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Die Qualität der Versorgung, ihre Sicherung, Verbesserung und Incentivierung sind das erklärte Ziel der Krankenhausgesetzgebung der letzten Jahre. Für die Diskussion über Bewertung, Vergütung und Kommunikation von Qualität im medizinischen Versorgungsgeschehen liefert der Qualitätsmonitor 2019 weitere Impulse. Das Werk greift jährlich relevante Themen aus stationärer und sektorenübergreifender Versorgung auf. Die Fachbeiträge gehen dabei der Frage nach, wie sich das Versorgungssystem unter Qualitätsaspekten gestalten lässt und wie Versorgungsqualität transparenter gemacht werden kann. Weiterhin werden Strukturanforderungen einer qualitätsorientierten medizinischen Versorgung diskutiert und die wissenschaftliche Evidenz zur Gestaltung relevanter Versorgungsbereiche zusammengefasst. Eine weitere Sektion zeigt Eckdaten zur Versorgungsstruktur und Qualitätsdaten der deutschen Krankenhäuser. Der Qualitätsmonitor 2019 unterstützt fundiert die Qualitätssicherungsdebatte in Deutschland.

Medical / Health Care Delivery --- Medicine --- Health Workforce --- quality --- health care --- health system --- germany

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Performance-based financing is a complex health system intervention aimed at improving coverage and quality of care. This paper presents the results of an impact evaluation in Cameroon that seeks to isolate the role of specific components of the performance-based financing approach on outcomes of interest, such as explicit financial incentives linked to results, additional resources available at the point of service delivery (not linked to performance), and enhanced supervision, coaching, and monitoring. Four evaluation groups were established to measure the effects of each component that was studied. In general, the results indicate that performance-based financing in Cameroon is an efficient mechanism to channel payments and funding to the provider level, leading to significant increases in utilization in the performance-based financing arm for several services (child and maternal vaccinations and use of modern family planning), but not for others, such as antenatal care visits and facility-based deliveries. However, for many of those outcomes, the differences between the performance-based financing group and the additional financing group are not significant. In terms of quality, performance-based financing was found to have a significant impact on the availability of essential inputs and equipment, qualified health workers, reduction in formal and informal user fees, and increased satisfaction among patients and providers. However, there was a clear effect of additional financing, irrespective of whether it was linked to incentives, in combination with reinforced supervision through performance-based financing. This result suggests that enhanced supervision and monitoring on their own are not sufficient to improve maternal and child health outcomes.

Health Care --- Health System --- Impact Evaluation --- Monitoring And Evaluation --- Performance-Based Financing

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Medicine, Military --- Health care reform --- Evaluation. --- United States. --- Military Health System (U.S.) --- Military Health System (U.S.) --- United States. --- Rules and practice. --- United States --- United States. --- Armed Forces --- Medical care --- Evaluation.

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education --- health --- curricula --- teaching --- unified health system --- Medical education --- Medicine --- Study and teaching --- Health Workforce --- Medical personnel --- Professional education --- Education

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Military hospitals --- Medicine, Military --- Military Health System (U.S.) --- United States. --- United States --- Armed Forces --- Medical care.