Using Economic Arguments to Strengthen the Case for Enhanced Intersectoral Working
Partners need to perceive collaboration to be in their own interests by adding value to what they can achieve in isolation. Too often, stakeholders from one sector do not look at the consequences of an action for their partners. Economic arguments can be used to address this issue. This is done by identifying and placing a monetary value on outcomes of interest to each sector in any collaboration, even if these outcomes appear tangential to the primary goal, in this case of better ageing with disability. It is particularly helpful to present cogent arguments indicating that the collaboration will be a win-win for all partners (McDaid & Wismar, 2015).
Consider a hypothetical voluntary arrangement between health care budget holders and local government leisure service budget holders to pool funds to tackle social isolation and loneliness in frail older people. There is increasing evidence that loneliness has an adverse impact on the physical health of vulnerable populations (Leigh-Hunt et al., 2017), and that leisure and other social activities can help to reduce the risk of loneliness (Gao et al., 2018). Demands for future expensive health care services may thus be reduced it health care budget holders invest resources in this type ot non-clinical activity. Similarly, local governments may be more prepared to invest resources in tackling loneliness, something that may not see as a core activity, if they are presented with the growing evidence base that high levels of loneliness are a risk factor for cognitive decline (Luchetti et al., 2020). The costs of providing social and long-term care for dementia account tor a large share of expenditure for local governments in many countries; relatively low-cost investment in measures to tackle loneliness may then appear more attractive.
Overcoming Barriers and Seizing the Opportunity
We believe that there is a real opportunity to use financial mechanisms to stimulate interaction and bridge the ageing and disability sectors to allow for better ageing with disability. There are potentially substantial benefits, not just to the health and social care sectors, but to the wider economy of promoting better ageing and the maintenance of independence in this population group. Historically, responsibility tor ageing and disability has often rested with multiple agencies, potentially in different sectors with different hierarchical and administrative structures. This may make collaboration difficult, but there is evidence broadly in the health, social care and public health sectors that financial mechanisms can incentivise collaboration between sectors.
Options to consider include earmarking funding for activities to support ageing with disability conditional on an intersectoral approach being taken. Ongoing financing of intersectoral activities could also be made conditional on effective monitoring and achievement of defined outputs and outcomes. This could include phased funding that could eventually lead to replication and/or scaling up, as has been used by the Innovation Strategy of the Public Health Agency of Canada.
Funding may also be delegated to a specific independent agency that has a remit to work across the ageing and disability sectors; much can be learnt from health promotion foundations that operate along these lines, such as the Victorian Health Promotion Foundation in Australia. Pooling budgets across sectors, to support the needs of people ageing with disability is another option. In England, the Better Care Fund allows local health budget holders to pool some funds with local government to promote healthy ageing and reduce the need for crisis interventions. This English model also provides an example of how establishing a legal and regulatory framework for these partnerships can help in the way they function, tor instance by allowing staff from either organisation to be paid in a comparable way. It also promotes accountability and transparency on how funds are spent.
The literature has also identified many different potential barriers to implementation of financing mechanisms. They can include poor leadership, a lack of buy-in from different stakeholders, organisational resistance to change, worries over impacts on core function, insufficient resources, imbalanced hierarchical structures and differences in work culture (McGuire et ah, 2019). Many of these issues boil down to the concept of trust. Intersectoral collaboration requires trust to be built between partners regardless of the financing mechanism. Building trust is particularly important when different sectors voluntarily come together to collaborate and share resources. This necessarily relies more heavily on trust and open discussion; in turn, mutual learning and innovation is enhanced by the development of trusting relationships. Creating collaboration champions and co-location of ageing and disability organisation personnel may also have a positive impact on establishing trust. Shared targets and rewards, flexibility in planning, and access to external mediation it necessary can also help (McDaid & Park, 2016; McGuire et ah, 2019).
It is also clear that identifying outcomes of interest to all potential intersectoral partnerships, as well as the economic costs and payoffs, can help to facilitate partnerships. This requires creative thinking recognising that sectors may have very different priorities. However, it also means that there may also be a need for compensation mechanisms, i.e. the additional transfer of funds across sectors may be helpful when it is not possible to generate economic win-wins for all sectors (Johansson & Tillgren, 2011). Even where there are economic win-wins, these may not be realised for some years, so it is important that these financing mechanisms are adequately resourced.
Reviews also suggest that many successful experiences in the use of financial mechanisms are more likely to operate at a local rather than national level, with local government often central to intersectoral activities identified. This may be because local governments are usually well positioned to lead intersectoral processes by influencing several sectors that can be fundamental to health, such as land use, transportation, environmental protection, leisure services, education, and community development.