Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review.

Abstract

Introduction:Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target ‘places’, broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches.Methods:We initially conducted a scoping review, a systematic database search (‘Medline’, ‘Embase’, ‘Econ Lit’ and ‘Google Scholar’) complemented by further snowballing for academic and ‘grey literature’ publications (1995 – 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies.Results:Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries.Conclusion:Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.