Allers Sanne, Eijkenaar Frank, Schut Frederik T, van Raaij Erik M
Erasmus School of Health Policy and Management, Erasmus University Rotterdam, The Netherlands.
Rotterdam School of Management, Erasmus University Rotterdam, The Netherlands.
Int J Integr Care. 2024 Jul 31;24(1):11. doi: 10.5334/ijic.7736. eCollection 2024 Jul-Sep.
While the benefits of integrated care are widely acknowledged, its implementation has proven difficult. Together with other factors, financial factors are known to influence progress towards care integration, but in-depth insight in their influence on the envisioned outcomes of integrated care projects is limited.
We conducted a multiple case study of four integrated care projects in the Netherlands. The projects were purposely sampled to be representative of integrated care in its different forms. A total of 29 semi-structured interviews were held with project members, both medical and non-medical staff. In addition, 141 documents were analyzed, including scientific publications and minutes of meetings. Based on elaborate project descriptions we deduced the synergistic influences of financial and other factors on the outcomes of the projects.
Financial factors have an important influence on integrated care projects, though this influence is neither deterministic nor isolated. This is because the likelihood of realizing a positive outcome is affected by the degree to which four key conditions are fulfilled: 1) willingness to change, 2) alignment of interests and uniformity goal, 3) availability of resources to change, and 4) effectiveness of management of external actors.
Financial factors have an impact on the outcomes of integrated care projects and must be viewed in synergy with interrelated other factors. Crucial for realizing success in integrated care, a balance must be struck between the level of ambition set in a project and the reality of the prevailing key conditions.
虽然综合医疗的益处已得到广泛认可，但其实施却颇具难度。众所周知，除其他因素外，财务因素会影响医疗整合的进展，但对于其对综合医疗项目预期成果的影响，深入了解却较为有限。
我们对荷兰的四个综合医疗项目进行了多案例研究。这些项目是经过特意抽样选取的，以代表不同形式的综合医疗。我们与项目成员（包括医疗和非医疗人员）共进行了29次半结构化访谈。此外，还分析了141份文件，包括科学出版物和会议记录。基于详尽的项目描述，我们推断出财务因素和其他因素对项目成果的协同影响。
财务因素对综合医疗项目有重要影响，不过这种影响既不是决定性的，也不是孤立存在的。这是因为实现积极成果的可能性受到四个关键条件的满足程度的影响：1）变革意愿；2）利益一致和目标统一；3）变革所需资源的可用性；4）外部行为者管理的有效性。
财务因素会影响综合医疗项目的成果，必须与其他相关因素协同看待。对于在综合医疗中取得成功至关重要的是，必须在项目设定的目标水平与当前关键条件的现实情况之间取得平衡。
