Integrated Health Care Payment Methods: Typology, Evidence And Pre-Conditions Of Implementation

Many countries have recently started the search for new payments methods with the specific objective to encourage integration in health care delivery – teamwork of providers, their coordination and continuity of care. This paper suggests the typology of three major integrated payment methods – pay-for-performance, episode based bundled payment and global payment. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of their effects on integration and other dimensions of medical service delivery performance. It is argued that relative to other integrated methods global payment is the most promising method, since it provides incentives for comprehensive organizational changes. The major pre-conditions for global payment implementation are risk bearing in integrated networks, shared savings schemes, performance transparency system, infrastructure for coordination and collaboration. It is also argued that global payment is hard to implement – mostly due to a high probability of excessive financial risks placed on providers in integrated networks. The activities to mitigate these risks are discussed based on the approaches piloted in Russia