(CHE Research Paper 97)
Centre for Health Economics, University of York, March 2014
- Financial barriers are often cited as the reason for the lack of significant cost benefits of integrated care systems. This evidence review (38 schemes from eight countries) focuses on the role of integrated financial mechanisms in supporting and incentivising integrated care.
- The reviewers conclude that, when compared with ‘usual care’, schemes that integrated funds and resources to support integrated care seldom led to improved health outcomes. Although some schemes succeeded in shifting care closer to home, and some achieved short term reductions in acute care utilisation, no scheme demonstrated a sustained and long term reduction in hospital use.
- In England, new schemes were often introduced in the context of a raft of existing and evolving policy initiatives, which makes the evaluation of their effects methodologically challenging. For this reason, new schemes need to be rolled out cautiously and their evaluation should strive to incorporate appropriate controls. Evaluations should seek to consistently measure a range of effects and costs, ncluding the routine assessment of unintended consequences and barriers to implementation, as well as patient-reported measures of outcomes (PROMs) and experience (PREMs).
