TY - JOUR

T1 - Integrated care in a Beveridge system

T2 - experiences from England and Denmark

AU - Tsiachristas, Apostolos

AU - Vrangbæk, Karsten

AU - Gongora-Salazar, Pamela

AU - Kristensen, Søren Rud

PY - 2023

Y1 - 2023

N2 - Health systems internationally face demands to deliver care that is better coordinated and integrated. The health system financing and delivery model may go some, but not all the way in explaining health system fragmentation. In this paper, we consider the road to care integration in two countries with Beveridge style health systems, England and Denmark, that are both ranked as highly Integrated systems in Toth's health integration index. We use the SELFIE framework to compare the policies and reforms that have affected care integration over the past 30 years in the two countries. The countries both started their reform path by reforming to introduce choice and competition, but did so in different ways that set them on different pathways. Nevertheless, after two decades, the countries ended the period with largely similar structures that emphasised the creation of a cross-sectoral governance structure. In the relatively centralised England, by introducing decentralised Integrated Care Systems, and in the relatively decentralised Denmark with a centralising element in the form of new Health Clusters.

AB - Health systems internationally face demands to deliver care that is better coordinated and integrated. The health system financing and delivery model may go some, but not all the way in explaining health system fragmentation. In this paper, we consider the road to care integration in two countries with Beveridge style health systems, England and Denmark, that are both ranked as highly Integrated systems in Toth's health integration index. We use the SELFIE framework to compare the policies and reforms that have affected care integration over the past 30 years in the two countries. The countries both started their reform path by reforming to introduce choice and competition, but did so in different ways that set them on different pathways. Nevertheless, after two decades, the countries ended the period with largely similar structures that emphasised the creation of a cross-sectoral governance structure. In the relatively centralised England, by introducing decentralised Integrated Care Systems, and in the relatively decentralised Denmark with a centralising element in the form of new Health Clusters.

KW - Humans

KW - Delivery of Health Care, Integrated

KW - Denmark

KW - England

KW - Health Care Reform

U2 - 10.1017/S1744133123000166

DO - 10.1017/S1744133123000166

M3 - Journal article

C2 - 37827835

VL - 18

SP - 345

EP - 361

JO - Health Economics, Policy and Law

JF - Health Economics, Policy and Law

SN - 1744-1331

IS - 4

ER -