Overcoming fragmentation in health care: chronic care in Austria, Germany and The Netherlands.
The growing recognition of care fragmentation is causing many countries to explore new approaches to healthcare delivery that can bridge the boundaries between professions, providers and institutions and so better support the rising number of people with chronic health problems. This paper examines the role of the regulatory, funding and organisational context for the development and implementation of approaches to chronic care, using examples from Austria, Germany and the Netherlands. We find that the three countries have implemented a range of policies and approaches to achieve better coordination within and across the primary and secondary care interface and so better meet the needs of patients with chronic conditions. This has involved changes to the regulatory framework to support more coordinated approaches to care (Austria, Germany), coupled with financial incentives (Austria, Germany) or changes in payment systems (the Netherlands). What is common to the three countries is the comparative 'novelty' of policies and approaches aimed at fostering coordinated care; however, the evidence of their impact remains unclear.
Health and Healthcare Research programme, Westbrook Centre, RAND Europe, Cambridge, UK. enolte@rand.org
Ellen
E
Nolte
Cécile
C
Knai
Maria
M
Hofmarcher
Annalijn
A
Conklin
Antje
A
Erler
Arianne
A
Elissen
Maria
M
Flamm
Brigit
B
Fullerton
Andreas
A
Sönnichsen
Hubertus J M
HJ
Vrijhoef
D001317:Austria; D002908:Chronic Disease / Q000191:economics / Q000628:therapy*; D003191:Comprehensive Health Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D003431:Cross-Cultural Comparison; D019468:Disease Management; D005858:Germany; D033161:Government Regulation; D005102:Health Expenditures / Q000639:trends; D006291:Health Policy / Q000191:economics / Q000331:legislation & jurisprudence* / Q000639:trends; D006801:Humans; D007348:Insurance, Health; D008134:Long-Term Care / Q000191:economics / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D009426:Netherlands