Abstract
Introduction: Aotearoa/New Zealand (A/NZ) is generally regarded as having a high-performing health care system, with universal coverage and generating good health outcomes at reasonable levels of expenditure. An assessment of integrated care over a decade ago [1] noted that most A/NZ reforms occurred via the system and organizational reforms (especially mergers), while clinical (or service delivery) integration at the micro-level has been far harder to achieve. Since then while integrated care is often mentioned in national policy documents, implementation has been left to regional and local decision making, and very few initiatives have spread beyond their initial locations, resulting in a patchwork of local initiatives.
Aims/Objectives, Methods: Referring to Valentijn’s Rainbow Model of Integrated Care, we take stock of what has occurred drawing from policy documents, evaluations of different initiatives, and semi-structured interview data from a research program investigating change in primary care. Our objective is to better understand how integrated care has progressed over the 2008–2020 period and how it might progress following a recent review and reform of the health system.
Key Findings: Internationally, while integrated solutions are often developed centrally or imposed from above by policymakers, in A/NZ top-down mandates are more diffuse. The light touch national policy environment has meant activities seeking to better integrate care are very diverse. Some energy has been put into organizational change at a local level (for example, co-location initiatives, creating Health Care Homes, and forming Alliances), while other regions experimented with process changes such as running co-design processes, encouraging new forms of data sharing and analysis, and fostering events and projects that built relationships. These changes varied by the formality with which they were implemented, and the attention given to ensuring a diversity of voices.
Very few initiatives have spread beyond their initial locations, resulting in a patchwork of local initiatives. Our interviews on primary health care change provided insight into the professional cultures and logic at a senior level that has influenced the potential to pick up new initiatives related to integrated care. Participants expressed views that despite the energy and effort put into projects designed to better integrate primary and secondary care, most had yet to become business-as-usual.
Conclusion: In the last ten years, integrated care is often mentioned in national policy documents. However, implementation has been left to regional and local decision-making. The broad range of initiatives designed to achieve integrated care has absorbed regional and local attention and produced some evidence of progress, but the national picture of change is mixed.
Implications: System incentives that preserve organizational “sovereignty” and path-dependent funding have slowed progress towards more integrated care in some areas. There is some evidence about specific initiatives and their impact, but it is difficult to discern significant trends and commonalities around the country.
Reference:
1.Cumming J. Integrated care in New Zealand. International Journal of Integrated Care. 2011; 11 [Special 10th Anniversary Edition]. DOI: https://doi.org/10.5334/ijic.678