Nordic School of Public Health, P.O. Box 12133, SE-402 42 Göteborg, Sweden.
Int J Integr Care. 2011 Jan;11 Spec Ed(Special 10th Anniversary Edition):e007. doi: 10.5334/ijic.566. Epub 2011 Mar 9.
The recent history of integrated health care in Sweden is explored in this article, focusing on the first decade of the 2000s. In addition, there are some reflections about successes and setbacks in this development and challenges for the next decade.
The first efforts to integrate health care in Sweden appeared in the beginning of the 1990s. The focus was on integration of intra-organisational processes, aiming at a more cost-effective health care provision. Partly as a reaction to the increasing economism at that time, there was also a growing interest in quality improvement. Out of this work emerged the 'chains of care', integrating all health care providers involved in the care of specific patient groups. During the 2000s, many county councils have also introduced inter-organisational systems of 'local health care'. There has also been increasing collaboration between health professionals and other professional groups in different health and welfare services.
Local health care meant that the chains of care and other forms of integration and collaboration became embedded in a more integrative context. At the same time, however, policy makers have promoted free patient choice in primary health care and also mergers of hospitals and clinical departments. These policies tend to fragment the provision of health care and have an adverse effect on the development of integrated care. As a counterbalance, more efforts should be put into evaluation of integrated health care, in order to replace political convictions with evidence concerning the benefits of such health care provision.
本文探讨了瑞典综合医疗保健的近期历史，重点关注 21 世纪初的第一个十年。此外，还对这一发展中的成功和挫折以及未来十年的挑战进行了反思。
瑞典最初尝试整合医疗保健的努力始于 20 世纪 90 年代初。重点是整合组织内部流程，旨在提供更具成本效益的医疗保健服务。部分原因是当时经济主义日益盛行，人们也越来越关注质量改进。这项工作产生了“护理链”，整合了所有参与特定患者群体护理的医疗保健提供者。在 21 世纪 00 年代，许多县议会还引入了跨组织的“地方医疗保健”系统。医疗保健专业人员与其他专业群体之间也在不同的健康和福利服务中加强了合作。
地方医疗保健意味着护理链和其他形式的整合与合作在更具综合性的背景下得到了巩固。然而，与此同时，政策制定者在初级医疗保健中提倡患者自由选择，并推动医院和临床科室的合并。这些政策往往会使医疗服务的提供碎片化，并对综合医疗保健的发展产生不利影响。作为一种制衡，应该投入更多的精力来评估综合医疗保健，以便用有关这种医疗保健服务提供的益处的证据取代政治信念。
