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The Use of Risk-Sharing Contracts in Healthcare: Theoretical and Empirical Assessments

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Abstract

Objective

The aim of this review is to provide a summary of the literature on risk-sharing agreements, including conceptual, theoretical and empirical (number of agreements and their achievements) perspectives, and stakeholders’  perceptions.

Methods

We conducted a systematic literature search in MEDLINE from 2000 to April 2019, following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology, and completed it with a manual search of other publications (mainly grey literature). The search was restricted to publications with English abstracts; the initial identification of articles was restricted to the title, abstract and key words fields. The geographical scope was not restricted.

Results

Over 20 studies proposed different taxonomies of risk-sharing contracts, which can be summarised as financial and paying-for-performance agreements. Theoretical studies modelling the incentives to implement risk-sharing agreements are scarce; they addressed different types of contracts and regulatory contexts, characterizing the drug prices and the optimal strategies of the involved agents. Empirical studies describing specific agreements are abundant and referred to different geographical contexts; however, few articles showed the economic results and assessed the value of such contracts. Stakeholders’ perceptions of risk-sharing contracting were favourable, but little is known about the economic and clinical advantages of specific agreements. Whether risk-sharing contracts have yielded the desired results for healthcare systems remains uncertain.

Conclusion

Risk-sharing contracts are increasingly used, although the lack of transparency and aggregated registries makes it difficult to learn from these experiences and assess their impact on healthcare systems.

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Data Availability

No underlying data exist for this article as it is based on a review of other published studies.

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Acknowledgements

The authors thank the editor and three anonymous referees for their comments and suggestions.

Author information

Authors and Affiliations

  1. Department of Economics, University of La Rioja, Logroño, Spain

    Fernando Antonanzas, Carmelo Juárez-Castelló, Reyes Lorente & Roberto Rodríguez-Ibeas

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  1. Fernando Antonanzas
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  2. Carmelo Juárez-Castelló
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  3. Reyes Lorente
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  4. Roberto Rodríguez-Ibeas
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Contributions

RRI acted as a health economist on this article, summarised the articles, developed the tables and was responsible of the final writing of the text, together with FA. CJC acted as a health economist on this article, collaborated in the search of the final texts, reviewed them and developed the PRISMA summary. RL acted as a health economist on this article and collaborated in the search of the articles and in the literature review. FA acted as a health economist on this article, conceptualised the design of the text, contributed to its writing, and acts as the overall guarantor for the overall content of this article. All authors contributed to the conception and planning of the work and critically revised and approved the final submitted version of the manuscript.

Corresponding author

Correspondence to Fernando Antonanzas.

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Conflict of interest

F. Antonanzas, C. Juárez-Castelló, R. Lorente and R. Rodríguez-Ibeas have no conflicts of interest directly relevant to the content of this article.

Funding

This study was funded by MINECO Grant (Project ECO2016-78685-R).

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Antonanzas, F., Juárez-Castelló, C., Lorente, R. et al. The Use of Risk-Sharing Contracts in Healthcare: Theoretical and Empirical Assessments. PharmacoEconomics 37, 1469–1483 (2019). https://doi.org/10.1007/s40273-019-00838-w

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