Informing the development of a resource allocation framework in the German healthcare system

In the German statutory health insurance (SHI) system, the payment of office-based physicians in the ambulatory care sector is based on a complex system involving national and regional stakeholders. Payment rates are derived from a national relative value scale but, as budgets are negotiated at the regional level, conversion factors for the relative values and thus prices for the same service can vary by region. Against this background, the National Association of Statutory Health Insurance Physicians (KBV) in Germany is looking to develop a national approach that allocates funds according to a unified framework, while taking account of regional characteristics. As part of this new approach, the KBV seeks to incorporate quality indicators into the allocation formula so as to improve the overall quality of care provided by SHI physicians. This report aims to inform the development of the quality component of the proposed national resource allocation framework in the German statutory healthcare system by providing an overview of quality indicator systems and quality measurement approaches, including criteria for selecting measures of quality currently used for 'high stakes' assessment in high-income countries globally. High stakes uses of performance measures mean that the provider's performance scores are used for public accountability (making results transparent through public reporting) and/or for differentially allocating resources (pay-for-performance or P4P).