Kicking off the Special Interest Group Health Economics in Integrated Care – key questions and actions to move research forward

摘要

Context, aims and objectives : Health economics is concerned with issues related to efficiency, effectiveness, value and behavior in the production and consumption of health and health care. Health economics can contribute valuable insights to the debate on integrated care, mainly in two areas: 1) economic evaluation and 2) financing, payment and incentive structures. Regarding the first area, we witness that economic evaluation is increasingly used as a basis for reimbursing, contracting, and commissioning integrated care models. However, standard methods of economic evaluation fall short in incorporating the several types of outcomes and costs of integrated care models. As a result, outcomes such as patient experience and satisfaction, self-management skills, wellbeing as well as costs related to the integration of health and social care or services provided by other sectors are not accounted for adequately. Overall, little is known about the cost-effectiveness of integrated care, partly due to the fact that adequate methods are lacking, partly due to a failure to include economic evaluation in the design, planning and implementation of integrated care. Therefore, existing evidence is contradictory and inconclusive. Concerning the second area, integration of services within and between sectors is often hampered by financial disincentives, budgetary restrictions, incompatible funding structures or inadequate price setting. This holds true for both tax-based and insurance-based systems, though to varying degrees. There are relatively few systematic evaluations of reforms in the funding and payment systems that aim to stimulate integrated care and even less is known on how to design financial structures which ensure its sustainability. In order to overcome the shortcomings in these two areas and accommodate the better integration of health economics in integrated care practice, a Special Interest Group Health Economics in Integrated Care (SIG HEIC) was initiated under the auspices of IFIC. Primarily, the SIG HEIC is striving to reconcile existing health economic evaluation methods with the complexities of evaluating and analyzing integrated care models. This necessitates a systematic appraisal of economic evaluation methods and their suitability for evaluating integrated care. Based on this analysis new approaches need to be developed and existing methods to be adapted to facilitate a thorough economic evaluation of integrated care. A first set of relevant research questions is currently addressed in a discussion paper, which outlines shortcomings of standard economic evaluation methods and proposes areas for future research. In order to foster discussion and involve an international pool of experts with interest in health economics, a SIG HEIC workshop is envisaged to take place at the ICIC16. This workshop aims to give participants the possibility of critiquing the discussion paper as well as to pool knowledge and expertise to establish a research agenda for the SIG HEIC. The proposed workshop will be the kick-off meeting for the SIG HEIC to refine research questions, prioritize research activities and form a working group to drive the agenda forward. The basis for the workshop will be the discussion paper, which will be published before ICIC16. The objectives for the workshop will be specifically to: - discuss existing health economic evaluation methods and their adaptability for integrated care research as outlined in the discussion paper and refine resulting research questions; - connect interested researchers in health economics and integrated care to collaborate on research projects, grant proposals, and other activities to answer the outlined research questions; - refine the discussion paper and develop it into a position paper on health economic research for integrated care; - establish further the SIG HEIC as a working group within IFIC, which will be responsible for the further development of the research agenda as agreed upon during the workshop. Participants : The target audience consists of the participants of the workshop on health economic evaluation in integrated care during the ICIC14 in Brussels; researchers and professionals who are interested in health economics in integrated care and decision-makers and insurers who are willing to get a better understanding of health economic issues.