Exploring payment schemes used to promote integrated chronic care in Europe

Tsiachristas, Apostolos; Dikkers, Carolien; Boland, Melinde; Mölken, Maureen P.M.H. Rutten-van

doi:10.1016/j.healthpol.2013.07.007

Cited by 72 publications

(70 citation statements)

References 15 publications

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“…These bundled payments cover all care for these patients, except for inpatient care, drugs, durable medical equipment and diagnostics. Their level is negotiated between the care groups and health insurers (Tsiachristas et al, 2013). between hospitals and insurers for some procedures, the share of which is rising over time.…”

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confidence: 99%

Spending on Health Care in the Netherlands: Not Going So Dutch

2017

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Standard-Nutzungsbedingungen:Die Dokumente auf EconStor dürfen zu eigenen wissenschaftlichen Zwecken und zum Privatgebrauch gespeichert und kopiert werden.Sie dürfen die Dokumente nicht für öffentliche oder kommerzielle Zwecke vervielfältigen, öffentlich ausstellen, öffentlich zugänglich machen, vertreiben oder anderweitig nutzen.Sofern die Verfasser die Dokumente unter Open-Content-Lizenzen (insbesondere CC-Lizenzen) zur Verfügung gestellt haben sollten, gelten abweichend von diesen Nutzungsbedingungen die in der dort genannten Lizenz gewährten Nutzungsrechte. Terms of use: Documents in AbstractThe Netherlands is among the top spenders on health in the OECD. We document the lifecycle profile, concentration and persistence of this expenditure using claims data covering both curative and long-term care expenses for the full Dutch population. Spending on health care is strongly concentrated: the one per cent of individuals with the highest levels of expenditure account for one quarter of the aggregate in any one year. Averaged over three years, the top one per cent still accounts for more than a fifth of the total, indicating a very high degree of persistence in the largest expenses. Spending on long-term care, which amounts to one third of all expenditure on health care, is even more concentrated: the top one per cent accounts for more than half of total spending on this type of care. Average expenditure rises steeply with age and even more so with proximity to death. Spending on individuals in their last year of life absorbs one tenth of aggregate health care expenditure. In a given year, spending on health care is highly skewed toward individuals with lower incomes. Average expenditure on the poorest fifth is more than three times that on the richest fifth. Spending on long-term care is five times more concentrated on the poor. Policy Points1. Spending on health care is highly concentrated on a small share of the population and is strongly persistent over time. 2. Public spending on long-term care is high and is even more concentrated and persistent. 3. In any given year, health spending is highly skewed towards poorer individuals. 4. The high concentration and persistence imply substantial interpersonal redistribution. 5. Steeply rising health expenditures with age and proximity to death imply substantial intrapersonal redistribution across the life cycle. JEL Codes: D12, I13, I14

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confidence: 99%

Spending on Health Care in the Netherlands: Not Going So Dutch

2017

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“…Following this approach, the design of personalized care strategies would benefit from a more precise allocation of resources. On the other hand, from a healthcare planner’s perspective, the availability of precise information on resource consumption linked to morbidity may help to improve the state-of-the-art of incentive-based payment schemes for chronic care [31]. …”

Section: Discussionmentioning

confidence: 99%

Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

Carreras

Sánchez-Pérez

Ibern

et al. 2016

International Journal of Integrated Care

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Background:The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care.Methods:A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burden were adjusted and individual healthcare costs were calculated using a retrospective full-costing system. The individual morbidity burden was inferred using the Clinical Risk Groups (CRG) patient classification system.Results:Depending on the characteristics of the data, and according to the algorithm criteria, the choice of model was a linear model on the log of costs or a generalized linear model with a log link. We checked for goodness of fit, accuracy, linear structure and heteroscedasticity for the models obtained.Conclusion:The proposed algorithm identified a set of suitable cost models for the distinct groups of services integrated care entails. The individual morbidity burden was found to be indispensable when allocating appropriate resources to targeted individuals.

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“…In many European countries alternative payments were combined (for example PFC and global payment in Germany) or provided on top of traditional payments (e.g. PFP on top of capitation and FFS in England), targeted key-stakeholders that were expected to respond to the financial incentives, had different form and size, incentivized the integration of different services, and their uptake varied across countries [56]. Some countries, such Austria, Denmark, France, and Germany, introduced pay-for-coordination to reward the coordination of multidisciplinary care teams.…”

Section: Financial Incentives To Stimulate Integrationmentioning

confidence: 99%

“…On the other hand, it was found that gaming of the payment mechanism and misaligned incentives between stakeholders were the most frequent barriers [5]. Another study investigated the impact of the financial agreements introduced in Europe on health care expenditure and found that PFC, bundled payment and global payment reduced the growth of outpatient expenditure at the year of implementation while PFP reduced the growth of hospital and administrative expenditure at the same year [6].…”

Section: Facilitators Barriers and Impact Of Financial Incentivesmentioning

confidence: 99%