PhD defence T.S. (Thomas) Reindersma

Below is a brief summary of the dissertation: 

In popular and scholarly discourse, consensus exists that current payment models for health and social care have drawbacks that prevent health and care systems from addressing issues of accessibility, affordability, and quality. The current fragmented and layered patchwork of payment models and funding streams poses challenges for the integration of health and social care and the implementation of (intersectoral) innovations that aim to improve quality. These developments call for a rethinking of how health and social care are paid for and funded. The current body of literature is dominated by descriptive and prescriptive studies on APMs, rather than the processual or relational aspects of its implementation. It is important to address this gap, as studies indicate that implementing and experimenting with APMs is cumbersome.

This thesis shows that issues of power, status, autonomy (both professional and organizational), and diverging interests and goals of purchasers, provider organizations, and professionals should be considered during implementation. Case studies illuminate how both purchasers and providers engage in pilots to experiment with alternative payment and funding models. They show how institutions both enable and constrain the implementation of APMs. The co-existence of traditional and alternative payment models allows actors to fall back on traditional, established payment and funding structures that are still legimate. Yet, actors exercise some degree of agency to shape the boundaries and institutions that underlie and influence payment models. However, with fading urgency – and faced with structural constraints – actors fall back on institutionalized practices and routines to maintain current models.