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The paper seeks to move the integrated care debate forward by exploring what contributes to improved quality and efficiency, and to consider the practical consequences of translating a model exemplifying that success into the English context.

The authors contend that a key driver is to unite the whole system in a single purpose, incentivising all parts to align with that single shared purpose. Although designed for a very different healthcare system, the Accountable Care Organisation (ACO) model exemplifies this principle – aligning incentives across a variety of providers to achieve practical integration driven by outcomes.

The authors explore what an ACO model would comprise if transposed, demonstrating that it offers the short term gains claimed for integrated care whilst also providing a structured framework setting out a clear long term roadmap for both commissioner and provider evolution, hitherto not addressed by policy. Drawing analogies from other industries it is suggested that potential conflict between integration, competition and choice is exaggerated. The discussions with leaders and whole community groups has consistently been found to provide fresh and helpful insight.

In this paper, the authors bring fresh insight to what aspects of integrated care contribute to future success and then explore why and how that insight can be applied by translating growing experience from elsewhere into the English NHS setting.

This study aims to present a comprehensive integrative review of capitation payment for primary healthcare (PHC) in the Indonesian national health insurance (Jaminan Kesehatan Nasional,JKN).

Whittemore and Knafl’s integrative review method is used within this review and analysis framework. Multiple types of academic literature were included in this review, including all studies related to capitation payment in the JKN from 2014 until 2022.

This review found that several practices of capitation payments in the JKN in Indonesia deviate from basic economic concept of capitation. It does not yet incentivize PHC to create a competitive environment in attracting members and it does not incentivize health promotion and prevention. Moreover, the capitation model uses the same scope of primary care services for all PHC throughout the country – which in fact has disparities in providing 155 medical conditions as required competencies for PHC. The authors recommend that the JKN apply bottom-up costing and pricing methods to set market prices of capitation rates.

This is the first study that reviews theory-practice gap of the capitation payment model using an integrative review that covers academic literature, journal articles and regulations in Indonesia.

Population‐based indices of needs have an influence on mental health care funding. Over the last 30 years, a number of needs indices have been developed that utilise sociodemographic and service utilisation data to calculate a proxy indicator of population‐based need. This approach is used because indicators of socio‐economic disadvantage expressed as weighted deprivation show a strong relationship with mental health morbidity. In this paper, we review the existing indices, illustrate the application of these indices using east London as an example, and consider the methodological and conceptual limitations of these indices. Although none of the current indices provide a definitive picture, commissioners and providers may find them to be a useful source of contextual information, which may be useful in combination. In England, this is particularly relevant in the light of the increased liberalisation of commissioning services and changes in the funding process.

Thailand, like a number of other less‐developed countries, has experienced a rapid rise in the share of its national product that is being devoted to health. This paper examines the ways in which the country is paying for its preventive and curative care. Section 1 provides the context by discussing age‐structure and geographical distribution of the population, together with the rates of mortality and morbidity. Section 2 explores the delivery of medical attention, private and State. Section 3 evaluates seven ways in which medical care is financed in Thailand. It also makes recommendations for the future of social insurance which are of relevance both to Thailand and to other countries at a similar stage of economic development.

The State of Washington’s Mental Health Division (MHD) is the State agency responsible for providing state sponsored mental health services. In 1993, the MHD received a Health Care Financing Administration (HCFA) waiver to implement a statewide system of managed care for outpatient mental health rehabilitation services. Payments were to be prepaid and capitated and based on the numbers of clients in each of at least 3 payment tiers. This paper describes financial findings from a HCFA-mandated evaluation of the waiver. It looks at payment rates for children and adults, by tier, and for separately rated groups such as the categorically needy, medically needy, and disabled clients. Three types of State expenditures are compared in this paper: predicted expenditures based on actuarial projections, expenditures made on the basis of service utilization, and expenditures made after being adjusted for over payment controls. Expenditure predictions were consistently lower than actual expenditures, even after adjustments for over payment.

Objective – Tanzania, Mexico, and the United States are at vastly different points on the economic development scale. Yet, their health systems can be classified as “developing”: they do not live up to their potential, considering the resources available to them. The three, representing many others, share a common structural deficiency: a segregated health care system that cannot achieve its basic goals, the optimal health of its people, and their possible satisfaction with the system. Segregation follows and signifies first and foremost the lack of financial integration in the system that prevents it from serving its goals through the objectives of equity, cost containment and sustainability, efficient production of care and health, and choice.

Method – The chapter contrasts the nature of the developing health care system with the common goals, objectives, and principles of the Emerging Paradigm (EP) in developed, integrated – yet decentralized –systems. In this context, the developing health care system is defined by its structural deficiencies, and reform proposals are outlined.

Findings – In spite of the vast differences amongst the three countries, their health care systems share strikingly similar features. At least 50% of their total funding sources are private. The systems comprise exclusive vertically integrated, yet segregated, “silos” that handle all systemic functions. These reflect and promote wide variations in health insurance coverage and levels of benefits – substantial portions of their populations are without adequate coverage altogether; a considerable lack of income protection from medical spending; an inability to formalize and follow a coherent health policy; a lack of financial discipline that threatens sustainability and overall efficiency; inefficient production of care and health; and an dissatisfied population. These features are often promoted by the state, using tax money, and donors.

Policy implications – The situation can be rectified by (a) “centralizing” – at any level of development and resource availability – health system finance around a set package of core medical benefits that is made available to the entire population and (b) “decentralizing” consumption and provision of care. The first serves equity and cost containment and sustainability. The second supports efficiency and client satisfaction.

Originality/value of chapter – The chapter views commonly discussed problems of the health care system – a lack of insurance coverage and income protection – as symptoms of a large problem: health system segregation.

This paper aims to analyse health reforms carried out in a sample of European countries.

Using a country‐specific approach, outstanding health reform features such as: greater competition between sickness funds in Germany; fund‐holding practices in the UK; managed care models in Switzerland; health networks in France; and healthcare system decentralisation in Italy are analysed.

There have been different approaches to controlling healthcare costs. Some states relied on public sector competition by creating quasi‐markets (UK), insurance sector competition, particularly in Switzerland and Germany, organisational reforms in France by creating health networks and decentralisation in Italy.

Societal and legal aspects are not discussed.

The paper compares healthcare reform effectiveness in a number of western European countries.

Examines the construction of the funding formula, following the 1988 Education Act, used to determine the levels of devolved budgets in three English local education authorities (LEAs). Explains that, in each LEA, a team was formed to determine the funding formula. Also explains that, as most schools pre‐local management of schools (LMS) only kept aggregate records showing the cost of education at the levels of primary/secondary sectors rather than individual school level, the LMS teams faced serious problems in defining budget parameters, identifying cost elements and attributing costs to functions. More critically, points out that while the 1988 Education Act made it clear that the new budgeting system should be comprehensive in the sense of not merely reflecting past expenditure patterns but being based on perceived education needs, the LMS teams developed funding formulae which predominantly preserved the status quo established by historical expenditure patterns. Explores both the arguments and the mechanisms which each LMS team deployed in order to produce an incrementalist budgeting system and the constraints that operated on incrementalism.