Aligned payment systems
Fragmented financial systems include those with separate funding streams and governance structures for different types of services, or provider payment mechanisms that do not adequately reward and encourage care coordination. Payment mechanisms to providers also tend to reward volume and provide little incentive for providers to collaborate whilst separate budgets also create incentives to shift people and costs. Many countries continue to finance health and social care substantially through direct and indirect fee-for-service systems.
Many countries and systems are moving to value-based rather than volume-based care. This also recognises the need for integration of health and social services to ensure the overall wellbeing of the population. However, evidence suggests that successful integrated care arrangements can be achieved without integration of financial flows if the necessary structures to sustain and institutionalise collaborative arrangements are in place.
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