title: Integration of care systems in Portugal: anatomy of recent reforms.
abstract: BACKGROUND
  Integrated care is increasingly present in the agenda of policy-makers, health professionals and researchers as a way to improve care services in relation to access, quality, user satisfaction and efficiency. These are overarching objectives of most sectoral reforms. However, health care and social care services and systems are more and more dependent on the performance of each other, imposing the logic of network. Demographic, epidemiologic and cultural changes result in pressure to increase efficiency and efficacy of services and organisations in both sectors and that is why integrated care has become so relevant in the last years.
  
  
  METHODS
  We first used concept maps to organise and systematise information that we had gathered through deep literature review in order to set a framework where to base the subsequent work. Then, we interviewed informants at several levels of the health and social care systems and we built a list of major recent reforms addressing integrated care in Portugal. In a third step, we conducted two independent focus groups where those reforms were discussed and evaluated within the context of the concepts and frameworks identified from the literature. Results were confronted and reconciled, giving place to a list of requisites and guidelines that oriented further search for documentation on those reforms.
  
  
  RESULTS
  Several important health reforms are in course in primary and hospital care in Portugal, while a so-called third level of care has been introduced with the launch of the National Network of Long-Term Integrated Care (RNCCI - Rede Nacional de Cuidados Continuados Integrados). The social care sector has itself been a subject of alternative models springing from opposite political orientations. All these changes are having repercussions on the way the systems work with each other as they are leading to ongoing and ill-evaluated reformulations on the way they are governed, financed, structured and operated.
  
  
  CONCLUSIONS
  Care integration is not absent from policy-making and implementation endeavour in Portugal. However, recurrent issues seem to be consistently hampering the efforts regarding the integration of care in the country. It is urgent to assess current situation as experienced by those closely involved and directly affected.
authors.affiliation: Institute of Electronics Engineering and Telematics of Aveiro (IEETA), University of Aveiro, Aveiro, Portugal.
authors.forename: Silvina
authors.initials: S
authors.lastname: Santana
authors.affiliation: Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal.
authors.forename: Nina
authors.initials: N
authors.lastname: Szczygiel
authors.affiliation: Department of Economics, Management and Industrial Engineering, University of Aveiro, Aveiro, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Redondo
keywords: Portugal; care systems integration; health care reform; social care reform
references.citation: Health Policy. 1999 Nov;49(3):149-59
references.pmid: 10827294
references.citation: Ann Pharmacother. 2009 Apr;43(4):677-91
references.pmid: 19336645
references.citation: Int J Integr Care. 2001;1:e21
references.pmid: 16896400
references.citation: Soc Sci Med. 2002 Jul;55(1):33-45
references.pmid: 12137187
references.citation: J Public Health Policy. 2004;25(3-4):259-87
references.pmid: 15683065
references.citation: Int J Integr Care. 2011 Jan;11:e001
references.pmid: 21637705
references.citation: Healthc Q. 2009;13 Spec No:6-15
references.pmid: 20057243
references.citation: Int J Integr Care. 2009 Dec 22;9:e100
references.pmid: 20087420
references.citation: Health Policy. 2010 Oct;97(2-3):113-21
references.pmid: 20557972
references.citation: Int J Integr Care. 2010 Dec 24;10:e120
references.pmid: 21289998
references.citation: Soc Sci Med. 2000 Apr;50(7-8):1025-36
references.pmid: 10714924
references.citation: J Int Dev. 1995 May-Jun;7(3):329-47
references.pmid: 12290761
references.citation: Soc Sci Med. 2010 Dec;71(11):1997-2004
references.pmid: 20947232
references.citation: Soc Sci Med. 2001 Apr;52(8):1205-17
references.pmid: 11281404
references.citation: Health Policy. 2010 Dec;98(2-3):156-63
references.pmid: 20619920
references.citation: Public Health. 2011 Jan;125(1):20-24
references.pmid: 21168177
references.citation: Health Policy. 1995 Apr-Jun;32(1-3):295-306
references.pmid: 10156645
references.citation: Health Policy. 2003 Dec;66(3):277-93
references.pmid: 14637012
references.citation: Int J Integr Care. 2000 Nov 01;1:e08
references.pmid: 16902699
references.citation: Int J Integr Care. 2007 Jan 15;7:e01
references.pmid: 17377639