Nordic School of Public Health, Göteborg, Sweden.
J Health Organ Manag. 2010;24(4):396-411. doi: 10.1108/14777261011065002.
The purpose of this paper is to explore the concepts of Swedish integrated health care, their state of development and interdependence, and, furthermore, evaluate whether the theoretical framework used improves the comprehension of why integrated health care arrangements endure or cease.
DESIGN/METHODOLOGY/APPROACH: The study is founded on descriptive data gathered from a literature search on integrated health care in Sweden. With inspiration from ecology theory, these data were analysed guided by a theoretical model based on a continuum of symbiotic effects, from antagonism to mutualism.
The era of Swedish integrated health care started in the 1990s, when a kind of clinical network called chains of care was launched. At the beginning the chain of care development was predominantly surrounded by non-integrative conditions, which had a restraining effect on these efforts. Even so, it seems that chains of care are here to stay. This faith in chains of care can to some extent be explained by the crucial role they have as connectors in the emerging local health care systems. Thus, these systems need chains of care to evolve and chains of care seem to require the integrative framework of local health care to progress and endure. Integrated health care performance could be troublesome, unless such mutualistic conditions are in place. States of commensalism may also be promoted, but the advantages are unilateral and therefore there is a risk of disloyalty by the unaffected part, which, in turn, can create a breeding-ground for an antagonistic liaison.
ORIGINALITY/VALUE: A theoretical approach founded on what may be called "Health Care System Ecology" appears to enhance the understanding of the complex logic of integrated health care.
本文旨在探讨瑞典综合医疗保健的概念、其发展状况和相互依存关系，并进一步评估所使用的理论框架是否能提高对综合医疗保健安排持续或停止的原因的理解。
设计/方法/途径：本研究基于对瑞典综合医疗保健的文献检索中收集的描述性数据。受生态学理论的启发，这些数据在一个基于共生效应连续体的理论模型的指导下进行分析，该模型的共生效应从对抗到互利。
瑞典综合医疗保健的时代始于 20 世纪 90 年代，当时推出了一种名为“关怀链”的临床网络。起初，关怀链的发展主要受到非整合条件的制约，这些条件对这些努力产生了抑制作用。即便如此，关怀链似乎仍将继续存在。这种对关怀链的信心在一定程度上可以解释为它们作为新兴地方医疗保健系统的连接器所发挥的关键作用。因此，这些系统需要关怀链来发展，而关怀链似乎需要地方医疗保健的整合框架来进步和持续。除非存在这种互利条件，否则综合医疗保健的表现可能会出现问题。共生状态也可能得到促进，但优势是单方面的，因此，未受影响的部分可能会出现不忠诚，这反过来又会为对抗性联系创造滋生的土壤。
原创性/价值：基于所谓的“医疗保健系统生态学”的理论方法似乎增强了对综合医疗保健复杂逻辑的理解。
