Abstract
Background and objectives: Integrated care aims to coordinate the care needs of a population, particularly individuals with complex care needs, across community, primary and secondary care settings. Ontario has been pursuing a whole systems approach to integration through reorganization into Ontario Health Teams (OHTs) where hospitals, doctors, and allied health providers work as a coordinated team to provide responsive, appropriate, and efficient health services. This study explores policy supports for integrated models of care in England, Germany, and the Netherlands to identify promising approaches to collaborative governance and their policy implications for integrated care initiatives in Ontario.
Methods: We reviewed academic and grey literature about integrated models of care across three comparator countries and conducted in-depth qualitative interviews with 14 expert informants from England, Germany and the Netherlands in Autumn 2023. We mapped country results against a conceptual framework about policy supports: governance/partnerships, workforce, financing, and data sharing (Wodchis et al 2020), and decision-making processes for policy transfer (Nolte and Groenewegen 2021) to understand the benefits, enabling factors and barriers to progress for integrated care reforms.
Results: All jurisdictions are pursuing integrated care initiatives through collaborative governance approaches that vary in scale and scope. We find that the comparator jurisdictions use population-level decision-making (Germany), joint decision making at the regional level through Integrated Care Boards (health-specific) and Integrated Care Partnerships (committees for both health and community-based organizations) (England), and voluntary consortia of relevant providers delivering care for chronic conditions or population subgroups (Netherlands). Service-specific innovations, such as the presence of policy entrepreneurs or knowledge brokers, also plays an important role in enabling the policy process for successful implementation. We identify several contributing factors, such as the balance of representatives across the health and community sectors, the use and availability of common standards, and flexibility for local-level adaptations, that enable collaborative governance. More policy supports for workforce-related initiatives are needed to support professional development and intersectoral knowledge. There remain significant challenges with data sharing and power disparities between the health and social care sector.
Conclusion: Integration projects that emphasise collaboration, workforce planning, and interdisciplinary teams are widely supported by health services providers to enable greater coordination of care to improve care effectiveness and efficiency for patients with chronic conditions or complex co-morbidities. Legislation is an important enabling factor for supporting collaborative governance. New financing streams can reward collaborative working for interdisciplinary teams. Our results are a starting point for further research that captures macro, meso and micro level variation and differing forms of patient segmentation in the implementation of integrated care systems.