Money matters. The way we pay for health care will affect both the types of services delivered, the way they are delivered and who gets access to them, Financial instruments, when appropriately designed, will help us reach our policy goals. However, financial instruments may also, when inappropriately designed, provide barriers to the same goals.
The purpose of this work package is to provide examples of different financing instruments and their impact on integrated care. Through case-study analysis, a review of the literature and an expert survey we review the structure and legal basis for funding and financial models, discuss incentives and disincentives in different payment mechanisms and describe current trends in the introduction of financial models and payment mechanisms aiming to support care integration. We will also assess barriers and facilitators to the implementation of these models in different contexts. Finally we will illustrate how different financial models may support care integration through best practice examples across different institutional and cultural settings.
At this point in the project we are in the process of analysing the information gathered from different sources, for presentation in the final report. Some preliminary results can, however, be indicated:
We have found it helpful to develop a typology of financial models. We also believe that such a typology is helpful for researchers as well as policy makers in order to better understand the potential advantages and disadvantages of different types of payment models. We have chosen to make a distinction between provider payment mechanisms and models of resource allocation and integration. Based on this typology we will also suggest a continuum of options for (further) financial integration, moving from adjustments (refinements) of existing models to full systems reform.
Moving to the literature review there is, as expected, a substantial heterogeneity of both payment and care models across (and sometimes even within) countries. This makes it difficult to provide conclusive evidence on the effectiveness of different financial models. Furthermore we find no strong evidence on the effects of payment mechanisms on care coordination or integration activities. Is a relationship simply not there, or are the mechanisms so complex that they are difficult to entangle from other factors that also influence health systems performance? This is a theme to be further explored in the report.
Want to read more? While waiting on our final report we would recommend reading the following paper by Ann Mason (2014): “Financial mechanisms for integrated care: An evidence review.” Our report will be completed mid 2015 and may be accessed through the Project INTEGRATE website later in the year.
Jon Magnussen, Jorid Kalseth and Frida Kasteng, SINTEF Health Services Research, Norway
SINTEF Health Research