Integrated care: What policies support and influence integration in health care across New Zealand, England, Canada and the United States?

Abstract

One of the key challenges for health systems worldwide is the substantial cost of fragmented care, not only financially, but also in terms of patient and population health. In light of this, integrated health care has been a key element of health reforms internationally. Despite substantial diversity in health systems across developed countries, there is consensus that current health care expenditure is unsustainable, particularly in the context of ageing populations with increasing prevalence of chronic disease and multi-morbidities. The universal challenge is to improve the quality and safety of health care and, concomitantly, to curb the rising costs of health care delivery. Evidence indicates that health systems with strong integrated primary health care (PHC) at their core are both effective and efficient at delivering appropriate services where they are needed most. Although Australia is comparable to New Zealand (NZ), England, Canada, and the United States (US) in terms of expenditure and coverage of PHC, recent evidence suggests that there is room for improvement in Australia on indicators of integration including access, cost, coordination, information sharing and chronic disease management, which may reflect the fact that, for the most part, these countries have been working at ways to achieve integrated health services for longer than Australia.