Impact of financial agreements in European chronic care on health care expenditure growth

Various types of financial agreements have been implemented in Europe to reduce healthcare expenditure by stimulating integrated chronic care. This study used difference-in-differences (DID) models to estimate differences in health care expenditure trends beforeand after the introduction of a financial agreement between 9 intervention countries and16 control countries. Intervention countries included countries with pay-for-coordination(PFC), pay-for-performance (PFP), and/or all inclusive agreements (bundled and globalpayment) for integrated chronic care. OECD and WHO data from 1996 to 2013 was used.The results from the main DID models showed that the annual growth of outpatient expen-diture was decreased in countries with PFC (by 21.28 US$ per capita) and in countries withall-inclusive agreements (by 216.60 US$ per capita). The growth of hospital and adminis-trative expenditure was decreased in countries with PFP by 64.50 US$ per capita and 5.74US$ per capita, respectively. When modelling impact as a non-linear function of time dur-ing the total 4-year period after implementation, PFP decreased the growth of hospital andadministrative expenditure and all-inclusive agreements reduced the growth of outpatientexpenditure. Financial agreements are potentially powerful tools to stimulate integratedcare and influence health care expenditure growth. A blended payment scheme that com-bines elements of PFC, PFP, and all-inclusive payments is likely to provide the strongestfinancial incentives to control health care expenditure growth.

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