Leichsenring Kai
European Centre for Social Welfare Policy and Research, Berggasse 17, A-1090 Vienna, Austria.
Int J Integr Care. 2004;4:e10. doi: 10.5334/ijic.107. Epub 2004 Sep 3.
This paper is to distribute first results of the EU Fifth Framework Project 'Providing integrated health and social care for older persons-issues, problems and solutions' (PROCARE-http://www.euro.centre.org/procare/). The project's first phase was to identify different approaches to integration as well as structural, organisational, economic and social-cultural factors and actors that constitute integrated and sustainable care systems. It also served to retrieve a number of experiences, model ways of working and demonstration projects in the participating countries which are currently being analysed in order to learn from success-or failure-and to develop policy recommendations for the local, national and European level.
The paper draws on existing definitions of integrated care in various countries and by various scholars. Given the context of an international comparative study it tries to avoid providing a single, ready-made definition but underlines the role of social care as part and parcel of this type of integrated care in the participating countries.
The paper is based on national reports from researchers representing ten organisations (university institutes, consultancy firms, research institutes, the public and the NGO sector) from 9 European countries: Austria, Denmark, Finland, France, Germany, Greece, Italy, the Netherlands, and the UK. Literature reviews made intensive use of grey literature and evaluation studies in the context of at least five model ways of working in each country.
As a result of the cross-national overview an attempt to classify different approaches and definitions is made and indicators of relative importance of the different instruments used in integrating health and social care services are provided.
The cross-national overview shows that issues concerning co-ordination and integration of services are high on the agenda in most countries. Depending on the state of service development, various approaches and instruments can be observed. Different national frameworks, in particular with respect to financing and organisation, systemic development, professionalisation and professional cultures, basic societal values (family ethics), and political approaches have to be taken into account during the second phase of PROCARE during which transversal and transnational analysis will be undertaken based on an in-depth analysis of two model ways of working in each country.
Far from a European vision concerning integrated care, national health and social care systems remain-at best-loosely coupled systems that are facing increasing difficulties, given the current challenges, in particular in long-term care for older persons: increasing marketisation, lack of managerial knowledge (co-operation, co-ordination), shortage of care workers and a general trend towards down-sizing of social care services continue to hamper the first tentative pathways towards integrated care systems.
本文旨在发布欧盟第五框架项目“为老年人提供综合健康和社会护理——问题、难题与解决方案”（PROCARE，网址：http://www.euro.centre.org/procare/）的初步成果。该项目的第一阶段旨在确定综合护理的不同方法，以及构成综合且可持续护理系统的结构、组织、经济和社会文化因素及参与者。它还用于收集参与国的一些经验、工作模式范例和示范项目，目前正在对这些进行分析，以便从成功或失败中吸取教训，并为地方、国家和欧洲层面制定政策建议。
本文借鉴了各国及不同学者对综合护理的现有定义。鉴于国际比较研究的背景，它试图避免给出单一的现成定义，而是强调社会护理在参与国这类综合护理中的重要组成部分作用。
本文基于来自9个欧洲国家（奥地利、丹麦、芬兰、法国、德国、希腊、意大利、荷兰和英国）的10个组织（大学机构、咨询公司、研究机构、公共部门和非政府组织部门）的研究人员提交的国家报告。文献综述大量使用了灰色文献以及每个国家至少五种工作模式背景下的评估研究。
通过跨国概述，尝试对不同方法和定义进行分类，并提供了整合健康和社会护理服务中使用的不同手段的相对重要性指标。
跨国概述表明，服务协调与整合问题在大多数国家的议程上都很突出。根据服务发展状况，可以观察到各种方法和手段。在PROCARE项目的第二阶段，即在对每个国家的两种工作模式进行深入分析的基础上进行横向和跨国分析时，必须考虑不同的国家框架，特别是在融资与组织、系统发展、专业化与专业文化、基本社会价值观（家庭伦理）以及政治方法方面。
距离欧洲关于综合护理的愿景还很远，国家健康和社会护理系统充其量仍然是松散耦合的系统，鉴于当前的挑战，尤其是在老年人长期护理方面面临越来越多的困难：市场化加剧、缺乏管理知识（合作、协调）、护理人员短缺以及社会护理服务普遍缩减的趋势继续阻碍着迈向综合护理系统的初步尝试之路。
