Report: the false promise of the self-improving health system
- 29 March 2019
- Posted by: Helen Nicol
- Category: Resources
A new report from the King’s Fund takes aim at the proposed reforms in the English NHS regarding incentive schemes for care integration. It doesn’t pull its punches, either, taking aim first at the lack of success produced by the preceding three decades of incentive structures:
One recurring challenge is how to measure the performance of health services as a basis for handing out financial rewards and penalties. As experience has shown, it is extremely difficult to devise metrics that effectively capture local health systems’ overall performance and can be measured accurately in the short to medium term. Another recurring challenge is how to apply financial incentives effectively in public health systems. If the state withholds payments from underperforming health care providers, this makes it harder for them to deliver adequate services: the absurdity of punishing patients who have already been let down by risking even worse care.
It’s not all critique, though; the report also addresses potential new directions.
While English policy makers have gravitated to the payment schemes for integrated care in insurance-based health systems, other countries with tax-funded healthcare have been heading in a different direction. A number of these countries are now foregoing complex financial incentive schemes in favour of partnership arrangements between funders and planners and groups of service providers, with the focus on effective joint working to make best use of healthcare resources.
Commissioners and providers in many local health systems in England have also now started the transition from arm’s length contracting to collaborative relationships. While these arrangements are at an early stage, there is emerging evidence of the benefits. Organisations across local systems are working together as a single team and resources that would in the past be consumed by contracting are now being used for improvement.
The full report, titled “Payments and contracting for integrated care: The false promise of the self-improving health system”, can be downloaded from the King’s Fund website, as can an executive summary thereof.