Exploring payment schemes used to promote integrated chronic care in Europ

Abstract

The rising burden of chronic conditions has led several European countries to reformhealthcare payment schemes. This paper aimed to explore the adoption and success ofpayment schemes that promote integration of chronic care in European countries. A liter-ature review was used to identify European countries that employed pay-for-coordination(PFC), pay-for-performance (PFP), and bundled payment schemes. Existing evidence fromthe literature was supplemented with fifteen interviews with chronic care experts in thesecountries to obtain detailed information regarding the payment schemes, facilitators andbarriers to their implementation, and their perceived success.Austria, France, England, the Netherlands, and Germany have implemented paymentschemes that were specifically designed to promote the integration of chronic care.Prominent factors facilitating implementation included stakeholder cooperation, adequatefinancial incentives for stakeholders, and flexible task allocation among different careprovider disciplines. Common barriers to implementation included misaligned incentivesacross stakeholders and gaming. The implemented payment schemes targeted differ-ent stakeholders (e.g. individual caregivers, multidisciplinary organizations of caregivers,regions, insurers) in different countries depending on the structure and financing of eachhealth care system. All payment reforms appeared to have changed the structure of chroniccare delivery. PFC, as it was implemented in Austria, France and Germany, was perceivedto be the most successful in increasing collaboration within and across healthcare sectors,whereas PFP, as it was implemented in England and France, was perceived most successfulin improving other indicators of the quality of the care process. Interviewees stated thatthe impact of the payment reforms on healthcare expenditures remained questionable.The success of a payment scheme depends on the details of the specific implementationin a particular country, but a combination of the schemes may overcome the barriers ofeach individual scheme.