Health System Characteristics Shape the Models of Implementation of Integrated Care Across Europe

We have recently discussed context-sensitivity in the advancement of integrated care across the European Union, Norway and Iceland. In this blog, we explain some of the health system characteristics that have shaped different models of integrated care. The heterogeneity and diversity of models and programmes in the implementation of integrated care reflects the values, principles and organisation of their health systems. For example:

  • In Iceland, a national health system of universal coverage, the stakeholders consulted for our study on Performance Assessment of Integrated Care would recognise that it took them some time to realise the organisation of their health system would be called “integrated care” in other parts of Europe. They are used to have members of different organisations in the health system to work together to improve the health of the population.
  • Population risk stratification - common in other health systems where implementation of integrated care is matured - is absent in Denmark as this practice does not resonate with the culture and values of the Scandinavian health systems.
  • Models of integrated care aiming at full integration of care - as opposed to linkage of services or co-ordination of care in some but not all areas - are more common in Spain than in other European countries. Nevertheless, important differences between the regions exist with some regions presenting strong top-down approaches (Basque Country, Catalonia), while others are reliant on relatively successful bottom-down approaches (Asturias). In most regions, integration between health and social care remains a challenge.
  • In the Netherlands, the system presents important differences in terms of implementation of integrated care. This heterogeneity has been attributed to the lack of a national policy for integrated care. Models have been emerging following bottom-up approaches, and while some of them are very successful, not everybody is receiving the same level of care. In Belgium, the implementation of integrated care has started recently but is driven by a national policy. There are currently 20 pilot projects across the country are implementing integrated care projects with common features.z

While co-designing a framework for the Performance Assessment of Integrated Care, we have taken into consideration all these differences to provide health professionals and managers with a flexible tool that can be used across health systems. If you are attending ICIC18 and want to know more, come to our session at the European Commission’s Implementation Rooms on the 25th of May!