medicine, Deuringen, Germany
3 Department of Organization & Management, University Seeburg Castle, Seekirchen/Wallersee, Austria



Pay for Quality (P4Q) is being discussed as an incentive to ensure high quality standards despite cost pressure in healthcare. However, P4Q can also have adverse effects, and the evidence for its effectiveness is limited, especially regarding chronic conditions and multimorbidity. For the treatment of the latter, specific evaluation criteria were defined. Whether these are feasible in the context of costs and remunerations is analyzed in this study using the German DRG system as an example. The aim is to show conditions under which P4Q can be effective.

Methods and Results:

Costs and remuneration for hospitals were compared for an exemplary geriatric indication, with and without complex treatment. Doing so, cost weights were shown to be more than triple for the latter. The results are applicable to health care systems with P4Q or similar approaches.


Introducing complex treatments poses higher and costly demands regarding structure, processes, and interdisciplinary cooperation in organizations. Additional average costs can be calculated by comparison to regular treatment. Covering the extra costs creates the necessary conditions for P4Q and makes the implementation of complex treatments more likely. As high standards have to be guaranteed for complex treatments and patient satisfaction rises when these are introduced, quality improvements can be assumed. This study can inform Health policy (incentive models) medical societies, give impulses for quality management, and healthcare research (patient-oriented health, e.g. consumer-driven health care, shared decision-making). Future studies should report patient-related outcomes and investigate further diagnoses.

Keywords: Reimbursement, Incentive, Costs and cost analysis, Chronic disease, Pain therapy, Remuneration.

Article Information

Identifiers and Pagination:

Year: 2020
Volume: 13
First Page: 405
Last Page: 410
Publisher Id: TOPHJ-13-405
DOI: 10.2174/1874944502013010405

Article History:

Received Date: 18/03/2020
Revision Received Date: 17/06/2020
Acceptance Date: 24/06/2020
Electronic publication date: 18/08/2020
Collection year: 2020

© 2020 Romeyke et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Institute for Management and Economics in Health Care,UMIT- University for Health Sciences, Medical Informatics and Technology, Hall , Austria; Tel: +4350-8648-3871; E-mail:

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