[Better care and lower costs through registries; a first step to reimbursement based on outcome]

We have recently shown that costs of surgical treatment for colorectal carcinoma differ greatly between various patient groups in the Netherlands. Those cost-differences could mostly be explained by the fact that high-risk patients have a greater risk of complications, which generate higher hospital costs. Hospitals with a high-risk population, for instant tertiary referral centres, spend more than hospitals that treat low-risk patients. Currently reimbursement however is not geared to risk differences. In this article we investigate this shortcoming of the current reimbursement system and discuss how a differential rewarding - in which reimbursement is aligned with the patient's risk profile - could serve as a tool to further quality improvement in healthcare. Current clinical registries may provide the necessary details of patient characteristics for risk profiling and may also contribute to the following goal: reimbursement based on the quality of delivered care.