The Impact of Payment Reforms on the Quality and Utilisation of Healthcare for Patients With Multimorbidity: A Systematic Review.

Toine E P Remers,Marcel Olde Rikkert,Patrick P T Jeurissen,Nina Nieuweweme,Simone A Van Dulmen

doi:10.5334/ijic.5937

Abstract

Inadequate treatment of multimorbidity is recognised as a major determinant of the effectiveness of healthcare and also of its inappropriate expenditures. However, current payment systems target, primarily, the treatment of single diseases, thus hindering integrated delivery of care for patients with multimorbidity (PwM). This review aims to assess the effects of targeted reforms of payment systems which could help attain a higher quality of care and reduce unnecessary healthcare utilisation. In June 2020, a search of Medline and EMBASE revealed 13 relevant articles. The most common payment models were the use of bundled payments (n = 4) and diagnosis-related group payments (n = 4). Except for an increase in hospital admissions (n = 3), no outcome showed unambiguous significant effects across more than one study. The two studies which focused explicitly on PwM showed a significant decrease in 30-day hospital readmissions. This, however, was not maintained after 60 days in one study. No general conclusion could be drawn on the effects of targeted payment reforms for PwM. Our findings suggest that reforms should be combined with more multifaceted healthcare delivery to address the complex patterns of healthcare use effectively. Thorough evaluations of targeted payment reforms are needed urgently to contribute to the body of evidence required.

Highlights

Multimorbidity, defined as the presence of multiple diseases or conditions, is a core topic in the field of healthcare management and is frequently the target of measures to increase the efficiency of healthcare systems [1,2,3,4]
The search string consisted of terms related to three main topics: (i) payment reform, (ii) patients suffering from multimorbidity, and (iii) outcomes regarding the quality and utilisation of healthcare
All other seven studies were determined to have a moderate risk of bias or, in case of the randomised controlled trial of Koehler et al, showed ‘some concerns’ of bias

Summary

Introduction

Multimorbidity, defined as the presence of multiple diseases or conditions, is a core topic in the field of healthcare management and is frequently the target of measures to increase the efficiency of healthcare systems [1,2,3,4]. Hoedemakers et al and Barnett et al among others, support this view [1, 18] They state that such initiatives are mostly implemented in delivery systems that provide specific reimbursements for treating a certain condition [1, 18]. Applying integrated care initiatives in payment systems that focus mainly on the treatment of a single disease might be ineffective because of undesired effects such as skimming off the easiest patients to treat and cost shifting. In such systems, introducing a payment reform designed to target PwM could contribute to a higher quality of care and, potentially, could reduce the healthcare utilisation for these groups of patients

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