Abstract
Introduction: Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find a solution to these demands, there has been a shift towards integrated care supported by information and communication technologies. However, little is understood about the role played by incentives and reimbursement schemes in the development of integrated care and information and communication technologies uptake. The objective of this paper is to investigate this question, specifically as regards telehealthcare.
Methods: In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case study approach was used. A clustering exercise was carried out and eight European countries were selected for in-depth study: Denmark, Estonia, Germany, France, Italy, the Netherlands, Spain and the UK. In total, 31 telehealthcare initiatives across eight countries involving over 20,000 patients were investigated.
Results: Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreaming and associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespread deployment.
Discussion and conclusions: Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions of Spain, Italy and France. Mainstreaming often went hand-in-hand with progress towards integrated care delivery and payment reforms.
A general trend was found towards outcomes-based payments and bundled payment schemes, which aimed to promote integrated care supported by telehealthcare deployment. Their effectiveness in achieving these goals remains to be seen.
In addition, a form of outpatient diagnostic-related group reimbursement for telehealthcare services was found to have emerged in a few countries. However, it is questionable how this incentive could promote integrated care delivery on its own.
This research suggests that incentives which align social, primary and hospital care are rare and there is a need to design new payment paradigms.
Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factors which can act as drivers or barriers for integrated care delivery.