[Case and disease management and improved integration of healthcare services in Spain. 2008 SESPAS Report].
The boundaries between health services levels are artificial as they are answers to health organizations' problems rather than to patients' needs. However, given that these boundaries are in place, coordination between these levels should overcome the difficulties so that patients receive the services they require. Case management (patients in specific situations, such as hospital discharge) and disease management (patients with specific diseases, such as diabetes) aim to solve problems of coordination either by improving the organization of health services or by adding a new structure to the already existing structure. These forms of management are highly attractive answers to coordination problems but have no scientific basis nor is there any empirical evidence of a positive impact on patients' health or the cost of services. Case and disease management programs are vertical structures that weaken the horizontal structure in Spain, i.e. primary care. The need for case and disease management programs is an argument to push for a pro-coordination reform of primary care that gives power, responsibility and autonomy to general practitioners, so that they would be able to coordinate clinical and social services according to patients' needs.
Gérvas
Juan
J
Médico general, Equipo CESCA, Madrid, España. jgervasc@meditex.es
D003695:Delivery of Health Care / Q000458:organization & administration* / Q000592:standards*; D006801:Humans; D013030:Spain