1. Quality Bonus System in Latvia
Inga Inkina
Senior expert of Outpatient Service Division
of Health Services Department

2. History of Quality Bonus System in PHC
First quality bonus system was introduced in 2004
mandatory for all GPs
8 indicators for regular practice, 6 indicators for pediatric practice
introduced together with capitation payment system
funding: 9% of capitation money
incentives for all indicators which are met

3. History of Quality Bonus System in PHC
In addition to mandatory system, a voluntary quality bonus system was introduced in 2011
On voluntary basis
Additional funding
36 process, outcome and resource indicators
to receive money, GPs were required to meet five compulsory indicators

4. Current Quality Bonus System
United Quality Bonus System was introduced in 2013
mandatory for all GPs
13 indicators for prevention, management of chronic conditions, improvement of cost effectiveness, increase of comprehensiveness of PHC
no compulsory indicators – incentives for all indicators which are met

5. Objectives of Quality Bonus system in Latvia for PHC
To strengthen organization of PHC practice To increase accessibility of GP To promote the GP active involvement in disease prevention To ensure more effective management of patients with chronic diseases To tackle the spread of infectious diseases To motivate GP-s to provide broad range of health services to patients

6. Organization of Primary Health Care in Latvia
General practitioner (family doctor) has a gate-keeping role
94.3% inhabitants have chosen a GP
An average number of patients per one GP: 1584
Access: up to 5 days, if acute situation: at the same day
Reimbursement system for the purchase of medicines (Pharmaceuticals reimbursed in whole or in part )

7. QBS indicators: Routine health checks
Indicator definition
Threshold
Percentage of new patients with routine health check-up within 3 months of registration
75-90%
Percentage of adult patients who have had check-up per annum
65-75%

8. Percentage of patients who have had check-up per annum, age 2-18 years
Child health
Indicator definition
Threshold
Percentage of children who have been vaccinated according to vaccination calendar
92- 98%
Percentage of patients who have had check-up per annum, age 2-18 years
75- 95%

9. Cancer screening indicators
Indicator definition
Threshold
Target population screened in defined period (CCS, women aged 25-70)
36-50%
Target population screened in defined period (BCS, women aged 50-69)
Target population screened in defined period (ColCS, men and women aged 50-74)
11-25%

10. Diabetes Mellitus: monitoring processes
Indicator definition
Threshold
Percentage of patients with type II diabetes who have had measured glycated haemoglobin tests
75-90%
Percentage of patients with type II diabetes who have had measured glycated haemoglobin tests (except in an inpatient setting) in the previous year and the result of test is below 7,5%
Percentage of patients with type II diabetes who have had a record of micro-albuminuria testing
50-75%

11. Arterial hypertension and Coronary Heart Disease monitoring processes
Indicator definition
Threshold
Cardiovascular disease risk assessment (SCORE)
60-90%
Percentage of arterial hypertension patients who have had a low-density cholesterol test
70-90%
Percentage of CHD patients who have had a low-density cholesterol test

12. Short description Indicator definition Threshold
Asthma monitoring processes
Percentage of asthma patients who have had at least one measurement of peak expiratory
75-90%
Cost efficiency of SEMS calls
Number of SEMS visits to patients with definite diagnosis, who had not been hospitalized
Quantity of additional services performed by GP
GP provides various range of procedures, interventions and services
25-50%

13. Results of QBS in 2015

14. Results of QBS 14

15. PhoneE-mail: nvd@vmnvd.gov.lv Homepage: www.vmnvd.gov.lv
Cesu Str. 31 k-3
Riga, Latvia, LV-1012
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