08 Dec Blog: The impact of financing/payments schemes and price-setting of integrated chronic care for multi-morbidity
By: Jonathan Stokes from The University of Manchester
In the past few months, SELFIE partners have been hard at work delivering work package 3, examining the impact of financing/payments schemes and price-setting of integrated chronic care for multi-morbidity.
It is commonly observed that current payment systems may not create appropriate incentives for providing integrated care for patients with multiple chronic conditions. In particular, common modes of health care payment such as fee-for-service and payments based on the diagnosis related groups (DRG) system reimburse single activities of care, reflecting the traditional focus of the health care system of dealing with discrete onsets of acute illness. It has been argued, that chronic illness, as opposed to acute illness, requires a long-term perspective with on-going, preventative disease management which is not incentivised by these current payment systems. In addition, the common way of paying providers across different sectors separately does not incentivise care coordination, and may even be perceived as a barrier to the integration of care.
As in the SELFIE project as a whole, we are particularly interested in how interventions might affect multi-morbid patients differently, and we concentrate on this through all of the work we have been involved in, described below.
To date, we have examined in detail the payment models implemented within the 17 SELFIE programmes, and macro-level policies in the 8 SELFIE countries. We have also described the payment models described in the wider literature using a systematic review led by our German colleagues. With both these approaches we observed that there are few payment models introduced for integrated care (especially considering multi-morbid patients), despite the policy rhetoric. Those that are introduced tend to be aimed at a very small proportion of the population, in a single healthcare sector, and usually for a single chronic disease. The appropriateness of this approach for multimorbid patients is debatable. In general, payment systems are not well described, with terms like ‘bundled payments’ having multiple meanings, for instance. Building on these results, we have begun to build a new typology for classifying payments in terms of their potential effects on integration of care, providing a basis to improve financial incentives supporting more effective and efficient integrated care systems.
We have also made good progress towards evaluating the impact of payment schemes on health care expenditures, quality of care, and efficiency at regional/national level. We have approached this using panel analysis, using cross-country survey data (SHARE/ELSA), as well as combining self-aggregated datasets made by country partners. Despite some challenges of obtaining and combining data constructed from very different sources with different regulations on what we are allowed to use and to do with it, we are optimistic on reconciling these differences and sourcing equivalent data from other countries. Finally, we have been conducting some theoretical work looking at optimal price-setting for integrated care for multi-morbidity.
We have just submitted our reports to the EU on our progress on the above deliverables. In the New Year, we look forward to continuing to develop the work described above for publication and wider dissemination.