Building Healthy Communities - Aligning Incentives to Address Social Determinants of Health

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Dec 10, 2017
by Salzburg Global Seminar
Building Healthy Communities - Aligning Incentives to Address Social Determinants of Health

Participants consider how aligned financial incentives could better support hospitals

Helen Buckingham in conversation at Salzburg Global Seminar

In among the discussions at Building Healthy Communities: The Role of Hospitals, participants have been asked to consider how aligned financial incentives could better direct and support hospitals to address the social determinants of health.

On Friday afternoon, Jay Bhatt, Helen Buckingham, and Mike Nader took part in a panel discussion to explore the question in further detail. Each panelist chose to modify the question and tackle it from a different angle.

Nader, executive vice-president and chief operating officer at the University Health Network, in Canada, suggested people needed to look at how to align the “health ecosystem” to promote better health. He highlighted Canada as an amalgamation of many health systems where each province manages its own health delivery. These provinces are structured in different ways.

Many systems are volume-based, according to Nader. The more you do, the more money you get Nader said the concept of how we fund health should be flipped on its head.

In addition to this, Nader also said people needed to look at how to incentivize good transitions, care and support upstream and downstream of hospitals.

Buckingham, a senior fellow at the Nuffield Trust, in the United Kingdom, said she was interested in what stopped people from making the decisions they ought to take. She said what drives people to do the things they do is fulfilling their ambitions and potential. It is difficult to design a financial system which would make someone do something they wouldn’t do in any event.

Success relies on the data and the people who deliver it. Buckingham called for more people who have a greater understanding of what drives clinician behavior, patient behavior, and managerial behavior. Participants heard there were opportunities to develop local arrangements that prevent money from being a barrier, reduce gaps, and allow money to be the enabler of change rather than the driver.

Bhatt, the chief medical officer at the American Hospital Association, reframed the question. He asked: what are we for when accelerating health? The answers to this question can help guide the strategy. He said people knew investing in the social determinants of health could make a difference, but the evidence supporting this was still emerging.

The people who sit on the board of trustees often don’t understand the benefits of investing in community health and why it is the right thing to do, according to Bhatt. He suggested it was up to others to convince them.

In response to this discussion, one participant remarked that for a panel about financial incentives the conclusion seemed to be money isn’t everything. Another table discussed how changing payment models and incentives was perhaps necessary but not sufficient to change health systems.


The session, Building Healthy Communities: The Role of Hospitals is part of Salzburg Global Seminar multi-year series Health and Health Care Innovation in the 21st Century. This year’s session is held in partnership with the Robert Wood Johnson Foundation. To keep up to date with the conversations taking place during the session, follow #SGShealth on Twitter and Instagram.

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