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Variance or clinical variation is a term that refers to the difference between similar processes and expected outcomes of the same stable healthcare processes. Some common causes of variance may include the overuse, underuse, or misuse of general healthcare practices and services, which lead to varying patient outcomes. Besides, a special-cause variation category includes deviance in the process caused by factors that are not the intrinsic parts of the procedure. One of the factors that may also cause variance is costs.
The cost factor and its effects on the variance in the healthcare process can be associated with the difference in payment structures. Specific public programs link spending and payment structures to quality improvement measures. As Ryan & Rodgers (2018) identified, the programs that link quality to spending are the Oncology Care Model, the Comprehensive End-Stage Renal Disease Model, and Home Health Value-Based Purchasing. As the study focused on seriously ill patients, the authors did not find much positive correlation between quality improvement measures and spending measures related to palliative care. Hence, the needs to be a balance between the payment structures and quality improvement measures, as the increase in spending does not affect the increasing effectiveness of care or patient outcomes.
Different sources identify different payment structures. Yet, the most basic two categories related to healthcare payment structures include retrospective and prospective payment systems. Most scholars agree that among the factors that affect quality outcomes, the socioeconomic variables of both patients and providers are significant. Hence, when choosing between prospective or retrospective payment structures, it is essential to evaluate their effect on both parties. Finding a balance between the interests and abilities of patients and healthcare providers is key to enhancing quality outcomes.
Reference
Ryan, A. M., & Rodgers, P. E. (2018). Linking quality and spending to measure value for people with serious illness. Journal of Palliative Medicine, 21(S2), S-74.
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