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Open Access 01-12-2018 | Research article

Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature

Authors: Isabelle Feldhaus, Inke Mathauer

Published in: BMC Health Services Research | Issue 1/2018

Abstract

Background

Strategic purchasing of health care services has become a key policy measure on the path to achieving universal health coverage. National provider payment systems for health services are typically characterized by mixes of provider payment methods with each method associated with distinct incentives for provider behaviours. Reaching incentive alignment across methods is critical to enhancing the effectiveness of strategic purchasing.

Methods

A structured literature review was conducted to synthesize the evidence on how purposively aligned mixed provider payment systems affect health expenditure growth management, efficiency, and equity in access to services with a particular focus on coordinated and/or integrated care management.

Results

The majority of the 37 reviewed articles focused on high-income countries with 74% from the US. Four categories of payment mixes were examined in this review: blended payment, bundled payment, cost-containment reward models, and aligned cost sharing mechanisms. Blended payment models generally reported moderate to no substantive reductions in expenditure growth, but increases in health system efficiency. Bundled payment schemes consistently report increases in efficiency and corresponding cost savings. Cost-containment rewards generated cost savings that can contribute to effective management of health expenditure growth. Evidence on aligned cost-sharing is scarce.

Conclusion

There is lacking evidence on when and how mixed provider payment systems and cost sharing practices align towards achieving goals. A guiding framework for how to study and evaluate mixed provider payment systems across contexts is warranted. Future research should consider a conceptual framework explicitly acknowledging the complex nature of mixed provider payment systems.

Available only for authorised users

Complete bundling turns into total capitation that is provided for the totality of care for a defined population (e.g. Accountable Care Organizations in the United States; Healthy Kinzigtal in Germany [21, 56]. Because it is beyond the focus of this paper on aligned mixed payment systems, this payment model is not reviewed here.

Kutzin J. A descriptive framework for country-level analysis of health care financing arrangements. Health policy [internet]. 2001;56:171–204 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11399345.CrossRef

Mathauer I, Dale E, Meessen B. Strategic purchasing for universal health coverage: key policy issues and questions: bottlenecks in institutional design and organizational practice of health financing and options to accelerate progress towards universal coverage [internet]. Heal. Financ. Work. Pap. No. 8. Geneva: World Health Organization; 2017. Available from: http://www.who.int/health_financing/documents/strategic-purchasing-discussion-summary/en/

World Health Organization. World Health Report: Health Systems Financing: The path to universal coverage. Geneva: World Health Organization; 2010.

Figueras J, Robinson R, Jakubowski E. Purchasing to improve health systems performance. World Health Organization Regional Office for Europe: Open University Press; 2005.

Cashin C, Ankhbayar B, Phuong HT, Jamsran G, Nanzad O, Phuong NK, et al. Assessing health provider payment systems: a practical guide for countries moving toward UHC [internet]. 2015. Available from: http://www.jointlearningnetwork.org/resources/assessing-health-provider-payment-systems-a-practical-guide-for-countries-w

Langenbrunner JC, Cashin C, O’Dougherty S, editors. Designing and. Implementing Health Care Provider Payment Systems: How-To Manuals. The World Bank; 2009.

Kalseth J, Kasteng F, Borgermans L. Project INTEGRATE D 8.1 Financial Models for Care Integration Title of deliverable Financial Models for Care Integration [Internet]. 2017. Available from: http://www.projectintegrate.eu.com/integrated-care/resource/articles/financial-models-for-care-integration.

Dashzeveg C, Mathauer I, Enkhee E, Dorjsuren B, Tsilaajav T, Batbayar C. A health financing review of Mongolia with a focus on social health insurance [internet]. 2011. Available from: http://www.who.int/health_financing/documents/cov-oasis_e_11-mongolia/en/

Phuong NK, Oanh TTM, Phuong HT, Tien T Van, Cashin C. Assessment of systems for paying health care providers in Vietnam: Implications for equity, efficiency and expanding effective health coverage. Glob. Public Health [Internet]. 2015 [cited 2018 mar 12];10:S80–S94. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25622127.

10.

Dkhimi F, Mathauer I, Appaix O. Une analyse du systeme mixte des modalites de paiement des prestataires au Maroc : Effets, implications et options vers un achat plus strategique. Rabat; 2017.

11.

Appaix O, Kiendrébéogo J, Dkhimi F. Etude sur le système mixte de modalités d’achat et de paiement des services de santé: Le cas du Burkina Faso. Ouagadougou; 2017.

12.

Perkowski P, Rodberg L. Cost sharing, health care expenditures, and utilization: an international comparison. Int. J. Heal. Serv. Planning, Adm. Eval. [internet]. 2016;46:106–23. Available from: http://www.ncbi.nlm.nih.gov/pubmed/26545706.

13.

Kolasa K, Kowalczyk M. Does cost sharing do more harm or more good? - a systematic literature review. BMC public health [internet]. 2016;16:992 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27633253.CrossRef

14.

Kostova D, Fox J. Chronic health outcomes and prescription drug copayments in Medicaid. Med. Care [internet]. 2017;55:520–7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/28234755.CrossRef

15.

Newhouse JP, Insurance Experiment Group. Free for All? Lessons from the RAND Health Insurance Experiment [Internet]. Cambridge: Harvard University Press; 1993 [cited 2017 Apr 17]. Available from: https://www.rand.org/pubs/commercial_books/CB199.html

16.

Hsu J, Price M, Huang J, Brand R, Fung V, Hui R, et al. Unintended Consequences of Caps on Medicare Drug Benefits. N. Engl. J. Med. [Internet]. 2006 [cited 2017 Apr 17];354:2349–2359. Available from: https://doi.org/10.1056/NEJMsa054436

17.

OECD. Better Ways to Pay for Health Care [Internet]. Paris: Organisation for Economic Co-operation and Development; 2016 [cited 2017 Jun 5]. Available from: http://www.oecd-ilibrary.org/content/book/9789264258211-en

18.

Tsiachristas A, Dikkers C, Boland MRS, Rutten-van Mölken MPMH. Exploring payment schemes used to promote integrated chronic care in Europe. Health policy [internet]. 2013;113:296–304 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23937868.CrossRef

19.

Hussey PS, Mulcahy AW, Schnyer C, Schneider EC. Closing the quality gap: revisiting the state of the science (vol. 1: bundled payment: effects on health care spending and quality). Evid. Rep. Technol. Assess. (full. Rep). [internet]. 2012:1–155 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24422914.

20.

de Brantes F, Delbanco S, Cabellero A. Reference Pricing and Bundled Payments: A Match to Change Markets. Newtown; 2013 Oct.

21.

Jakab M, Evetovits T, McDaid D. Health financing strategies to support scale up of NCD core interventions and services. How heal. Syst. Respond to NCDs. World Health Organization, Europe Regional Office; 2018

22.

Bailit M, Hughes C. Key design elements of shared-savings payment arrangements; 2011.

23.

Scott A, Tjosvold L, Chojecki D. Gainsharing and shared savings strategies in the healthcare setting: evidence for effectiveness. Canada: Alberta; 2016.

24.

Tangcharoensathien V, Limwattananon S, Patcharanarumol W, Thammatacharee J, Jongudomsuk P, Sirilak S. Achieving universal health coverage goals in Thailand: the vital role of strategic purchasing. Health Policy Plan. [Internet]. 2015 [cited 2017 Apr 26];30:1152–1161. Available from: https://academic.oup.com/heapol/article/30/9/1152/663037/Achieving-universal-health-coverage-goals-in

25.

Wu J, Li X, Song Y, Shao H, Shi Q, Qin D, et al. The impact of a bundled policy intervention on improving the performance of rural healthcare in China. Int. J. Equity health [internet]. 2016;15:46 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26964860.CrossRef

26.

Yip WC-M, Hsiao W, Meng Q, Chen W, Sun X. Realignment of incentives for health-care providers in China. Lancet (London, England) [internet]. 2010;375:1120–30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20346818.CrossRef

27.

Tsiachristas A, Dikkers C, Boland MRS, Rutten-van Mölken MPMH. Impact of financial agreements in European chronic care on health care expenditure growth. Health policy [internet]. 2016;120:420–30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26971018.CrossRef

28.

Hollander MJ, Kadlec H. Incentive-based primary care: cost and utilization analysis. Perm. J. [internet]. 2015;19:46–56 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26263389.

29.

Meng Q. Health provider payment reforms in China: an updated review. DC: Washington; 2008.

30.

Howard M, Goertzen J, Kaczorowski J, Hutchison B, Morris K, Thabane L, et al. Emergency department and walk-in clinic use in models of primary care practice with different after-hours accessibility in Ontario, Healthc. Policy [internet]. 2008;4:73–88 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19377344.

31.

Hutchison B, Levesque J-F, Strumpf E, Coyle N. Primary health care in Canada: systems in motion. Milbank Q. [internet]. 2011;89:256–88 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21676023.CrossRef

32.

Kantarevic J, Kralj B, Weinkauf D. Enhanced fee-for-service model and physician productivity: evidence from family health groups in Ontario, J. Health econ. [internet]. 2011;30:99–111 Available from: http://www.ncbi.nlm.nih.gov/pubmed/21111500.

33.

Kiran T, Kopp A, Moineddin R, Glazier RH. Longitudinal evaluation of physician payment reform and team-based care for chronic disease management and prevention. C. Can. Med. Assoc. J. = J. l’Association medicale can. [internet]. 2015;187:E494–502 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26391722.CrossRef

34.

Bachrach D, du Pont L, Lipson M. Arkansas: a leading laboratory for health care payment and delivery system reform. Issue brief (Commonw. Fund) [internet]. 2014;20:1–18 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25204031.

35.

Bolz NJ, Iorio R. Bundled payments: our experience at an Academic Medical Center. J. Arthroplasty [internet]. 2016;31:932–5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27020651.CrossRef

36.

Edmonds C, Hallman GL. CardioVascular care providers. A pioneer in bundled services, shared risk, and single payment. Texas Hear Inst J [internet]. 1995;22:72–6. Available from: http://www.ncbi.nlm.nih.gov/pubmed/7787473.

37.

Doran JP, Zabinski SJ. Bundled payment initiatives for Medicare and non-Medicare total joint arthroplasty patients at a community hospital: bundles in the real world, J. Arthroplasty [internet]. 2015;30:353–5. Available from: http://www.ncbi.nlm.nih.gov/pubmed/25680450.

38.

Froemke CC, Wang L, DeHart ML, Williamson RK, Ko LM, Duwelius PJ. Standardizing care and improving quality under a bundled payment initiative for Total joint arthroplasty. J. Arthroplasty [internet]. 2015;30:1676–82 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26092251.CrossRef

39.

Froimson MI, Rana A, White RE, Marshall A, Schutzer SF, Healy WL, et al. Bundled payments for care improvement initiative: the next evolution of payment formulations: AAHKS bundled payment task force. J. Arthroplasty [internet]. 2013;28:157–65 Available from: http://www.ncbi.nlm.nih.gov/pubmed/24034511.CrossRef

40.

Iorio R, Clair AJ, Inneh IA, Slover JD, Bosco JA, Zuckerman JD. Early results of Medicare’s bundled payment initiative for a 90-day Total joint arthroplasty episode of care. J. Arthroplasty [internet]. 2016;31:343–50 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26427938.CrossRef

41.

Kirby JS, Delikat A, Leslie D, Miller JJ. Bundled payment models for actinic keratosis management. JAMA dermatology [internet]. 2016;152:789–97 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27028662.CrossRef

42.

Liu FX, Walton SM, Leipold R, Isbell D, Golper TA. Financial implications to Medicare from changing the dialysis modality mix under the bundled prospective payment system. Perit. Dial. Int. J. Int. Soc. Perit. Dial. [internet]. 2014;34:749–57 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25292402.CrossRef

43.

Porter ME, Kaplan RS. How to pay for health care. Harv. Bus. Rev. [internet]. 2016;94:88–98, 100, 134 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27526565.

44.

Wagner K. Shifting gears: the move toward value-based payment. Healthc. Exec. [internet]. 2015;30:10–12, 14–6, 18 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26742339.

45.

Chambers JD, Weiner DE, Bliss SK, Neumann PJ. What can we learn from the U.S. expanded end-stage renal disease bundle? Health policy [internet]. 2013;110:164–71 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23419419.CrossRef

46.

Courtney PM, Ashley BS, Hume EL, Kamath AF. Are bundled payments a viable reimbursement model for revision Total joint arthroplasty? Clin. Orthop. Relat. Res. [internet]. 2016;474:2714–21 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27357691.CrossRef

47.

Nolte E, Knai C, Hofmarcher M, Conklin A, Erler A, Elissen A, et al. Overcoming fragmentation in health care: chronic care in Austria, Germany and the Netherlands. Health econ. Policy. Law [internet]. 2012;7:125–46 Available from: http://www.ncbi.nlm.nih.gov/pubmed/22221931.CrossRef

48.

Tsai TC, Joynt KE, Wild RC, Orav EJ, Jha AK. Medicare’s bundled payment initiative: most hospitals are focused on a few high-volume conditions. Health Aff. (Millwood). [internet]. 2015;34:371–380 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25732486.

49.

Whitcomb WF, Lagu T, Krushell RJ, Lehman AP, Greenbaum J, McGirr J, et al. Experience with designing and implementing a bundled payment program for Total hip replacement. Jt. Comm. J. Qual. Patient Saf. [internet]. 2015;41:406–413 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26289235.

50.

Curry A, Fee JP. Ramping up for bundled payments: fostering hospital-physician alignment. Healthc. Financ. Manag. J. Healthc. Financ. Manag. Assoc. [internet]. 2016;70:46–49 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27382707.

51.

Conrad DA, Vaughn M, Grembowski D, Marcus-Smith M. Implementing value-based payment reform: a conceptual framework and case examples. Med. Care res. Rev. MCRR [internet]. 2016;73:437–57 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26545852.CrossRef

52.

Iorio R. Strategies and tactics for successful implementation of bundled payments: bundled payment for care improvement at a large, urban, academic medical center. J. Arthroplasty [internet]. 2015;30:349–50 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25680447.CrossRef

53.

Slover JD, Mullaly KA, Payne A, Iorio R, Bosco J. What is the best strategy to minimize after-care costs for Total joint arthroplasty in a bundled payment environment? J. arthroplasty [internet]. 2016;31:2710–3 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27344351.CrossRef

54.

Lessons from Medicare’s Demonstration Projects on Disease Management, Care Coordination, and Value-Based Payment [Internet]. 2012. Available from: https://www.cbo.gov/sites/default/files/112th-congress-2011-2012/reports/01-18-12-MedicareDemoBrief.pdf

55.

Kuhn B, Lehn C. Value-based reimbursement: the banner health network experience, Front. Health Serv. Manage. [internet]. 2015;32:17–31 Available from: http://www.ncbi.nlm.nih.gov/pubmed/26817267.

56.

Busse R, Stahl J. Integrated care experiences and outcomes in Germany, the Netherlands, and England. Health Aff. (Millwood). [internet]. 2014;33:1549–1558 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25201659.

57.

Foster MM, Mitchell GK. “The onus is on me”: primary care patient views of Medicare-funded team care in chronic disease management in Australia. Heal. Expect. An Int. J. Public Particip. Heal. Care heal. Policy [internet]. 2015;18:879–91 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23521424.

58.

Foster MM, Cornwell PL, Fleming JM, Mitchell GK, Tweedy SM, Hart AL, et al. Better than nothing? Restrictions and realities of enhanced primary care for allied health practitioners. Aust. J. Prim. Health [Internet]. 2009 [cited 2017 Apr 18];15:326–334. Available from: http://www.publish.csiro.au/py/PY08065

59.

Haines TP, Foster MM, Cornwell P, Fleming J, Tweedy S, Hart A, et al. Impact of enhanced primary care on equitable access to and economic efficiency of allied health services: a qualitative investigation. Aust. Heal. Rev. a Publ. Aust. Hosp. Assoc. [internet]. 2010;34:30–5 Available from: http://www.ncbi.nlm.nih.gov/pubmed/20334753.

60.

Foster MM, Mitchell G, Haines T, Tweedy S, Cornwell P, Fleming J. Does enhanced primary care enhance primary care? Policy-induced dilemmas for allied health professionals. Med. J. Aust. [internet]. 2008;188:29–32 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18205560.

61.

Stokes J, Struckmann V, Kristensen SR, Fuchs S, van Ginneken E, Tsiachristas A, et al. Towards incentivising integration: A typology of payments for integrated care. Health Policy [Internet]. 2018 [cited 2018 Oct 17];122:963–969. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0168851018302185

62.

Xin H, Harman JS, Yang Z. How do high cost-sharing policies for physician care affect total care costs among people with chronic disease? J. Insur. Med. [internet]. 2014;44:38–48 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25004597.

63.

Xin H. How do high cost-sharing policies for physician care affect inpatient care use and costs among people with chronic disease? J. Ambul. Care manage. [internet]. 2015;38:100–108 Available from: http://www.ncbi.nlm.nih.gov/pubmed/25748258.

64.

Galles J, Handmaker K. Building a value-based primary care network for population health. Healthc. Financ. Manag. J. Healthc. Financ. Manag. Assoc. [internet]. 2016;70:76–80 Available from: http://www.ncbi.nlm.nih.gov/pubmed/27183762.

65.

Struckmann V, Quentin W, Busse R, van Ginneken E. How to strengthen financing mechanisms to promote care for people with multimorbidity in Europe? [internet]. 2016. Available from: http://www.euro.who.int/__data/assets/pdf_file/0006/337587/PB_24.pdf?ua=1.

66.

Charlesworth A, Davies A, Dixon J. Reforming payment for health care in Europe to achieve better value. Research report. Nuffield Trust; 2012. Available from: https://www.nuffieldtrust.org.uk/research/reforming-payment-for-health-care-in-europe-to-achieve-better-value.

67.

Schäfer I, Küver C, Gedrose B, Hoffmann F, Russ-Thiel B, Brose H-P, et al. The disease management program for type 2 diabetes in Germany enhances process quality of diabetes care - a follow-up survey of patient’s experiences. BMC health Serv. Res. [internet]. 2010;10:55. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20199685.

68.

Stock S, Drabik A, Büscher G, Graf C, Ullrich W, Gerber A, et al. German diabetes management programs improve quality of care and curb costs. Health Aff. (Millwood). [internet]. 2010;29:2197–205. Available from: http://www.ncbi.nlm.nih.gov/pubmed/21134920.

69.

Elissen AMJ, Duimel-Peeters IGP, Spreeuwenberg C, Spreeuwenberg M, Vrijhoef HJM. Toward tailored disease management for type 2 diabetes. Am. J. Manag. Care [internet]. 2012;18:619–30 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23145806.

70.

Raaijmakers LG, Hamers FJ, Martens MK, Bagchus C, de Vries NK, Kremers SP. Perceived facilitators and barriers in diabetes care: a qualitative study among health care professionals in the Netherlands. BMC fam. Pract. [internet]. 2013;14:114 Available from: http://www.ncbi.nlm.nih.gov/pubmed/23937325.CrossRef

71.

Millett C, Gray J, Wall M, Majeed A. Ethnic disparities in coronary heart disease management and pay for performance in the UK. J. Gen. Intern. Med. [internet]. 2009;24:8–13 Available from: http://www.ncbi.nlm.nih.gov/pubmed/18953616.CrossRef

72.

Casale AS, Paulus RA, Selna MJ, Doll MC, Bothe AE, McKinley KE, et al. “ProvenCareSM”: a provider-driven pay-for-performance program for acute episodic cardiac surgical care. Ann. Surg. [internet]. 2007;246:613–21 discussion 621-623 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17893498.CrossRef

73.

Basu S, Andrews J, Kishore S, Panjabi R, Stuckler D. Comparative Performance of Private and Public Healthcare Systems in Low- and Middle-Income Countries: A Systematic Review. PLoS Med. [Internet]. 2012 [cited 2016 Dec 11];9. Available from: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3378609/

Title: Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature
Authors: Isabelle Feldhaus
Inke Mathauer
Publication date: 01-12-2018
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2018
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-018-3779-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effects of mixed provider payment systems and aligned cost sharing practices on expenditure growth management, efficiency, and equity: a structured review of the literature

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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