Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership.
BACKGROUND
To improve health-care delivery, care providers must base their services on community health needs and create a seamless continuum of care in which these needs can be met. Though, it is not obvious that providers apply this vision. Experiments with regulated competition in the health systems of many industrialized countries trigger providers to optimize individual organizational goals rather than improve population health from a community perspective. Thus, a tension exists between the need to collaborate and the need to compete. Despite or because of this tension, community health partnerships are being promoted, and this should enforce a needs-based and integrated care delivery.


METHODS
In this single case study, we retrospectively explored how local health-care providers in Amsterdam collaborated for more than 30 years, interacting with the changes to the national health-care system. In-depth analysis of interviews, documents and literature focused on the complex relationship between the activities of this health partnership, its nature and its changing context.


RESULTS
The findings revealed that the partnership itself was successful and sustainable over time, although the partnership lost its initial broad explorative nature and narrowed its strategic focus towards care of the elderly. Furthermore, the realized projects--although they enforced integrated care--lost their community-based character. This declining scope of community-based integrated care seems to have been influenced by the incremental introduction of regulated competition in Dutch health care. This casts doubts on the ability of health partnerships to apply a vision of community-based integrated care within the context of competition.


CONCLUSIONS
Collaborating health-care providers can build seamless continuums of care in a competitive environment, although these will not automatically maximize community health with limited resources. Active policies with regard to health system design, incentive structures and population-based performance measures are warranted in order to insure that community-based integrated care through health partnerships will be more than just policy rhetoric.
Department of Social Medicine, Academic Medical Centre, University of Amsterdam, PO Box 22660, 1100 DD, Amsterdam, The Netherlands. t.plochg@amc.uva.nl
Thomas
T
Plochg
Diana M J
DM
Delnoij
Nelleke P C
NP
Hoogedoorn
Niek S
NS
Klazinga
D000368:Aged; D002908:Chronic Disease / Q000628:therapy; D018672:Community Health Planning / Q000458:organization & administration*; D003256:Community Participation; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006291:Health Policy; D006302:Health Services Research; D006299:Health Services for the Aged; D006801:Humans; D007407:Interviews as Topic; D018854:Managed Competition; D009426:Netherlands; D019982:Organizational Case Studies; D010317:Partnership Practice / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D016730:Program Development; D011795:Surveys and Questionnaires; D019037:Urban Health Services / Q000458:organization & administration*