Integrated care in Western Europe: a wise solution for the future?

ABSTRACT

Introduction

IC is a term commonly adopted across the world underpinning a positive attitude against fragmentation of healthcare service provision. While the principles supporting IC are simple, their implementation is more controversial.

Areas covered

The growing number of IC definitions is related to the increasing domains of applications, which reflect the increasing demand induced by aging multi-morbid patients. A comprehensive definition of IC should now include the coordination of health and social services useful to deliver continuous care across organizational boundaries. The recent debate on IC is largely influenced by the mismatch between the increasing burden of health and social needs for chronic conditions from the demand side, and the design of health-care systems still focused on acute care from the supply side.

Expert opinion

The major reasons of persisting IC weakness in European countries stem from arguable choices of health policy taken in the recent past. The political creed in ‘market competition’ is probably the most emblematic. All initiatives encouraging health-care providers to compete with each other are likely to discourage IC. Since most European GPs are still self-employed professionals working in their own cabinets, the anachronistic professional status of GPs is another historically rooted reason of IC weakness.

KEYWORDS:

• Case management
• Europe
• general practice
• integrated care
• national health service

Article highlights

• IC is a term underpinning a positive attitude against fragmentation of healthcare service provision.

• While the principles supporting IC are simple, their implementation is more controversial.

• A modern definition of IC should include the coordination of health and social services potentially useful to deliver continuous care across organizational boundaries.

• The present debate on IC is influenced by the mismatch between the increasing burden for chronic conditions from the demand side and the healthcare systems still centered on acute care from the supply side.

• The major reasons of IC weakness in European countries stem from arguable choices of health policy taken in a quite recent past.

• The political creed in market competition and the anachronistic professional status of general practitioners are the major historical reasons of IC weakness in Europe.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.