Reforming payment for health care in Europe to achieve better value

This report compares different payment systems for health care used across Europe and examines their role in improving the efficiency and quality of care.

Watch video highlights from the Nuffield Trust Euro Summit 2012, supported by KPMG, which addressed health care payment system reform in Europe.

In January 2012 the Nuffield Trust, with support from KPMG, held a summit for European health leaders, focusing on how best to reform health care payment mechanisms to achieve high-value, sustainable care.

With many countries across Europe facing a severe spending squeeze the summit aimed to:

  • provide the latest information and evidence on European payment reform innovations;
  • draw out cross-country learning;
  • identify the most promising next steps; and
  • promote wider debate.

Reforming payment for health care in Europe to achieve better value reflects the discussion that took place among summit participants and incorporates subsequent analysis.

Health care systems across Europe need to tackle the system-wide inefficiencies in the balance of care provided between hospitals, primary care and other settings

The report authors, Anita CharlesworthAlisha Davies and Jennifer Dixon, suggest that rather than a single payment system such as ‘pay for performance’ or diagnosis-related groups, blended payment systems have repeatedly been found to contribute to the delivery of high-quality, affordable care.

They also explore the reasons why, despite the strong interest in rewarding providers for good quality care and developing payments that cover entire patient care pathways, such reforms have not yet been systematically implemented in Europe.

The authors conclude that, while payment systems are an important tool for policy-makers, they should be seen as part of a basket of measures for maximising efficiency and effectiveness that also includes professional culture, public attitudes, and the legal and regulatory framework. Therefore, changes to payment systems need to be part of a wider programme of reform.

The Nuffield Trust is grateful to KPMG for their expertise, support and advice throughout this project.



Suggested citation

Charlesworth A, Davies A and Dixon J (2012) Reforming payment for health care in Europe to achieve better value. Research report. Nuffield Trust.