Healthcare Financial Incentives in the Czech Republic from Behavioral Economics and Nudge Theory Perspectives
Abstract
The objective of this paper is to discuss positive and negative outcomes of financial incentives within Payment for Performance (P4P) in health care in the Czech Republic from both international and cross-sectorial comparative perspective. The P4P policymaking processes will be reviewed employing behavioral economics and nudge theory instruments as well as public policy theories focused on stakeholders and historical institutionalism.
On one hand there is a general public and political consensus for supporting healthy lifestyle but on the other there are barriers stemming from the belief why doctors should be rewarded for something that is their job and duty. P4P programs in the Czech Republic are focused mainly and only on general practitioners.
The paper aims to fill in this gap. P4P as a method of reimbursement in healthcare may encourage other healthcare providers to raise healthcare quality, quality of life of patients and bring savings, for instance in the area of obesity which often leads to a number of serious and potentially life-threatening diseases such as type 2 diabetes (DM2), high blood pressure, coronary heart disease, cancer and stroke.
The rate of adult obesity in the Czech Republic is one of the highest in the EU and has increased by more than 30% in the last 15 years. Approximately 20% of adults are obese, above the EU average (15%).
Over 900 thousand Czech people (8.5% of the population) suffer from diabetes, of which 97% have DM2. Every year, 60,000 people become newly diagnosed with diabetes, and 22,000 patients die of incurred complications.
By 2030, there might be up to 1.3 million diabetics. The cost of treatment for DM2 takes up to 15% of the amount paid on public health insurance per year, i.e. over 2 billion euros.
Given that diabetes belongs to the so-called diseases of civilization and its development can be positively influenced by a suitable lifestyle and the improvement of living conditions, it seems possible not only to reduce the number of new patients but also achieve the remission of the disease and relieve public budgets. It is not possible to cope with this problem only medically, it is necessary to involve the institute of public policy in its solution.
P4P with the use of behavioral economics interventions seems to be one of the possible policy options to mitigate the problem as it is based on fair and ethical care for patients, supporting the patient-doctor relations, voluntary participation, using accurate and relevant data and providing fair bonuses for positive outcomes. Hence, the aim of the discussion will be to apply a theoretical lens of behavioral economics and the nudge theory in the analyses and compare their power and validity with other public policy theories.