To encourage innovation in health care, governments need to move away from current siloed funding to funding that encourages collaboration among providers in managing patients who need care in a variety of settings, argue the authors of an analysis in CMAJ (Canadian Medical Association Journal)
Funding in silos is a barrier to innovation, especially to improving transitions of care for patients who need multiple types of care in different settings. In Canada's health system, no player is well-positioned both to make the investment in an innovative model of care and to easily claim back the financial benefits.
"Although we often focus on who pays for health care (i.e., private versus public), how we fund health care providers also deserves attention," says Dr. Noah Ivers, a family physician at Women's College Hospital and assistant professor at the University of Toronto, Toronto, Ontario. "To better integrate care, we may need funding to be integrated, and then providers must learn to work together to make the most of that funding."
A key challenge for modern health care systems is to implement evidence-based health care. This is especially difficult when patients transition from one sector to another, such as after hospital discharge, or when multiple health care professionals are working with the same patient in an uncoordinated fashion.
There are many promising pilot projects to improve integration of care, but these typically are not implemented. One reason may be that current approaches to funding health care providers -- both individuals and organizations -- involve many independent, siloed budgets. The result is that even if a proven strategy can be implemented in one part of the system (e.g., primary care), to improve patient outcomes and produce savings in another part of the system (e.g., fewer hospitalizations) it may be impossible to find the funds to invest in that strategy.
Health systems around the world are experimenting with novel funding strategies to address this problem.
"A true learning health system would commit to experimenting with, and evaluating, changes in how we fund health care providers to constantly strive for better patient outcomes," he says.