{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T03:37:06Z","timestamp":1775705826149,"version":"3.50.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T00:00:00Z","timestamp":1365033600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2013,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Background<\/jats:title>\n            <jats:p>Stroke services are a form of integrated care which have been introduced in many countries, including the Netherlands, to improve health outcomes and processes of care by connecting the acute, rehabilitative, and chronic phases of stroke care. Limited research exists on the effects of payment systems on the functioning of integrated care services from the perspectives of those involved in providing, planning and contracting the care. This qualitative study identified stakeholder views on i) challenges in integrated stroke care associated with fee-for-service systems; ii) other possible financing models for stroke care, and iii) challenges in the implementation of an integrated financing mechanism for stroke care.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Twenty-four participants were interviewed using face-to-face audio-recorded semi-structured interviews. Respondents were purposively selected from five stakeholder groups; care providers, health care managers, health insurers, experts and patient representatives. Transcribed data were coded and analysed to generate themes relating to the study aims.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Respondents mentioned the following challenges associated with the current fee-for-service system; inappropriate incentives for cooperation, efficiency and improving quality and the inability to exert steering power at the level of the stroke service. In addition, care is not patient-centred and the financing system is inflexible.<\/jats:p>\n            <jats:p>The respondents mentioned several solutions for the challenges, but there was no consensus amongst them. Regarding the implementation of integrated financing, respondents mentioned the following general challenges; a) the foundations of the financing system are incompatible with integrated financing, b) co-morbidity and c) the lack of evidence on the effect of integrated financing. Stroke-specific challenges were; a) the diverse patient population, b) a non-uniform care trajectory, c) unclear division of responsibility for the overall care and d) different stages of development among stroke services.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This study provides new knowledge on stakeholder perception of the effect of payment systems and financial incentives on cooperation processes, quality of care and cost-containment in integrated stroke care. The results show that fee-for-service does not provide the right incentives for the integration of stroke care. We recommend to perform financial experiments for integrated stroke care.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/1472-6963-13-127","type":"journal-article","created":{"date-parts":[[2013,4,4]],"date-time":"2013-04-04T16:15:01Z","timestamp":1365092101000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["A qualitative study of stakeholder views on the effects of provider payment on cooperation, quality of care and cost-containment in integrated stroke care"],"prefix":"10.1186","volume":"13","author":[{"given":"Johanneke FMM","family":"Tummers","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Augustinus JP","family":"Schrijvers","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Johanna MA","family":"Visser-Meily","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2013,4,4]]},"reference":[{"key":"2540_CR1","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1056\/NEJMhpr0706165","volume":"358","author":"T Bodenheimer","year":"2008","unstructured":"Bodenheimer T: Coordinating care\u2013a perilous journey through the health care system. N Engl J Med. 2008, 358: 1064-1071. 10.1056\/NEJMhpr0706165.","journal-title":"N Engl J Med"},{"key":"2540_CR2","doi-asserted-by":"publisher","first-page":"1627","DOI":"10.1377\/hlthaff.2011.0836","volume":"30","author":"JK Iglehart","year":"2011","unstructured":"Iglehart JK: Desperately seeking savings: states shift more Medicaid enrollees to managed care. Health Aff. 2011, 30: 1627-1629. 10.1377\/hlthaff.2011.0836.","journal-title":"Health Aff"},{"key":"2540_CR3","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/S0168-8510(00)00125-1","volume":"55","author":"BA van der Linden","year":"2001","unstructured":"van der Linden BA, Spreeuwenberg C, Schrijvers AJ: Integration of care in The Netherlands: the development of transmural care since 1994. Health Policy. 2001, 55: 111-120. 10.1016\/S0168-8510(00)00125-1.","journal-title":"Health Policy"},{"key":"2540_CR4","doi-asserted-by":"publisher","first-page":"e12","DOI":"10.5334\/ijic.67","volume":"2","author":"DL Kodner","year":"2002","unstructured":"Kodner DL, Spreeuwenberg C: Integrated care: meaning, logic, applications, and implications\u2013a discussion paper. Int J Integr Care. 2002, 2: e12.","journal-title":"Int J Integr Care"},{"key":"2540_CR5","doi-asserted-by":"publisher","first-page":"1509","DOI":"10.1056\/NEJMsb0707912","volume":"358","author":"JJ Mongan","year":"2008","unstructured":"Mongan JJ, Ferris TG, Lee TH: Options for slowing the growth of health care costs. N Engl J Med. 2008, 358: 1509-1514. 10.1056\/NEJMsb0707912.","journal-title":"N Engl J Med"},{"key":"2540_CR6","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1377\/hlthaff.28.2.w262","volume":"28","author":"RE Mechanic","year":"2009","unstructured":"Mechanic RE, Altman SH: Payment reform options: episode payment is a good place to start. Health Aff. 2009, 28: 262-271. 10.1377\/hlthaff.28.1.262.","journal-title":"Health Aff"},{"key":"2540_CR7","doi-asserted-by":"publisher","first-page":"1197","DOI":"10.1056\/NEJMp0804658","volume":"359","author":"MB Rosenthal","year":"2008","unstructured":"Rosenthal MB: Beyond pay for performance\u2013emerging models of provider-payment reform. N Engl J Med. 2008, 359: 1197-1200. 10.1056\/NEJMp0804658.","journal-title":"N Engl J Med"},{"key":"2540_CR8","doi-asserted-by":"publisher","first-page":"1075","DOI":"10.1056\/NEJMp1113361","volume":"366","author":"DM Cutler","year":"2012","unstructured":"Cutler DM, Ghosh K: The potential for cost savings through bundled episode payments. N Engl J Med. 2012, 366: 1075-1077. 10.1056\/NEJMp1113361.","journal-title":"N Engl J Med"},{"key":"2540_CR9","doi-asserted-by":"publisher","first-page":"1557","DOI":"10.1161\/STROKEAHA.108.535088","volume":"40","author":"PU Heuschmann","year":"2009","unstructured":"Heuschmann PU, Di Carlo A, Bejot Y, Rastenyte D, Ryglewicz D, European Registers of Stroke (EROS) Investigators: Incidence of stroke in Europe at the beginning of the 21st century. Stroke. 2009, 40: 1557-1563.","journal-title":"Stroke"},{"key":"2540_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.5334\/ijic.847","volume":"12","author":"JFMM Tummers","year":"2012","unstructured":"Tummers JFMM, Schrijvers AJ, Visser-Meily JMA: Economic evidence on integrated care for stroke patients; a systematic review. Int J Integr Care. 2012, 12: 1-15.","journal-title":"Int J Integr Care"},{"key":"2540_CR11","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.5334\/ijic.118","volume":"5","author":"MM Minkman","year":"2005","unstructured":"Minkman MM, Schouten LM, Huijsman R, van Splunteren PT: Integrated care for patients with a stroke in the Netherlands: results and experiences from a national Breakthrough Collaborative Improvement project. Int J Integr Care. 2005, 5: e14.","journal-title":"Int J Integr Care"},{"key":"2540_CR12","doi-asserted-by":"publisher","first-page":"e17","DOI":"10.5334\/ijic.50","volume":"2","author":"H Rosendal","year":"2002","unstructured":"Rosendal H, Wolters CA, Beusmans GH, de Witte LP, Boiten J, Crebolder HF: Stroke service in The Netherlands: an exploratory study on effectiveness, patient satisfaction and utilisation of healthcare. Int J Integr Care. 2002, 2: e17.","journal-title":"Int J Integr Care"},{"key":"2540_CR13","doi-asserted-by":"publisher","first-page":"518","DOI":"10.1017\/S0266462306051464","volume":"22","author":"JN Struijs","year":"2006","unstructured":"Struijs JN, Van Genugten MLL, Evers SMAA, Ament AJH, Baan CA, Van Den Bos GAM: Future costs of stroke in the Netherlands: The impact of stroke services. Int J Technol Assess Health Care. 2006, 22: 518-524.","journal-title":"Int J Technol Assess Health Care"},{"key":"2540_CR14","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1016\/S0168-8510(99)00037-8","volume":"48","author":"B Hardy","year":"1999","unstructured":"Hardy B, Mur-Veemanu I, Steenbergen M, Wistow G: Inter-agency services in England and The Netherlands. A comparative study of integrated care development and delivery. Health Policy. 1999, 48: 87-105. 10.1016\/S0168-8510(99)00037-8.","journal-title":"Health Policy"},{"key":"2540_CR15","doi-asserted-by":"publisher","first-page":"w532","DOI":"10.1377\/hlthaff.26.4.w532","volume":"26","author":"HH Pham","year":"2007","unstructured":"Pham HH, Ginsburg PB, McKenzie K, Milstein A: Redesigning care delivery in response to a high-performance network: the Virginia Mason Medical Center. Health Aff. 2007, 26: w532-w544. 10.1377\/hlthaff.26.4.w532.","journal-title":"Health Aff"},{"key":"2540_CR16","first-page":"1","volume":"112","author":"PB Ginsburg","year":"2007","unstructured":"Ginsburg PB, Pham HH, McKenzie K, Milstein A: Distorted payment system undermines business case for health quality and efficiency gains. Issue Brief Cent Stud Health Syst Change. 2007, 112: 1-4.","journal-title":"Issue Brief Cent Stud Health Syst Change"},{"key":"2540_CR17","doi-asserted-by":"publisher","first-page":"1166","DOI":"10.1056\/NEJMe078007","volume":"356","author":"K Davis","year":"2007","unstructured":"Davis K: Paying for care episodes and care coordination. N Engl J Med. 2007, 356: 1166-1168. 10.1056\/NEJMe078007.","journal-title":"N Engl J Med"},{"key":"2540_CR18","doi-asserted-by":"publisher","first-page":"690","DOI":"10.1377\/hlthaff.2010.1277","volume":"30","author":"RM Werner","year":"2011","unstructured":"Werner RM, Kolstad JT, Stuart EA, Polsky D: The effect of pay-for-performance in hospitals: lessons for quality improvement. Health Aff. 2011, 30: 690-698. 10.1377\/hlthaff.2010.1277.","journal-title":"Health Aff"},{"key":"2540_CR19","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1016\/j.healthpol.2005.11.011","volume":"78","author":"S Greb","year":"2006","unstructured":"Greb S, Focke A, Hessel F, Wasem J: Financial incentives for disease management programmes and integrated care in German social health insurance. Health Policy. 2006, 78: 295-305. 10.1016\/j.healthpol.2005.11.011.","journal-title":"Health Policy"},{"key":"2540_CR20","doi-asserted-by":"publisher","first-page":"2197","DOI":"10.1377\/hlthaff.2009.0799","volume":"29","author":"S Stock","year":"2010","unstructured":"Stock S, Drabik A, Buscher G, Graf C, Ullrich W, Gerber A: German diabetes management programs improve quality of care and curb costs. Health Aff. 2010, 29: 2197-2205. 10.1377\/hlthaff.2009.0799.","journal-title":"Health Aff"},{"key":"2540_CR21","doi-asserted-by":"publisher","first-page":"990","DOI":"10.1056\/NEJMp1011849","volume":"364","author":"JN Struijs","year":"2011","unstructured":"Struijs JN, Baan CA: Integrating care through bundled payments\u2013lessons from The Netherlands. N Engl J Med. 2011, 364: 990-991. 10.1056\/NEJMp1011849.","journal-title":"N Engl J Med"},{"key":"2540_CR22","doi-asserted-by":"publisher","first-page":"e046","DOI":"10.5334\/ijic.539","volume":"10","author":"H Hildebrandt","year":"2010","unstructured":"Hildebrandt H, Hermann C, Knittel R, Richter-Reichhelm M, Siegel A, Witzenrath W: Gesundes Kinzigtal Integrated Care: improving population health by a shared health gain approach and a shared savings contract. Int J Integr Care. 2010, 10: e046.","journal-title":"Int J Integr Care"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-13-127.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/1472-6963-13-127\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-13-127","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/1472-6963-13-127.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T22:52:19Z","timestamp":1630536739000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/1472-6963-13-127"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,4,4]]},"references-count":22,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2013,12]]}},"alternative-id":["2540"],"URL":"https:\/\/doi.org\/10.1186\/1472-6963-13-127","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,4,4]]},"assertion":[{"value":"23 May 2012","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 February 2013","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"4 April 2013","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}}],"article-number":"127"}}