How can health promotion and prevention efforts become a financially sustainable business? What incentives, compensation models and business models may contribute to shifting focus from healthcare to preventive health work in prevention of childhood obesity? These are questions that are being addressed in the work package Incentives, Remuneration Models and Business Models.
It may seem obvious, that by preventing, for example, type 2 diabetes and cardiovascular disease, there are major savings to be made. OECD calculations shows that every dollar invested in preventive work, later saves six dollars in healthcare costs.
Furthermore, these calculations only focus on financial costs at societal level and not human costs for the individual. However, it is more complex than the figures imply.
– What we see is that everyone thinks it is important to work preventively, but it is difficult to get a long-term perspective in the work as everyone always thinks that it is someone else that should do something. Everyone has the assignment, but no one has the main responsibility, says Maria Bjerstam, innovation leader in health at Innovation Skåne, who leads the work in Incentives, Remuneration Models and Business Models.
Preliminary study examines incentives
In 2020 a pilot study looked at various incentives for health promotion and preventive measures against childhood obesity. The report describes various compensation models in the public sector, mainly in connection with health care. In addition, an attempt is made to describe relationships for and definition of business models in the commercial sector.
– The challenge is that this is long-term work, and it takes time to see the effects, and neither budgets in the public sector nor business plans in the private sector works that way, says Maria Bjerstam.
There are many indications that some form of program management is needed, where several actors collaborate and have a common goal. The next question is how the context should be delimited and the pilot study shows that it is most appropriate to delimit on basis of the municipality or, in larger cities, on basis of the district and focus on residents within a certain geographical area.
Several actors influence
But even within a geographically delimited area, there are several actors who could influence whether a child develops obesity or not. Both close actors such as maternity care, child health care and preschool, actors in the geographical area such as the local grocery store and the planning and building committee and actors far away as video game developers and marketers.
– We do not see that there is one model that works for everyone, but there are different parts that need to be combined, perhaps based on a common compensation model, says Maria Bjerstam.
Both root causes and system level
To really achieve lasting change, it is important to find and address the root causes of childhood obesity and at the same time work at the system level. Today, there is neither a clear picture of all the root causes nor clear incentives to do something about them.
– What is positive and what has become clear during the first phase of the project is that there is a major willingness from everyone to contribute to the change that is needed. There are a lot of actors really involved in and committed to this issue. But many operates without enough knowledge and run into a lot of obstacles that we need to address together, says Maria Bjerstam.
During 2021 the plan is to, in dialogue with other the work packages, developing a first proposal for a model to test in at least one, but preferably two different municipalities.