Nies Henk, Stekelenburg Diny, Minkman Mirella, Huijsman Robbert
Director of Strategy & Development, Vilans, Centre of Expertise for Long-term Care, Utrecht, The Netherlands.
Professor of Organization, Policy Development in Long-term Care, Vrije Universiteit, Amsterdam, The Netherlands.
Int J Integr Care. 2021 Nov 8;21(4):15. doi: 10.5334/ijic.5703. eCollection 2021 Oct-Dec.
In the Netherlands multiple single, cross sector and cross governance level policy reforms were introduced to improve health and social care and decrease fragmentation. In addition to legislative and funding measures, the governmental strategy was to set up long-lasting improvement programs and supported by applied research.
Five national improvement programs on chronic disease management, maternity care, youth care, care for older people and dementia care were analysed. The Laws of integration of Leutz were used as an analytical framework. The programs demonstrated a mixture of employing policy, quality and financial measures to stimulate coherence and integration.
The Laws that Leutz formulated are to a large extent applicable in the Dutch context. However, the characteristics of the system of governance being corporatist in its structure and its culture imply that it is hard to distinguish single actors being in the lead. Integration is a more complex process and requires more dynamics, than the law 'keep it simple, stupid' suggests.
In the Dutch context integration implies a permanent pursuit of aligning mechanisms for integration. Sustainable integration requires long-standing efforts of all relevant stakeholders and cannot be achieved quickly. It may take a decade of consistently applying a mix of policy instruments.
在荷兰，多项单一、跨部门和跨治理层面的政策改革被引入，以改善卫生和社会护理并减少碎片化。除了立法和资金措施外，政府战略是设立长期改进计划并辅以应用研究。
分析了五项关于慢性病管理、孕产妇护理、青少年护理、老年人护理和痴呆症护理的国家改进计划。吕茨整合法被用作分析框架。这些计划展示了采用政策、质量和财务措施来促进连贯性和整合的混合方式。
吕茨制定的法律在很大程度上适用于荷兰的情况。然而，治理体系在结构和文化上具有社团主义特征，这意味着很难区分处于主导地位的单一行为体。整合是一个比“保持简单，傻瓜”法则所暗示的更为复杂的过程，需要更多的活力。
在荷兰的情况下，整合意味着对整合机制的持续追求。可持续的整合需要所有相关利益攸关方长期努力，无法迅速实现。可能需要十年持续应用一系列政策工具。
