What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Introduction: Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identif...

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Autores principales:	Katrien Danhieux, Monika Martens, Elien Colman, Edwin Wouters, Roy Remmen, Josefien van Olmen, Sibyl Anthierens
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2021
Materias:	integrated care health care policy chronic care stakeholder interviews governance health care systems Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/648f8b9d9f9942b3bc8f5b85a0527762
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spelling	oai:doaj.org-article:648f8b9d9f9942b3bc8f5b85a05277622021-11-08T08:08:08ZWhat Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium1568-415610.5334/ijic.5671https://doaj.org/article/648f8b9d9f9942b3bc8f5b85a05277622021-10-01T00:00:00Zhttps://www.ijic.org/articles/5671https://doaj.org/toc/1568-4156Introduction: Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view. Methods: 27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed. Results: Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact. Discussion: This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial.Katrien DanhieuxMonika MartensElien ColmanEdwin WoutersRoy RemmenJosefien van OlmenSibyl AnthierensUbiquity Pressarticleintegrated carehealth care policychronic carestakeholder interviewsgovernancehealth care systemsMedicine (General)R5-920ENInternational Journal of Integrated Care, Vol 21, Iss S2 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	integrated care health care policy chronic care stakeholder interviews governance health care systems Medicine (General) R5-920
spellingShingle	integrated care health care policy chronic care stakeholder interviews governance health care systems Medicine (General) R5-920 Katrien Danhieux Monika Martens Elien Colman Edwin Wouters Roy Remmen Josefien van Olmen Sibyl Anthierens What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
description	Introduction: Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view. Methods: 27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed. Results: Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact. Discussion: This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial.
format	article
author	Katrien Danhieux Monika Martens Elien Colman Edwin Wouters Roy Remmen Josefien van Olmen Sibyl Anthierens
author_facet	Katrien Danhieux Monika Martens Elien Colman Edwin Wouters Roy Remmen Josefien van Olmen Sibyl Anthierens
author_sort	Katrien Danhieux
title	What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
title_short	What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
title_full	What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
title_fullStr	What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
title_full_unstemmed	What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium
title_sort	what makes integration of chronic care so difficult? a macro-level analysis of barriers and facilitators in belgium
publisher	Ubiquity Press
publishDate	2021
url	https://doaj.org/article/648f8b9d9f9942b3bc8f5b85a0527762
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What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

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