Integrating Specialist Care with Primary and Long-Term Care: Examples from Five Countries

Michel L., Or Z. (IRDES)

Questions d'économie de la santé (Issues in Health Economics) n° 248 - April 2020

QES n° 248

Population ageing, with an increasing number of persons living with chronic diseases, is challenging the traditional approaches to healthcare provision. Supporting care for patients who have multiple long-lasting needs requires better coordination of their treatments at the crossroads of primary care, specialised medicine, and personal and social care. In France, over the past fifteen years, primary care has been restructured through the development of Multidisciplinary Health Centres (MHC). However, despite their name, these centres rarely involve specialist doctors. Specialists work mostly in solo practice or in hospitals and have little association with primary or long-term care providers. Overspecialisation, which risks increasing the fragmentation of healthcare provision, and the difficulties in access to specialist care, raises concerns about the ways in which the specialists care is organised in France.
Based on eight case studies carried out in five countries, this article examines novel organisational models which shift the frontiers of specialist care for improving integration with primary and long-term care. We summarize here the different approaches and methods that have been used to better address patients' needs by improving care coordination between specialists working in or out of hospitals and other care providers. We also examine how these approaches have altered the roles of specialists and other healthcare professionals involved in patient care, and how funding methods have changed to support the new care models. The publications providing more detailed description of each case study can be found here:
Report 577: International Comparison of Specialist Care Organization. Innovations in Five Countries: Integrated Funding for Maternity Care in the Netherlands
Report 574: International Comparison of Specialist Care Organization: Innovations in Five Countries (England, Germany, Italy, Netherlands, United States). Italy: Multidisciplinary Networks in Tuscany

See also Questions d'économie de la santé n° 248 in French: Décloisonner les prises en charge entre médecine spécialisée et soins primaires : expériences dans cinq pays.