Figure 1
Flowchart diagram of the study selection process for the systematic search.
Figure 2
Flowchart diagram of the study selection process for the further ‘snowballing’ search.
Table 1
Summary of the models included in the final qualitative synthesis.
| MODEL | COUNTRY | COUNTRY HEALTH SYSTEM TYPE ([54]) | TARGET POPULATION | DESCRIPTION OF THE BUDGET | PLACE-BASED (YES/NO) | SUMMARY OF FINDINGS |
|---|---|---|---|---|---|---|
| 1. Australian Coordinated Care Trials (ACT) [32, 66, 72, 73, 74, 75]. | Australia | National Health Insurance Regulation: State Financing: State Provision: Private | Population size: ~5000 participants for each of the nine trials. Population description: Patients with complex healthcare needs | Monetary size: Capitated budget of 0.50 to 5 Australian dollars per participant per day depending on which sites. Existing/Additional funding: Additional Service included: a broad set of services. | No | Study Design: Randomised controlled trial Summary of findings: cost-neutral and the mean quality of life did not improve. |
| 2. SIPA (System of Integrated Services for Aged Persons) [9, 18, 22, 68, 73, 83, 84, 85]. | Canada | National Health Insurance Regulation: State Financing: State Provision: Private | Population size: 606 participants Population description: elderly persons. | Monetary size: capitated budget of $400 per patient per year. Existing/Additional funding: Additional Service included: a broad set of services | No | Study Design: Randomised controlled trial Summary of findings Accessibility increased, no significant difference in hospital services utilisation or costs. |
| 3. The Program of All-inclusive Care of the Elderly (PACE) [76, 77, 78, 79, 80, 81, 119, 120] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: 651 participants. Population description: frail elderly persons | Monetary size: capitated budget. Service included: a broad set of services | No | Study Design: A cross-sectional time-series Summary of findings: Decreased hospital admission rates and hospital length of stay. |
| 4. The British Columbia Model [61, 86, 87, 121] | Canada | National Health Insurance Regulation: State Financing: State Provision: Private | Population size: regional model Population description: frail elderly persons | Monetary size: n/a Existing/Additional funding: additional Service included: broad set of services | No | Study Design: Cost-minimisation analysis Summary of findings: No difference in life satisfaction. |
| 5. Accountable Care Organisations (ACOs)[11, 15, 26, 35, 96] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: Various sizes. More than 750 ACOs in the U.S. serve around 20 million people. Population description: All the insured individuals in that specific geographical area | Monetary size: Capitated budget under a contractual arrangement with an insurer. Existing/Additional funding: Service included: a broad set of services | No | Study Design: Various evaluations (both qualitative and quantitative). Summary of findings: mixed findings: mixed |
| ACO example: Kaiser Permanente [9] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: 8.7 million people in eight regions. Population description: All the insured individuals in that specific geographical area | Monetary size: Capitation payment. Existing/Additional funding: Existing Service included: broad set of services. | No | Study design: Various evaluations (both quantitative and qualitative) Summary findings: one of the top-performing health systems in the U.S. |
| ACO example: The Veterans Health Administration (V.A.)[9, 88] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: Regionally based. Population description: older people | Monetary size: Capitation payment. Existing/Additional funding: Existing Service included: broad set of services | No | Study design: Various evaluations, both quantitative and qualitative Summary findings: Reduced hospital bed days by 55 per cent |
| ACO example: Geisinger Health System [9] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: 2.6 million people Population description: People with high healthcare needs | Monetary size: Bundled payments Existing/Additional funding: Existing Service included: a broad set of services | No | Study design: Various evaluations, both quantitative and qualitative Summary findings: increased productivity and patient satisfaction. |
| 6. Gesundes Kinzigtal [58, 59, 71, 90] | Germany | Social Health Insurance Regulation: Societal actors Financing: Societal actor Provision: Private | Population size: ~35,000 Population description: nearly half of the 69,000 residents of the Kinzigtal region | Monetary size: shared savings contract based on (virtual) capitated budget Existing/Additional funding: additional Service included: a broad set of services. | Yes | Study design: Propensity Score Matching Summary of findings: reduction of 2.5 years in mortality rate. |
| 7. The Arizona Long-Term Care System (ALTCS) [122, 123] | United States | Private Health System Regulation: Private Financing: Private Provision: Private | Population size: all the individuals in a given geographical area. Population description: patients at high risk of institutionalisation. | Monetary size: capitated budget Existing/Additional funding: additional Service included: a broad set of services. | No | Study design: computer simulation with survey data. Summary of findings: decreased nursing home utilisation |
| 8. Better Care Fund (BFC) [8, 29, 124, 125, 126, 127] | England | National Health Service Regulation: State Financing: State Provision: State | Population size: 14,362,968 Population description: All the patients ehad any planned or emergency hospital admission in the two financial years before the first adoption of the BCF. | Monetary size: £5.3 billion in 2015/16, and£5.8 billion in 2016/17 for a total of £11.1 billion over the two years. Existing/Additional funding: existing funds Service included a broad set of services | No | Study design: ordinary least squares (OLS) regression and quasi-experimental methods (difference indifference). Summary of the findings: no effects on secondary care use for the whole population. Increased use of bed days increased in the short-term by 0.164 (4.9%) per patient per year |
| 9. Norrtalje [42, 55, 56, 57] | Sweden | National Health Service Regulation: State Financing: State Provision: State | Population size: 65,000. Population description: Residents of Norrtalje | Monetary size: Capitated budget. Up to 5% of the local authorities’ budget. Existing/Additional funding: Existing funding Service included: broad set of services. | Yes | Study Design: Pilot, qualitative. Summary of findings: Improved coordination but no cost reductions nor improvements in health outcomes. |
| 10. Eksote [128] | Finland | National Health Service Regulation: State Financing: State Provision: State | Population size: 132,000. Population description: Residents of EKSOTE region | Monetary size: 550 million € Existing/Additional funding: Existing funding Service included: all social and healthcare services | Yes | Study Design: various studies both qualitative and quantitative. Summary of findings: avoid necessary visits and optimized hospital admission |