Incentives for telehealthcare deployment that support integrated care: a comparative analysis across eight European countries

Abstract

Introduction: Health care systems are struggling to deal with the increasing demands of an older population. In an attempt to find asolution 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 informationand communication technologies uptake. The objective of this paper is to investigate this question, specifically as regardstelehealthcare.Methods: In order to identify the deployment of telehealthcare applications and their role in supporting integrated care, a case studyapproach 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 over20,000 patients were investigated.Results: Reflecting on specific examples in each initiative, drivers promoting integrated care delivery supported by telehealthcare mainstreamingand associated incentive mechanisms were identified. Attention was also paid to other factors which acted as barriers for widespreaddeployment.Discussion and conclusions: Trends towards telehealthcare mainstreaming were found in Denmark, the UK, and in some regions ofSpain, 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 caresupported 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 fewcountries. 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 paymentparadigms.Finally, eHealth penetration, interoperability, governance, availability of evidence and reorganisation of services represent additional factorswhich can act as drivers or barriers for integrated care delivery.