title: Healthcare payment reforms across western countries on three continents: lessons from stakeholder preferences when asked to rate the supportiveness for fulfilling patients' needs.
abstract: To test the hypothesis that care typology-being complex and highly unpredictable versus being clear-cut and highly predictable-guides healthcare payment preferences of physicians, policy makers, healthcare executives, and researchers. We collected survey data from 942 stakeholders across Canada, Europe, Oceania, and the United States. A total of 48 international societies invited their members to participate in our study.
  
  
  METHODS
  Cross-sectional analysis of stakeholder survey data linked to four scenarios of care typology: primary prevention, trial-and-error care, standard care and network care.
  
  
  RESULTS
  We identified two "extremes": (1) dominant preferences of physicians, who embraced fee for service (FFS), even when this precludes the advantages of other payment systems associated with a minimal risk of harm (OR 1.85 for primary prevention; OR 1.89 for standard care, compared to non-physicians); and (2) the dominant preferences of healthcare executives and researchers, who supported quality bonus or adjustment (OR 1.92) and capitation (OR 2.05), respectively, even when these could cause harm.
  
  
  CONCLUSIONS
  Based on exploratory findings, we can cautiously state that payment reform will prove to be difficult as long as physicians, healthcare executives, and researchers misalign payment systems with the nature of care. Replication studies are needed to (dis)confirm our findings within representative subsamples per area and stakeholder group.
authors.affiliation: Center for Health Services and Nursing Research, University of Leuven, Kapucijnenvoer 35, 3000 Leuven, Belgium. pieter.vanherck@med.kuleuven.be
authors.forename: Pieter
authors.initials: P
authors.lastname: Van Herck
authors.forename: Roselinde
authors.initials: R
authors.lastname: Kessels
authors.forename: Lieven
authors.initials: L
authors.lastname: Annemans
authors.forename: Abdelouahab
authors.initials: A
authors.lastname: Bellou
authors.forename: Johan
authors.initials: J
authors.lastname: Wens
authors.forename: Walter
authors.initials: W
authors.lastname: Sermeus
mesh_terms: D001291:Attitude of Health Personnel; D001315:Australia; D002170:Canada; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration; D005060:Europe; D018588:Fee-for-Service Plans / Q000191:economics / Q000458:organization & administration; D005260:Female; D018166:Health Care Reform / Q000191:economics / Q000458:organization & administration; D006270:Health Facility Administrators; D006291:Health Policy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010820:Physicians; D011322:Primary Prevention / Q000191:economics / Q000458:organization & administration; D011445:Prospective Payment System / Q000191:economics / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D014481:United States