Danhieux Katrien, Martens Monika, Colman Elien, Wouters Edwin, Remmen Roy, van Olmen Josefien, Anthierens Sibyl
University of Antwerp, Family medicine and Population Health, Doornstraat 331, 2610 Wilrijk, BE.
Institute of Tropical Medicine, Department of Public Health, Kronenburgstraat 43, 2000 Antwerpen, BE.
Int J Integr Care. 2021 Oct 29;21(4):8. doi: 10.5334/ijic.5671. eCollection 2021 Oct-Dec.
Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view.
27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed.
Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact.
This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial.
尽管许多国家一直在实施综合护理，但扩大规模仍然困难。宏观层面的制度障碍起着重要作用。通过选择过去10年在比利时实施综合护理的三项关键政策，我们旨在超越对其具体障碍和促进因素的识别，以获得一个总体的通用观点。
有目的地选择了27名参与者，包括比利时慢性病护理宏观层面涉及的所有重要利益相关者。半结构化访谈以政策时间线为指导，并进行了归纳主题分析。
在医疗保健和政策层面都确定了障碍和促进因素。限制综合护理扩大规模的主要因素是按服务收费的报销制度、有限的数据共享以及不同层级政府之间责任的分散。值得注意的是，这些因素之间存在强烈的相互作用。
本文强调了政府在综合护理方面责任同质化的重要性以及政策和医疗保健系统因素的相互依存性。需要进行整个系统的变革，而不是目前比利时那种在相互冲突的意见之间长期寻求共同点的模式。政治承诺和公民参与将至关重要。
