Governing Integrated Health and Social Care: An Analysis of Experiences in Three European Countries.

IF 2.6 3区 医学 Q2 HEALTH CARE SCIENCES & SERVICES International Journal of Integrated Care Pub Date : 2024-02-07 eCollection Date: 2024-01-01 DOI:10.5334/ijic.7610
Josephine Exley, Rebecca Glover, Martha Mccarey, Sarah Reed, Anam Ahmed, Hubertus Vrijhoef, Tommaso Manacorda, Concetta Vaccaro, Francesco Longo, Ellen Stewart, Nicholas Mays, Ellen Nolte
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Abstract

Purpose: Achieving greater health and social care integration is a policy priority in many countries, but challenges remain. We focused on governance and accountability for integrated care and explored arrangements that shape more integrated delivery models or systems in Italy, the Netherlands and Scotland. We also examined how the COVID-19 pandemic affected existing governance arrangements.

Design/methodology/approach: A case study approach involving document review and semi-structured interviews with 35 stakeholders in 10 study sites between February 2021 and April 2022. We used the Transparency, Accountability, Participation, Integrity and Capability (TAPIC) framework to guide our analytical enquiry.

Findings: Study sites ranged from bottom-up voluntary agreements in the Netherlands to top-down mandated integration in Scotland. Interviews identified seven themes that were seen to have helped or hindered integration efforts locally. Participants described a disconnect between what national or regional governments aspire to achieve and their own efforts to implement this vision. This resulted in blurred, and sometimes contradictory, lines of accountability between the centre and local sites. Flexibility and time to allow for national policies to be adapted to local contexts, and engaged local leaders, were seen to be key to delivering the integration agenda. Health care, and in particular acute hospital care, was reported to dominate social care in terms of policies, resource allocation and national monitoring systems, thereby undermining better collaboration locally. The pandemic highlighted and exacerbated existing strengths and weaknesses but was not seen as a major disruptor to the overall vision for the health and social care system.

Research limitations: We included a relatively small number of interviews per study site, limiting our ability to explore complexities within sites.

Originality: This study highlights that governance is relatively neglected as a focus of attention in this context but addressing governance challenges is key for successful collaboration.

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管理综合医疗和社会护理:三个欧洲国家的经验分析》。
目的:实现更大程度的医疗和社会护理一体化是许多国家的政策重点,但挑战依然存在。我们重点关注综合医疗的治理和问责制,并探讨了意大利、荷兰和苏格兰形成更多综合服务模式或系统的安排。我们还研究了 COVID-19 大流行对现有治理安排的影响:案例研究方法包括文件审查和半结构化访谈,在 2021 年 2 月至 2022 年 4 月期间对 10 个研究地点的 35 名利益相关者进行了访谈。我们使用透明、问责、参与、诚信和能力(TAPIC)框架来指导我们的分析调查:研究地点从荷兰自下而上的自愿协议到苏格兰自上而下的授权整合不等。访谈确定了七个主题,这些主题被认为有助于或阻碍了当地的一体化工作。参与者描述了国家或地区政府希望实现的目标与他们自己为实现这一愿景所做的努力之间的脱节。这导致中央和地方之间的责任界限模糊不清,有时甚至相互矛盾。为使国家政策适应当地情况而提供的灵活性和时间,以及当地领导人的参与,被认为是实施一体化议程的关键。据报告,在政策、资源分配和国家监测系统方面,医疗保健,特别是急症医院护理,主宰着社会护理,从而破坏了地方上更好的合作。大流行病凸显并加剧了现有的优势和劣势,但并未被视为对医疗和社会护理系统整体愿景的重大破坏因素:研究局限性:我们在每个研究地点进行了相对较少的访谈,这限制了我们探索研究地点内部复杂性的能力:原创性:本研究强调,在这种情况下,治理作为关注重点相对被忽视,但应对治理挑战是成功合作的关键。
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来源期刊
International Journal of Integrated Care
International Journal of Integrated Care HEALTH CARE SCIENCES & SERVICES-
CiteScore
3.80
自引率
8.30%
发文量
887
审稿时长
>12 weeks
期刊介绍: Established in 2000, IJIC’s mission is to promote integrated care as a scientific discipline. IJIC’s primary purpose is to examine critically the policy and practice of integrated care and whether and how this has impacted on quality-of-care, user experiences, and cost-effectiveness. The journal regularly publishes conference supplements and special themed editions. To find out more contact Managing Editor, Susan Royer. The Journal is supported by the International Foundation for Integrated Care (IFIC).
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