Abstract
Many countries have recently started the search for new payments methods with the specific objective to encourage the integration in service delivery. This paper suggests their typology. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of their effects on integration and other dimensions of service delivery performance. It is argued that relative to other integrated methods global payment is the most promising method, since it provides incentives for comprehensive organizational changes. But this method is hard to implement – mostly due to a high probability of excessive financial risks placed on providers in integrated networks. The activities to mitigate these risks are discussed based on the approaches used in the Alternative Quality Contract in Massachusetts and fundholding scheme in Russia. The major pre-conditions for global payment implementation are specified: involvement of hospitals in global payment schemes, shared savings arrangements, special set of activities to mitigate financial risks, performance transparency system. It is also argued that there is a dilemma of strong economic incentives with serious implementation problems and lower economic incentives with less substantial implementation problems.
Highlights
A key instrument to encourage integration of service delivery is the adoption of health care payment system that incorporates economic incentives for better interaction between health care providers
We suggest the typology of financial incentives and payment methods for integration (Table 1)
The evidence available coupled with the experience of new methods implementation (The author has been involved in building global payment schemes in Kaluga, Kemerovo, Samara and Perm regions of Russia) provides the ground for the comparison of their relative strengths and weaknesses, as well as making generalizations on pre-conditions of their successful implementation
Summary
A key instrument to encourage integration of service delivery is the adoption of health care payment system that incorporates economic incentives for better interaction between health care providers. Three major attributes of integration should be promoted through methods of payment: 1) Teamwork of various providers, 2) Coordination of their activity, 3) Continuity of care at various stages of service delivery. They most comprehensively reflect integration activities: multispecialty groups of providers are established that work on the basis of joint clinical guidelines; their members interact with each other to enhance clinical and economic outcome; every stage of patients’ “route” in the health system is closely connected with the previous and the subsequent ones. The scope of activities ranges from small-scale pilots to regional schemes This search seems to be most intensive in the countries with the dominance of fee-for-service (FFS) and the lack of regulatory mechanisms for integration. The most interesting and ambitious projects have started in the USA and are followed by some European countries
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