In this chapter the authors describe an integrated contract (population based financing) between health care payers, such as governments and/or health insurers) and different health care providers. The chapter considers a simple and stylized theoretical model involving a health care payer and two different health care providers (e.g., general practitioners and hospitals) and compares different contracting options. Based on the theoretical model, the authors argue that population bases financing offers better incentives for the coordination in the provision of health care services. Contracts should be augmented with quality outcome measures to provide incentives to prevent undertreatment. The chapter gives examples of integrated contracting in the US, Germany and a proposed experiment in the Netherlands.
Peter Bogetoft, Misja Mikkers and Victoria Shestalova
Jos Boertjens, Johan van Manen, Misja Mikkers and Wolf Sauter
Because the risk of ill health is part of the human condition, there is a universal interest in providing access to high-quality healthcare while controlling the sacrifices that are necessary to obtain it – after all, the funds used for healthcare cannot be allocated to alternative uses. Affordability is therefore an important consideration that is closely linked to access. Quality determines the health value of the treatment provided. Arriving at a social consensus on how to achieve these goals is difficult, however, which in most countries leads to intense debate on healthcare, as the contributions to this book regarding the US, South Africa, Colombia and the Netherlands all illustrate. Unsurprisingly, there is no one particular healthcare system that meets all three of the needs identified above perfectly. Instead, there is a wide variety of such systems, each with different advantages, disadvantages and trade-offs. Hence it is important that data on the problems encountered are collected and analysed, and that learning occurs between different health systems. This is a practical as well as a scientific challenge, because hitherto most studies on healthcare regulation have not taken a comparative perspective based on comparable data. In fact, in many respects, no such data yet exists. This book charts hospital financing across the three dimensions of access, affordability and quality. It does so based on an international comparison spanning four different continents. For the purpose of our project, we have collected 11 country reports, compiled by national experts according to a standard structure. In addition, six thematic chapters are included that explore specific questions. The invited authors include academics and practitioners (primarily, but not exclusively, policymakers).