Integrated Care in Europe: Time to Get it Together?

Garattini, Livio; Martini, Marco Badinella; Nobili, Alessandro

doi:10.1007/s40258-021-00680-2

Cited by 5 publications

(4 citation statements)

References 27 publications

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“…The goal of integrated care and the scare of dual practice Integrated care (IC) is the modern approach that better supports the choice in favour of the public sector also for service delivery (Garattini et al, 2022a). IC is a concept of common sense that emerged in the literature at the beginning of the new millennium and has undoubtedly laudable aims for people.…”

Section: The Realistic Approach Of Funding and Provisionmentioning

confidence: 99%

Including mental health care in a model of European health system

Garattini

Barbato

D’Avanzo

et al. 2023

Epidemiol Psychiatr Sci

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The management of a health system is a matter of economics and business administration because of the costs induced by goods and services delivered. Economics teaches us that the positive effects induced by competition in free markets cannot be expected in health care, which is a classic example of market failure from both demand and supply sides. The most sensible key concepts to refer for managing a health system are funding and provision. While the logical solution for the first variable is universal coverage through general taxation, the second one requires a deeper understanding. Integrated care is the modern approach that better supports the choice in favour of the public sector also for service provision. A major threat against this approach is dual practice legally allowed for health professionals, which inevitably raises financial conflicts of interest. An exclusive contract of employment for civil servants should be the sine qua non for providing public services effectively and efficiently. Integrated care is particularly important for long-term chronic illnesses associated with high levels of disability, such as neurodegenerative diseases and mental disorders, where the mix of health and social services needed can be very complex. Nowadays the growing number of community-dwelling patients with multiple physical and mental health needs is the major challenge for the European health systems. This happens also in public health systems, which should provide universal health coverage in principle, and the case of mental disorders is striking. In the light of this theoretical exercise, we strongly believe that a public National Health and Social Service should be the most indicated model for both funding and providing health and social care in modern societies. The big challenge of the common model of European health system here envisaged would be to limit the negative influences of politics and bureaucracy.

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Section: The Realistic Approach Of Funding and Provisionmentioning

confidence: 99%

Including mental health care in a model of European health system

Garattini

Barbato

D’Avanzo

et al. 2023

Epidemiol Psychiatr Sci

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“…Key objectives and minimum standards must be agreed upon to achieve improved patient outcomes at affordable costs. Reference pathways should be defined that can be adapted to individual patient needs, and a coordinated and collaborative approach should be implemented between providers of clinical and social care, with input from providers of dental, housing, economic and educational support as needed [29,30] . Integrated and personalised health budgets for providers would facilitate this.…”

Section: Combined Digital and Human Pathwaysmentioning

confidence: 99%

Short- and longer-term goals for change – A report from the 2nd workshops of the EHC Think Tank Workstreams on Access Equity and Future Care Pathways

Gacser,

Skouw-Rasmussen,

Bourke

et al. 2023

The Journal of Haemophilia Practice

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Introduction The second series of workshops for the EHC Think Tank Workstreams on Access Equity and Future Care Pathways involved working towards consensus on addressing challenges to progress around achieving equitable access to care and shaping rare disease care pathways that meet patient needs while remaining practicable and affordable to healthcare providers. This report summarises workshop outcomes from these two workstreams, in which stakeholder participants identified a ‘guiding star’ determining the direction of ongoing focus, defined achievable ‘near star’ milestones, and enablers and constraints to achieving these. Guiding Stars The Access Equity Workstream proposed focusing on developing a healthcare system that enables patients to benefit from care and treatment fairly and impartially. The Future Care Pathways Workstream agreed that their focus would be on developing care pathways that provide the right intervention at the right time by the right healthcare professional in the right formats with a variety of delivery methods to suit the person. Near Stars For the Access Equity Workstream, changes in narrative and behaviour were the achievable milestones that the group agreed to prioritise. Greater stakeholder collaboration and consistent data collection and use will be important enablers for change. Participants proposed greater emphasis on investment and value (instead of cost and return) and a change of mindset from ‘fixing the patient’ to achieving a healthy life through early intervention and preventing comorbidities. However, lack of clarity over what constitutes ‘value’ and around stakeholders' responsibilities, limited outcome measures and resistance to change may constrain progress. A near star for the Future Care Pathways workstream was the development of seamless, personalised care pathways with integrated digital and AI-based technologies to enable real-time measurement of pathway effectiveness. Participants felt that understanding and respecting patient behaviour and the nudges and incentives needed to promote pathway acceptance will be important. As in the Access Equity Workstream, they recognised the role of routine, standardised data collection for measuring outcomes, sharing information and informing decision-making. They predicted that building trust between stakeholder groups (including patients, healthcare providers, academic and life science companies) and using patient networks and advocates effectively would enable collaboration and ensure that patient needs and insights are acted upon. However, financial and legal aspects, inadequate implementation of technological infrastructure, limited systems integration, and lack of stakeholder time, effort and energy are all potential constraints that will need to be addressed.

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“…Rather, we are firmly convinced that the pressing priority for a modern primary care is to support large-scale organizations open through the day [11], providing all types of community services (administrative and social included) with multidisciplinary professionals (GPs included), thus able to fulfil the increasing expectations of local people. With advantages for planning and supervision, these organizations would dramatically extend daily access to services in the community and should better filter minor ailments away from emergency departments in hospitals [12].…”

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confidence: 99%

“…According to this scenario, vertical IC might fit more for hospitals with post-acute care services downstream. In general, striving to enhance patients' health as the primary interest of health and social services, the future organization of NHSs should be inspired by a culture of systemic collaboration and coordination among health and social professionals [12], competing only for quality of services delivered to patients and not for their funding. This should make also more plausible for IC to achieve its quadruple aim [13] of improving the work life of healthcare professionals.…”

mentioning

confidence: 99%