Community-based integrated care: myth or must?
OBJECTIVE
In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care.
This fact can be shown by reducing the complexity of today's health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way.
Community-based integrated care is a promising approach to addressing this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands.
Plochg
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T
Department of Social Medicine, Academic Medical Center/University of Amsterdam, The Netherlands. t.plochg@amc.uva.nl
Klazinga
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D003153:Community Health Services / Q000458:organization & administration*; D003657:Decision Making; D003695:Delivery of Health Care / Q000191:economics / Q000458:organization & administration*; D006801:Humans; D009426:Netherlands; D011634:Public Health / Q000639:trends*; D011787:Quality of Health Care