Integrated Payment, Fragmented Realities? A Discourse Analysis of Integrated Payment in the Netherlands

Thomas Reindersma, Isabelle Fabbricotti, Kees Ahaus and Sandra Sülz
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Thomas Reindersma: Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
Isabelle Fabbricotti: Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
Kees Ahaus: Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands
Sandra Sülz: Department of Health Services Management & Organisation, Erasmus School of Health Policy & Management, Erasmus University, Burgemeester Oudlaan 50, 3062 PA Rotterdam, The Netherlands

IJERPH, 2022, vol. 19, issue 14, 1-14

Abstract: The current models used for paying for health and social care are considered a major barrier to integrated care. Despite the implementation of integrated payment schemes proving difficult, such initiatives are still widely pursued. In the Netherlands, this development has led to a payment architecture combining traditional and integrated payment models. To gain insight into the justification for and future viability of integrated payment, this paper’s purpose is to explain the current duality by identifying discourses on integrated payment models, determining which discourses predominate, and how they have changed over time and differ among key stakeholders in healthcare. The discourse analysis revealed four discourses, each with its own underlying assumptions and values regarding integrated payment. First, the Quality-of-Care discourse sees integrated payment as instrumental in improving care. Second, the Affordability discourse emphasizes how integrated payment can contribute to the financial sustainability of the healthcare system. Third, the Bureaucratization discourse highlights the administrative burden associated with integrated payment models. Fourth, the Strategic discourse stresses micropolitical and professional issues that come into play when implementing such models. The future viability of integrated payment depends on how issues reflected in the Bureaucratization and Strategic discourses are addressed without losing sight of quality-of-care and affordability, two aspects attracting significant public interest in The Netherlands.

Keywords: integrated payment; integrated care; discourse; healthcare policy; alternative payment models (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
References: View references in EconPapers View complete reference list from CitEc
Citations: View citations in EconPapers (1)

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