Gongora-Salazar Pamela, Glogowska Margaret, Fitzpatrick Ray, Perera Rafael, Tsiachristas Apostolos
Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, GB.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, GB.
Int J Integr Care. 2022 Oct 7;22(4):3. doi: 10.5334/ijic.6693. eCollection 2022 Oct-Dec.
The emergence of Integrated Care Systems (ICSs) across England poses an additional challenge and responsibility for local commissioners to accelerate the implementation of integrated care programmes and improve the overall efficiency across the system. To do this, ICS healthcare commissioners could learn from the experience of the former local commissioning structures and identify areas of improvement in the commissioning process. This study describes the investment decision process in integrated care amid the transition toward ICSs, highlights challenges, and provides recommendations to inform ICSs in their healthcare commissioning role.
Twenty-six semi-structured interviews were conducted with local commissioners and other relevant stakeholders in South East England in 2021. Interviews were supplemented with literature.
England's local healthcare commissioning has made the transition towards a new organisational architecture, with some integrated care programmes running, and a dual top-down and bottom-up prioritisation process in place. The commissioning and consequent development of integrated care programmes have been hindered by various barriers, including difficulties in accessing and using information, operational challenges, and resource constraints. Investment decisions have mainly been driven by national directives and budget considerations, with a mixture of subjective and objective approaches. A systematic and data-driven framework could replace this ad-hoc prioritisation of integrated care and contribute to a more rational and transparent commissioning process.
The emerging ICSs seem to open an opportunity for local commissioners to strengthen the commissioning process of integrated care with evidence-based priority-setting approaches similar to the well-established health technology assessment framework at the national level.
英格兰各地综合医疗系统（ICSs）的出现给地方医疗服务采购者带来了额外的挑战和责任，要求他们加快综合医疗计划的实施并提高整个系统的整体效率。为此，ICS医疗服务采购者可以从前地方采购结构的经验中学习，并确定采购过程中的改进领域。本研究描述了向ICSs过渡过程中综合医疗的投资决策过程，突出了挑战，并提供了建议，以指导ICSs在其医疗服务采购角色中的工作。
2021年，对英格兰东南部的地方医疗服务采购者和其他相关利益相关者进行了26次半结构化访谈。访谈辅以文献资料。
英格兰地方医疗服务采购已向新的组织架构过渡，一些综合医疗计划正在实施，并且存在自上而下和自下而上的双重优先排序过程。综合医疗计划的采购及后续发展受到各种障碍的阻碍，包括获取和使用信息的困难、运营挑战和资源限制。投资决策主要由国家指令和预算考虑驱动，采用主观和客观方法相结合的方式。一个系统的、数据驱动的框架可以取代这种临时的综合医疗优先排序方式，并有助于实现更合理、透明的采购过程。
新兴的ICSs似乎为地方医疗服务采购者提供了一个机会，使其能够通过类似于国家层面成熟的卫生技术评估框架的循证优先排序方法，加强综合医疗的采购过程。
