The King’s Fund has published a report on “Payments and contracting for integrated care: The false promise of the self-improving health system”.
The report, authored by Ben Collins, mainly focuses on the emerging new payment model for integrated care, which aims to improve the performance of the providers of health services, and questions whether this new model will be more successful than the previous ones.
The report also examines two case studies, from The Canterbury District Health Board in New Zealand and the NHS’s Bolton Foundation Trust, that explore different approaches to improving performance through allocating spend based on public health needs rather than arm’s length control through financial incentives.
Carolyn Gullery, the Executive Director for Funding and Planning at the Canterbury District Health Board points out when asked about financial incentive models:
“One of the interesting things about transferring risk in these models (incentive based) is in fact you don’t. Ultimately the risk comes back to the health board. […] So, if you step back and realise that this is about making sure you’ve got care for patients, you move away from these approaches and you move to a collaborative approach. […] As soon as you start talking about money and contracts, collaboration goes out the window.”
In a more recent talk between Ben Collins and Professor Don Berwick on the current systems of financial incentive schemes, Prof Berwick noted:
“We need to think about payment as a support system. It’s pay to support the activities you wish to emerge. […] The purchaser and provider split should be reconsidered. We need purchaser and provider partnership. […] [The best thing we can do with our financing systems is] to get rid of the obstacles of complexity: competition, demoralisation, scrutiny.”