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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引用次数: 0
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.
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).