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Overcoming fragmentation in health care: chronic care in Austria, Germany and the Netherlands

Published online by Cambridge University Press:  05 January 2012

Ellen Nolte ,
Cécile Knai ,
Maria Hofmarcher ,
Annalijn Conklin ,
Antje Erler ,
Arianne Elissen ,
Maria Flamm ,
Brigit Fullerton ,
Andreas Sönnichsen  and
Hubertus J. M. Vrijhoef
Ellen Nolte*
Affiliation:
Director, Health and Healthcare Research programme, RAND Europe, Cambridge, UK
Cécile Knai
Affiliation:
Lecturer in European Health Policy, Faculty of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
Maria Hofmarcher
Affiliation:
Director Health and Care, European Centre for Social Welfare Policy and Research, Vienna, Austria
Annalijn Conklin
Affiliation:
Analyst, Health and Healthcare Research programme, RAND Europe, Cambridge, UK
Antje Erler
Affiliation:
Senior Researcher, Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Germany
Arianne Elissen
Affiliation:
Research Fellow, Department of Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, The Netherlands
Maria Flamm
Affiliation:
Research Fellow, Institute of General Practice, Paracelsus Medical University Salzburg, Austria
Brigit Fullerton
Affiliation:
Research Fellow, Institute of General Practice, Johann Wolfgang Goethe University Frankfurt, Germany
Andreas Sönnichsen
Affiliation:
Professor of Medicine, Institute of General Practice, Paracelsus Medical University Salzburg, Austria
Hubertus J. M. Vrijhoef
Affiliation:
Professor, TRANZO Scientific Center for Care and Welfare, Tilburg University, The Netherlands
*
*Correspondence to: Dr Ellen Nolte, RAND Europe, Westbrook Centre, Milton Road, Cambridge CB4 1YG, UK. E-mail: enolte@rand.org
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Abstract

The growing recognition of care fragmentation is causing many countries to explore new approaches to healthcare delivery that can bridge the boundaries between professions, providers and institutions and so better support the rising number of people with chronic health problems. This paper examines the role of the regulatory, funding and organisational context for the development and implementation of approaches to chronic care, using examples from Austria, Germany and the Netherlands. We find that the three countries have implemented a range of policies and approaches to achieve better coordination within and across the primary and secondary care interface and so better meet the needs of patients with chronic conditions. This has involved changes to the regulatory framework to support more coordinated approaches to care (Austria, Germany), coupled with financial incentives (Austria, Germany) or changes in payment systems (the Netherlands). What is common to the three countries is the comparative ‘novelty’ of policies and approaches aimed at fostering coordinated care; however, the evidence of their impact remains unclear.

Type
Articles
Information
Health Economics, Policy and Law , Volume 7 , Issue 1 , 05 January 2012 , pp. 125 - 146
Copyright
Copyright © Cambridge University Press 2012

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