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2018 ; 18
(1
): 2
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Contract Design: Financial Options and Risk
#MMPMID29588640
Mühlbacher AC
; Amelung VE
; Juhnke C
Int J Integr Care
2018[Jan]; 18
(1
): 2
PMID29588640
show ga
INTRODUCTION: Integrated care systems as well as accountable care organisations
(ACOs) in the US and similar concepts in other countries are advocated as an
effective method of improving the performance of healthcare systems. These
systems outline a payment and care delivery model that intends to tie provider
reimbursements to predefined quality metrics. By this the total costs of care
shall be reduced. When designing healthcare options contractors are faced with a
variety of financial options. The costs of market utilisation are highly relevant
for the conception of healthcare contracts; furthermore contract-specific
investments are an obstacle to the efficient operation of ACOs. METHODS: A
comprehensive literature review on methods of designing contracts in Integrated
Care was conducted. This article is the second in a row of three that are all
published in this issue and contribute to a specific issue in designing
healthcare contracts. The first dealt with the organisation of contracts and
information asymmetries, while part 3 concludes with the question of risk
management and evaluation. The specific research question of this second article
focusses on the financial options and reimbursement schemes that are available to
define healthcare contracts. RESULTS: A healthcare contract is a relational
contract, which determines the level of reimbursement, the scope of services and
the quality between service providers and payers, taking account of the risks
relating to population and performance. A relational contract is an agreement
based upon assumption of a longer timeframe. A major obstacle to the practical
implementation of healthcare contracts is the prognosis of the inflows and
outflows due to the actuarial risks of the insured population. Financing
conditions and reimbursement arrangements that are based on a prospectively
determined fixed price, have a significant drawback: it is very difficult to take
the differences in health status and the utilisation of distinct insured
clientele (panel) into account. DISCUSSION AND CONCLUSION: The first two articles
of this series on contract design have shown that complete contracts in
healthcare are unrealistic. Healthcare reimbursement contracts are incomplete
contracts with a high degree of uncertainty. In incomplete contracts specific
contractual regulations are not made for any eventuality. For this reason it is
important that the parties agree on the prevention of endogenous risks
(asymmetric information after the conclusion of the contract) and on the
procedure in the case of unforeseen circumstances (the risks of random, parameter
risk and change risks to the healthcare program).
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