Sammendrag
The results of the Project INTEGRATE case studies and the expert survey show that fragmented financial systems, i.e. with separate funding streams and governance structures for different types of services, or provider payment mechanisms that do not adequately reward and encourage care coordination may create barriers to care integration. Payment mechanisms to independent providers rewarding volume provide little incentive for providers to collaborate and hamper service redesign. Separate budgets may create incentives to shift patients and costs to another level/part of the care system. Without agreed care pathways and accountability lines it may be difficult to realign incentives even across providers within a single payer system. Payment reform options span from amending existing independent provider payment systems paying for coordination activities, e.g. on a 'per member per month/year' basis, mechanisms for payment across providers such as bundled payments along disease or entire care pathways, to population-based payments where providers assume responsibility for the health of defined populations. There are increased ambitions to move towards payment approaches that reward value instead of volume, and consider final health outcomes and patient satisfaction as well as costs.