Keywords: shared savings, payment reform, primary care, integrated care, chronic conditions
Background: Social health insurance models that share savings among providers may promote more integrated and preventative healthcare but risk service under-provision to cut costs. There's limited evidence on optimal savings distribution to incentivise patients’ health outcomes. We explored a primary care-oriented shared savings model (PCO-SSM) in China, reallocating a greater portion of savings to primary care providers to boost primary care use and prevent costly hospital admissions.
Methods: We analysed claims data for 47,710 chronic condition patients from January 2020 to December 2022. Using an interrupted time series and controlling for individual characteristics, fixed effects, and seasonality, we evaluated service utilisation and expenditure changes post-reform in January 2021, including subgroup analyses for single and multiple conditions.
Results: PCO-SSM decreased monthly per-patient inpatient admissions by 0.03%, inpatient expenditure by 0.40%, and inpatient days by 0.14%. Trends in outpatient visits at primary care decreased by 0.72% and outpatient expenditure by 4.81%. Hospital outpatient visits saw a minor decline of 0.26%. Notably, inpatient admissions slightly increased at primary care facilities for patients with multimorbidity. Additionally, inpatient admissions slightly increased at primary care facilities for patients with multimorbidity.
Conclusion: Shifting a larger share of savings from hospitals to primary care providers under PCO-SSM reduced inpatient admissions and associated expenditures, reflecting potentially better management of chronic conditions. However, it also led to reduced primary care utilisation, suggesting possible undertreatment or limited service capacity. This underscores the need for robust support to primary care facilities, particularly in rural areas.

Introduction. Capitation, a healthcare financing model where providers receive a fixed payment per patient over a specified period regardless of services used, offers a significant shift in healthcare management. By transferring the financial risk of care quality and outcomes from consumers or third-party payers to providers, capitation incentivises preventive care, cost efficiency, and patient-centred management. However, this redistribution of financial risk poses unique challenges in Singapore’s healthcare landscape, particularly given its traditional reliance on fee-for-service (FFS) payments, a fragmented private primary care sector, and the 3Ms – MediSave, MediShield Life, and MediFund – and substantial government subsidy.
In Singapore’s current system, consumers bear much financial responsibility for healthcare through personal savings and insurance, while the government provides subsidies and assistance for the underprivileged. The predominant fee-for-service economy focuses care delivery on treating sickness rather than managing the overall health of the population, which limits the ability to transition smoothly into a capitation-based model.
Current Situation. The Healthier SG initiative represents a critical first step in reshaping Singapore’s healthcare system towards population health management and preventive care. Capitation could play a pivotal role in this transformation by incentivising providers to engage with groups of individuals under their care, not just those presenting with illness. However, shifting financial risk to providers under Singapore’s current structure presents significant hurdles. Providers may lack the operational scale, resources and risk management capabilities to succeed under capitation. The fragmented primary care system, characterised by many small clinics with only one or a few doctors, compounds these challenges. Such clinics typically lack the patient volume to spread the financial risks associated with capitation, making it difficult for them to absorb the costs of managing patients with complex or high-cost conditions. These limitations could lead to under-servicing or reluctance to take on high-risk patients without adequate safeguards.
Key Considerations. The key to successful capitation lies in balancing financial risk with incentives for high-quality care. In Singapore’s context, implementing capitation requires careful calibration of capitation rates, robust quality benchmarks and safeguards to support providers in managing risk effectively. Policymakers must also address equity concerns to ensure high-risk or complex patients receive adequate care.
Policy Options. A mixed, partially-capitated model offers a potential solution. In this model, primary care providers receive a base capitation payment for preventive care and population health activities while maintaining limited FFS payments for episodic treatments. This hybrid approach spreads financial risk while maintaining sufficient provider revenue. Larger provider networks or collaborations among smaller clinics (or primary care networks) help to share risk and pool resources effectively. Digital health records, integrated across public and private sectors, will be essential for tracking care outcomes, monitoring quality, and ensuring transparency in a capitation framework.
Conclusion. This presentation explores the potential of a partially-capitated model tailored to Singapore’s healthcare system. It examines how capitation could align with Healthier SG’s goals, addressing the challenges of risk transfer while leveraging Singapore’s strengths to create a system that prioritises health outcomes, equity and sustainability.

Background: Health systems in the Latin American region are characterized by segmentation and fragmentation, shaped by sociohistorical processes tied to political, economic, and sociocultural dynamics. As a result, these systems reflect prevailing development models, ideological paradigms, and diverse organizational arrangements at the levels of care models, insurance frameworks, system structure, and funding sources, among others. In this context, it is imperative that health services and care be person-centered, incorporating a complex adaptive social approach and a relational, population-based, plurinational, and territorial perspective. These services must integrate family and community care into care models, considering diversity and ensuring effective participation. To contribute to this vision, the study titled "Health System Conditions for Scaling Integrated Care in Latin American Contexts Using the SCIROCCO Tool" aims to analyze the organizational maturity conditions in local contexts across the region. The study seeks to strengthen integrated care centered on people, families, and communities in Latin America by addressing the question: What are the health system conditions for scaling integrated care in the contexts of Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, and Mexico, using the Scaling Integrated Care in Context (SCIROCCO) tool?

Approach: To answer this question, the study will characterize the degree of organizational maturity in health services across the study contexts based on the integrated care dimensions of the SCIROCCO tool. It will identify divergences and convergences in organizational maturity across these contexts and propose guidelines to advance person-, family-, and community-centered integrated care in the study contexts within Latin America.

Results: This initiative is underway and has successfully formed and prepared research teams in Bolivia, Chile, Colombia, Costa Rica, and Mexico. Additionally, it has secured the support and guidance of the Pan American Health Organization (PAHO).

Implications: Developing this initiative has involved extensive preparation of research teams, including creating spaces for discussions to understand the functioning of health systems in participating contexts. This process has facilitated the inclusion of the complexity of each context in the fieldwork. Following this preparatory phase, the study will be implemented in the participating contexts during 2025–2026.

Background and objectives
Integrated care aims to coordinate the care needs of a population, particularly individuals with complex care needs, across community, primary and secondary care settings. Ontario has been pursuing a whole systems approach to integration through reorganization into Ontario Health Teams (OHTs) where hospitals, doctors, and allied health providers work as a coordinated team to provide responsive, appropriate, and efficient health services. This study explores policy supports for integrated models of care in England, Germany, and the Netherlands to identify promising approaches to collaborative governance and their policy implications for integrated care initiatives in Ontario.

Methods
We reviewed academic and grey literature about integrated models of care across three comparator countries and conducted in-depth qualitative interviews with 14 expert informants from England, Germany and the Netherlands in Autumn 2023. We mapped country results against a conceptual framework about policy supports: governance/partnerships, workforce, financing, and data sharing (Wodchis et al 2020), and decision-making processes for policy transfer (Nolte and Groenewegen 2021) to understand the benefits, enabling factors and barriers to progress for integrated care reforms.

Results
All jurisdictions are pursuing integrated care initiatives through collaborative governance approaches that vary in scale and scope. We find that the comparator jurisdictions use population-level decision-making (Germany), joint decision making at the regional level through Integrated Care Boards (health-specific) and Integrated Care Partnerships (committees for both health and community-based organizations) (England), and voluntary consortia of relevant providers delivering care for chronic conditions or population subgroups (Netherlands). Service-specific innovations, such as the presence of policy entrepreneurs or knowledge brokers, also plays an important role in enabling the policy process for successful implementation. We identify several contributing factors, such as the balance of representatives across the health and community sectors, the use and availability of common standards, and flexibility for local-level adaptations, that enable collaborative governance. More policy supports for workforce-related initiatives are needed to support professional development and intersectoral knowledge. There remain significant challenges with data sharing and power disparities between the health and social care sector.

Conclusion
Integration projects that emphasise collaboration, workforce planning, and interdisciplinary teams are widely supported by health services providers to enable greater coordination of care to improve care effectiveness and efficiency for patients with chronic conditions or complex co-morbidities. Legislation is an important enabling factor for supporting collaborative governance. New financing streams can reward collaborative working for interdisciplinary teams. Our results are a starting point for further research that captures macro, meso and micro level variation and differing forms of patient segmentation in the implementation of integrated care systems.