Payment mechanisms to improve prevention spending in health care settings: A policy-focused evidence brief.

The policy challenge: Decades of evidence indicate that preventative healthcare is both effective and value for money in improving population health long-term. However, healthcare organisations often focus on short-term factors. Leveraging funding mechanisms to promote prevention may facilitate higher implementation of prevention initiatives. The most common funding mechanisms include capitation, Fee-for-service (FFS) and Pay-for-performance (P4P). Here, we explore the policy relevant studies which explore payment incentives for improving long-term population health and under which circumstances these incentives should be encouraged. Key evidence to inform policy: There are six key lessons for policy makers from the evidence base of how healthcare funding mechanisms can be best designed to promote long-term prevention: 1) spending on prevention is highly efficient and its beneficial effects are likely underestimated, 2) well-funded capitation models best incentivise preventative healthcare, 3) variable funding mechanisms, such as FFS and P4P, can be beneficial in increasing quantity focused preventative interventions-those with a uniform and straightforward approach, such as immunisation programs, 4) non-payment to hospitals may be effective in encouraging prevention, 5) Social Impact Bonds may facilitate prevention spending whilst mitigating financial risk away from the public sector, but come with complexity, 6) return on-investment tools can improve spending efficiency, but their impact on decision making is unclear. Further considerations and implications: To most effectively incentivise preventative healthcare, capitation payments should be complemented by more variable funding models for specific preventative services. Alternative payment mechanisms, such as Social Impact Bonds and non-payment may have their place. Integrating equity into decision making shows promise in further improving outcomes.