In the UK the requirement for organisations involved in the delivery of care to NHS patients to collaborate between themselves and across the healthcare system has now become law.
There is a duty on healthcare organisations and providers within the NHS system to collaborate rather than compete. But what benefits does this collaboration bring and do other health systems around the world put partnership, integration and collaboration at the core of how they work? How well are we doing globally with providing an integrated healthcare system to our populations and what are the benefits of doing so?
Integrated care systems in England
Integrated care systems (ICSs) are partnerships that bring together NHS organisations, local authorities and other relevant stakeholders to take collective responsibility for planning health and care services, improving the health of the population and reducing inequalities across geographical areas in England. There are 42 ICSs across England, covering populations of around 500,000 to 3m people each. ICSs are the centrepiece of the reforms introduced through the Health and Care Act 2022 and are part of a fundamental shift in the way the English health and care system is organised. Following several decades during which the emphasis was on organisational autonomy, competition and the separation of commissioners and providers, ICSs depend instead on collaboration and a focus on places and local populations as the driving forces for improvement.
There is general consensus among those involved with the health sector, and more broadly, that this is a “good thing to do" and that, if done well, it will: benefit the patient, improve patient pathways, improve outcomes in population health, reduce inequalities, improve access and enhance productivity and value for money. To support these aims each ICS in England has the purpose of bringing partner organisations together to:
- improve outcomes in population health and healthcare
- tackle inequalities in outcomes, experience and access
- enhance productivity and value for money
- help the NHS support broader social and economic development.
Health systems partnerships around the world
When we look at other countries around the world, we can see quite a difference in approaches to how health systems are organised. There are other adopters of this more joined-up approach, but in certain places the system is still siloed and fragmented.
Well-integrated health systems
In the Kingdom of Saudi Arabia we see a similar approach to the Integrated Care Systems in Health Clusters. These organisations are being established in the regions to facilitate patient access to a more integrated and interconnected network of service providers, subject to one administrative structure overseen by the Ministry of Health.
In fact, this transformation is a key element of Saudi Arabia's “Vision for 2030". The key reforms are centred around improving access to health services, expanding the provision of e-health services and digital solutions, as well as improving the quality of health services. Like many other countries, Saudi Arabia wants to move from a curative system which effectively addresses sick care to a preventative system that addresses health care based on the principle of value-based care, involving privatisation through adopting Public Private Partnerships (PPPs). Specific aims in improving the quality of services and access to them will focus on optimising coverage, including geographically, through expanding e-health services and digital solutions.
Estonia has also been implementing an integrated care system since 2008 to provide seamless and patient-centred care. The system includes electronic health records, e-prescriptions, and a national health information exchange. According to a 2019 report by the European Observatory on Health Systems and Policies, Estonia’s integrated care system has shown promising results in improving patient outcomes and reducing healthcare costs.
In the Netherlands there is also a well-established integrated care system. The Dutch healthcare system is highly decentralised, and the responsibility for healthcare delivery is shared between municipalities, health insurers, and healthcare providers. The system is based on the principle of "managed competition,” which aims to promote quality, efficiency, and innovation in healthcare. The Dutch integrated care system includes various initiatives such as disease management programmes, multidisciplinary care teams, and electronic health records.
Denmark, Sweden, and Australia amongst others are also noted for having well integrated healthcare systems.
Less integrated approaches
The United States, Brazil, and India may be said to have less integrated care systems. In the US, healthcare is largely delivered through a more fragmented system of private insurance providers, healthcare facilities, and government programmes. This can lead to challenges in coordinating care across different providers and settings, which can result in inefficiencies and gaps in care. However, the system of integrating a patient’s pathway delivered by some private insurance providers is a positive approach to holistic health provision that may be worth considering.
Similarly, in Brazil and India healthcare is delivered through a mix of public and private providers, which can lead to fragmentation and challenges in coordinating care. In these countries, there are also significant disparities in access to healthcare services, which can further exacerbate issues related to integration.
The benefits of an integrated care system
Integrated care systems are based on the aspiration to benefit patients by providing coordinated and seamless care across different healthcare providers and settings. This should lead to improved health outcomes, better patient experience, and reduced healthcare costs. Patients can also benefit from increased access to preventative care, early diagnosis, and timely treatment.
In the Netherlands, for example, integrated care systems have been shown to improve patient outcomes for chronic conditions such as diabetes and CORD. In Denmark, integrated care has led to reduced hospital admissions and improved patient satisfaction. In Sweden, integrated care has been associated with improved quality of care and reduced healthcare costs.
This greater integrated care in nations in theory should provide a more joined up international approach to develop the benefits of shared knowledge, through greater joint research on such as genomics, to support the building of a preventative health culture.
“Many systems still remain fragmented, focused on episodic acute care and unsuitable to solve complex health needs through a patient-centred approach”
Across OECD countries, ageing populations and an increasing number of people living with chronic diseases has shifted the focus of health and care delivery beyond acute hospitals. Almost two in three people aged over 65 years live with one or more chronic conditions, often requiring multiple interactions with different providers, thus making them more susceptible to poor and fragmented care. Ensuring health systems are people-centred is a goal of most countries. This approach requires integrated systems capable of continuous, co-ordinated, and high-quality healthcare delivery throughout a patient’s lifetime. Despite mostly local- level promising experiences of integrated care models, many systems still remain fragmented, focused on episodic acute care and unsuitable to solve complex health needs through a patient-centred approach that blends a preventative approach with curative interventions when needed.
In order to measure the success of an integrated system we need to better understand, capture and use the data available to us. Equally, we need to develop the capability to share understanding internationally, so all systems can better develop their health care offer to their citizens.
Success factors for an effective integrated care system
Strong leadership: Effective leadership is critical to the success of an integrated healthcare system. Leaders must be able to articulate a clear vision for integration, build consensus among stakeholders, and provide the resources and support needed to implement integrated care models. They must also be able to build strong and lasting relationships across an integrated care system to ensure trust in the approach.
Collaborative partnerships: Successful integration requires collaboration among healthcare providers, community organisations, and other relevant stakeholders (country dependent). Partnerships can help to break down siloes and facilitate communication and coordination across different settings.
Information technology: The use of information technology can play a key role in facilitating integration by enabling the sharing of patient data across different providers and settings. Electronic health records, telemedicine, and other digital tools can help to improve communication and coordination among healthcare providers. It is also dear thatAI has an important role to play in healthcare delivery in the future.
Patient-centred care: Integrated healthcare systems should prioritise patient-centred care, which involves tailoring care to meet the unique needs and preferences of individual patients. This approach can help to improve patient outcomes, experience and satisfaction and ensure nothing is missed, also enabling systems to tackle issues of inequality.
Outcome measurement: Effective integrated healthcare systems should have systems in place to measure and evaluate outcomes that can help to identify areas for improvement and ensure that integrated care models are delivering the intended benefits.
The right way?
So, is integrated care the right way forward for health systems? There is developing and supportive evidence to indicate that integrated care systems will support the delivery of improved healthcare services for citizens that make sense for patients and develop preventative rather than curative systems in the future. However, it is clear we need to develop better systems to collect, understand, use and share data to inform how we continue to adapt our healthcare offerings and support the development of successful integrated care systems.