Integrated health systems and cost: accountability and price control are also important.

Integrated Health Services are frequently thought as a tool to decrease healthcare-related costs, specially in systems with a high level of fragmentation. In the US healthcare system reform, Medicare has often been used as a reference point of the overall health expenditure. In this post, this hypothesis is analysed according to a recent article from the National Bureau of Economic Research ("The Price Ain’t Right? Hospital Prices and Health Spending on the Privately Insured") where the authors review the costs of 306 Hospital Referral Regions in the US, showing a big discordance between Medicare costs and overall costs.

In the analysis of Josh Freeman it is said that the dominant position of some integrated health services in some regions is used to perform very efficient healthcare provission in the Medicare level but also to increase the rates to private insurers.

Unintended costs of health care integration.

Decreasing -or, at least, containing- costs is one of the most important values usually attributed to health services integration. In this post published in the Harvard Medical School website, cost containing is questioned according to a paper published in JAMA Internal Medicine, where researchers describe how anual outpatient spending has grown in some integrated areas by 3.1 percentage point even when changes in use of outpatient care were minimal.

In this text, the author hypothesizes that integration between physicians and hospitals turn their position with insurers stronger, specially for prices of outpatient care. Health care integration may, in some situations, promote positions of power in the market, so that could have an influence in price negotiation and healthcare spending.

This unexpected cost increasing should be considered when designing integrated care policies and incentives, in order to avoid unintended spending cost that could threaten the sustainability of integrated health services.

Mapping Evidence of Patients’ Experiences in Integrated Care Settings: A Protocol for a Scoping Review

Integrated care (IC) models have emerged to address gaps in care for individuals with complex healthcare needs. Although the clinical and cost-effectiveness of IC models are well-established, the understanding of whether IC models facilitate a patient-centred care experience from the patients’ perspective is not well understood. This scoping review aims to comprehensively map the literature to provide a broad overview of patients’ experiences in IC settings with a focus on the experiences of complex patients with comorbid mental and physical illnesses. It also aims to describe current gaps identified in the literature in our understanding of aspects of care that are often unrecognised.