International Journal for Quality in Health Care 14:91-101 (2002)
© 2002 International Society for Quality in Health Care
Community-based integrated care: myth or must?
Department of Social Medicine, Academic Medical Center/University of Amsterdam, the Netherlands
Address reprint requests to Thomas Plochg, Academic Medical Center/University of Amsterdam, Department of Social Medicine, PO Box 22660, 1100 DD Amsterdam, The Netherlands. E-mail: t.plochg{at}amc.uva.nl
Issue. In spite of the many efforts that have been made to rationalize and improve the functioning and the quality of health care delivery in industrialized countries, too limited a degree of success has been achieved so far. This paper argues that this limited success originates from a lack of coherence among the various strategies and instruments developed to rationalize and improve the delivery of health care.
Addressing the issue. This fact can be shown by reducing the complexity of today’s health care into three levels of decision making: the primary process of patient care, the organizational context, and the financing and policy context of health care systems. Distinct rationales exist on each of these three levels of decision making as actors have their own perspectives, cultures, disciplines, and traditions concerning the delivery of health care. These differences can often result in ambiguity of goals, conflicting interests between decision-makers, bureaucracy, poor information transfer, and limited use of the available scientific knowledge on all three levels. In such a context, rationalization and quality-improvement efforts are frustrated and will have limited effectiveness. Therefore, the various rationalization strategies and instruments on all three levels of decision making should be embedded in our health care systems in a synergistic way.
Demonstrating the proposed solution. Community-based integrated care is a promising approach to address this issue successfully. How this concept might function as a unifying concept for quality improvement will be illustrated by relevant developments in the Academic Medical Center, University of Amsterdam in The Netherlands.
Keywords: community-based care, health services, health systems, integrated care, public health, quality of care
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