Abstract
Background: A unified funding system is critical step in enhancing integrated health and social care in fragmented systems. It has been demonstrated policies that support joint access to and responsibility for funding increases participation in integrated care. However, knowledge regarding the type of funding systems employed in integrated health and social care initiatives is usually scarce, underreported, and are rarely well described at programmatic levels. This paper contributes to building a stronger body of knowledge on the different funding models currently used in integrating health and social care services by mapping models utilised in local programs in Sydney, Australia.
Approach: Qualitative interviews were designed to map current funding models in integrated health and social care programs in the Sydney metropolitan region aligned with the Wodchis Policy Supports Framework. Researchers were interested to explore the funding models and describe innovative policies and agreements to support the integration of health and social care funds.
Results: We reviewed 24 locally-led health and social care initiatives and first distinguished between sources of funding and control of funds within a program of work. Innovative models of sourcing funds for piloting new initiatives at health-led programs are emerging; such as combining research grants combined with in-kind contributions from the local health authorities. Two health-led initiatives had combined funding sources from social and health funders employing a memorandum of understanding (including control of the funds) as policy support. Two initiatives were reporting separate pathways as funding arrangements to support integration. Funding from social-led-programs was more diverse and broad compared to funding in health-lead programs. Importantly, the health sector is also supporting social care via New South Wales Health or the Australian Government Department of Health and Age Care.
Implications: The current landscape of funding models for both health and social care are complex and, while we recognise the scattered nature of the health and social care systems overall (tending to be reactive rather than proactive), the results of this study demonstrate that systems are beginning to adopt pooled funding models and entering to agreements to reduce fragmentation and better serve priority populations. There is an opportunity to build more robust funding systems and channels to expand integrated funding schemes, including contractually agreed sharing of control of funds, given existing health and social sectors collaborations and partnerships highlighted in this study.