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Introduction: Over the last decade in the United States (US), the burden of chronic disease, health care costs, and fragmented care delivery have increased at alarming rates. To address these challenges, policymakers have prioritized new payment and delivery models to incentivize better integrated health and social services. Policy practice: This paper outlines three major national and state policy initiatives to improve integrated health and social care over the last ten years in the US, with a focus on the Medicaid public insurance program for Americans with low incomes. Activities supported by these initiatives include screening patients for social risks in primary care clinics; building new cross-sector collaborations; financing social care with healthcare dollars; and sharing data across health, social and community services. Stakeholders from the private sector, including health systems and insurers, have partnered to advance and scale these initiatives. This paper describes the implementation and effectiveness of such efforts, and lessons learned from translating policy to practice. Discussion and Conclusion: National policies have catalyzed initiatives to test new integrated health and social care models, with the ultimate goal of improving population health and decreasing costs. Preliminary findings demonstrated the need for validated measures of social risk, engagement across levels of organizational leadership and frontline staff, and greater flexibility from national policymakers in order to align incentives across sectors. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this paper is to examine the effects of health care policy on the development of integrated mental health services in England. Data sources: Drawing largely from a narrative review of the literature on adult mental health services published between January 1997 and February 2003 undertaken by the authors, we discuss three case studies of integrated care within primary care, secondary care and across the primary/secondary interface for people with serious mental illness. Conclusion: We suggest that while the central thrust of a raft of recent Government policies in England has been towards integration of different parts of the health care system, policy waterfalls and implementation failures, the adoption of ideas before they have been thoroughly tried and tested, a lack of clarity over roles and responsibilities and poor communication have led to an integration rhetoric/reality gap in practice. This has particular implications for people with serious mental health problems. Discussion: We conclude with suggestions for strategies that may facilitate more integrated working. [ABSTRACT FROM AUTHOR]

In response to increasing care needs, the development of elderly care systems has become a prominent policy concern across the OECD. Since the beginning of the 1990s, the increasing economic constraints led to the rise of policies that focus on the improvement of "coordination" and "integration" of administrations and services - in other words, policies that aim at reducing the fragmentation of health and social care system. As a result, a growing number of studies focus on innovative integrated care schemes and their transferability from one national context to another. Yet they do not systematically investigate the political, organizational, cultural and societal contexts in which they have emerged neither do they link them to the diverse conceptions of integration or coordination carried by the multiple actors concerned. In this paper, we identified three policy-making mechanisms underpinning integration policies at both national and local levels. Theory/Methods: The POLIA-INLOVE comparative research investigates integration/coordination policies in three European countries - France, Sweden and UK. Its analytical framework borrows from sociology, public policy analysis and management studies. Based on a qualitative and diachronic perspective, not presupposing the existence of any integration/coordination policy in the countries studied, it focuses on the understanding of whether, when and how the need for professional, institutional and organizational integration/coordination came to be formulated. Our approach seeks to deconstruct the meaning of integration and coordination policies led in the three countries, and to understand their institutional, organisational and historical contexts. This paper presents the first results of a literature review and an empirical survey by semi-directive interviews led since 2013 in France (n=27), Sweden (n=22) and the UK (n=28). It covers two levels: interviews with national experts at the macro level of policies developed and implemented nationally and with actors at the micro level concerning specific schemes implemented locally, to take into account the organizational particularities in each of the countries and on chosen territories. Results: The analysis of the policies in France, Sweden and UK shows the impact of both the national and the territorial contexts, which varies from one country to the other. It leads us to identify three different policy-making processes towards coordination/integration. We provisionally named them "layers", "chains" and "lineages". These logics are unequally shared out between the three countries: the layering process can be identified as a dominant trend in France whereas the chaining logic is dominant in Sweden. The lineage metaphor, finally, looks more appropriate when it comes to analyze the history of attempts for reducing fragmentation in England. Yet, further analysis including concrete solutions experimented on both national and local levels shows that there come to be a mix of logics mobilized in each concrete situation. Thus, the different logics are not directly opposed and they can be expected to work together. Discussion: Qualitative comparison raises significant challenges due to the risk of comparing schemes or elements which are not comparable, particularly for locally implemented models developed in specific territorial contexts, unless one focus on the learning and adaptation processes. Secondly, comparison between countries representing different welfare models runs the risk of reducing the observed outcomes to the same variables used for the identification of the welfare models. By putting the accent on identifying the underpinning logics of integration/coordination policies in the three countries rather than running a systematic comparison of their content, we address these challenges in two ways: - The three logics identified articulate both macro and micro analysis since they are based on the identification of the mechanisms underpinning both national policies and locally implemented measures. -The three logics are analyzed in relation to the different welfare state models and to the wider political projects they belong to. Conclusion: The next step of the research consists in identifying common cross-cutting issues in at least two of the three countries studied: -The impact of the political variable on the orientation and the content of integration/coordination policies; -Interactions between local and national levels as opportunities and constraints for integration; -The issue of New Public Management in the integration/coordination process Taken as basis for comparison, these issues can inform aspects of processes of integration/coordination that are often analyzed in one single national/local context. [ABSTRACT FROM AUTHOR]

Introduction: For more than a decade the English NHS has pursued integrated care through three national pilot programmes. The independent evaluators of these programmes here identify several common themes that inform the development of integrated care. Description: The three pilot programmes shared the aim of better coordination between hospital and community-based health services and between health and social care. Each programme recruited local pilot sites that designed specific interventions to support inter-professional and inter-organisational collaboration. The pilots were highly heterogenous and results varied both within and between the three programmes. While staff were generally positive about their achievements, pilots had mixed success especially in reducing unplanned hospital admissions. Common facilitators to achieving pilots' objectives included effective senior leadership and shared values, simple interventions and additional funding. Barriers included short timescales, poor professional engagement, information and data sharing problems, and conflicts with changing national policy. Discussion: There was little stable or shared understanding of what 'integrated care' meant resulting in different practices and priorities. An increasing focus on reducing unplanned hospital use among national sponsors created a mismatch in expectations between local and national actors. Conclusion: Pilots in all three national programmes made some headway against their objectives but were limited in their impact on unplanned hospital admissions. [ABSTRACT FROM AUTHOR]

The article discusses the proposals for reform on the implementation of strategic plan and health care innovations for chronic diseases in Belgium. It states that the Belgian health care system is governed by the National Institute for Health and Disability Insurance (NIHDI) social security agency of the country's Minister of Social Affairs. It also emphasizes the several sectors of that financed the healthcare system including the national, social security based and health insurance system.