Definition

Health care delivery integration is a concept that focuses on the interplay of inputs, delivery, management, and organization of services as they relate to diagnosis, treatment, care, rehabilitation, and health promotion.

Health care system integration focuses on a set of methods and models of funding, administration, and organization of health systems and their relationship to service delivery. Health care system integration is designed to create connectivity, alignment, and collaboration within and between the cure and care sectors.

Both health care delivery integration and health care system integration are key to providing access to and quality of care for individuals.

Different levels of integration also exist in health care delivery:

• Functional integration exists through mainstreaming of financing and regulation systems for prevention, acute, and social services.
• Organizational integration occurs through mergers, contracting or strategic alliances between and across health care and social care institutions.
• Professional integration occurs when contracting or alliances are developed with health care professionals.
• Clinical integration exists at the micro level (individual patient level) when continuity of care, cooperation, and coherence are provided at the place of service for the patient.

Different levels of integration also exist in health care delivery including:

• Functional integration exists through mainstreaming of financing and regulation systems for prevention, acute, and social services.
• Organization integration occurs through mergers, contracting or strategic alliances between and across health care and social care institutions.
• Professional integration occurs when contracting or alliances are developed with health care professionals.
• Clinical integration exists at the micro level (individual patient level) when continuity of care, cooperation and coherence is provided at the place of service for the patient.

Relevance

Health care systems may roll out integration strategies for a number of reasons, including:

• Operational efficiencies related to economies of scale;
• Clinical efficiencies to improve quality, safety and clinical health care improvements;
• Strategic growth for providing certain expertise in the health care market;
• Expanded mission such as addressing unmet needs of population; and
• Innovation opportunities to integrate recent research and technology improvements for the more efficient delivery of health care services.

Context

Health care delivery and system integration have become even more critical given the changing demand for care and changes in population demographics, such as Europe’s growing aging population. The chronically ill and elderly are more likely to experience the negative consequences of a weak or limited system of integration. For example, older people are more likely to experience multiple chronic conditions and therefore integrated care models may provide greater access and quality of care for chronic condition management. In addition, older populations are living longer lives at home and require health and social services to maintain adequate quality of care.

Integration improves health system efficiencies by appropriately targeting resources and costs and preventing duplicative health interventions and treatment. Health care system integration may represent a sound strategy for achieving desired clinical, educational, academic and business outcomes, however, the main goal of integration in health care systems should be to address patients care needs.

Innovative Options to Addressing Health Care Delivery and System Integration—Country Examples

Kaiser Permanente (KP) in the United States of America: KP has been studied as an example of a successful integrated health care delivery model due to its team-based approach to care, multi-specialty medical centers, electronic health records, financial structures, and focus on primary care and disease management programs.

Health Facility Integration in France: France has experienced success in the promotion of an integrated health care system approach to prevention, acute care and rehabilitative care through their regional hospitals. The hospitals became the central point for coordinating care and development of medical plans for regions. Preliminary evaluation indicates increased patient satisfaction of care received due to the re-focus on specifically identified local needs.

PRISMA model in Canada: PRISMA (Program of Research to Integrate the Services for the Maintenance of Autonomy) in Canada has proven effective in integrating care for frail seniors with chronic conditions living in the community and maintaining their independence in the community. The components that have made this model of care successful thus far include:

• Coordination between decision makers and managers at the regional and local levels;
• Single point of entry to services and coordination;
• Case management services;
• Individual service plans;
• Single assessment instrument coupled with a case mix management system; and
• Computerized clinical chart.