Presently, Canada does not have integrated health care, but rather a series of disconnected parts – a health care industry comprising hospitals, doctors’ offices, group practices, community agencies, private sector organizations, public health departments, and so on. While each Canadian province is experimenting with different types of organizational structures and processes to enhance service delivery and ensure improved health care to the population, regional authorities and their variants do not posses the basic characteristics of integrated health care, such as physician integration.
In contrast, most developed countries are currently emphasizing the integration health care components as a solution to many of the challenges facing national health care systems. Evidence from the international experience with integrated systems has relevance in the Canadian context. These lessons from other countries, juxtaposed against Canadian health care objectives, can be applied to developing a model of integrated health care truly unique to Canada.
Progress Towards Integrated Health Care
By the late 1990s, most Canadian provinces (with the exception of Ontario) had adopted some form of regionalization in which responsibility for the allocation of resources and the control of costs was transferred from the provincial to the regional level. However, regionalization is not true integration since regional health authorities do not have responsibility for physicians and pharmaceuticals, which are two critical components of the integrated system.
There is relatively little literature directly related to performance of integrated health systems as a whole. However, there are lessons and ideas that can be extrapolated from material that has been published. They include:
- Traditional fee-for-service payment models and managed care plans show no overall difference in terms of satisfaction or quality of care.
- Under managed care, access may be adversely affected for specific populations.
- Bringing together hospitals, physicians and payors at the corporate level has no relationship to the local patient-care level.
- The goal of integration is best achieved in a series of incremental steps.
- There is no “one best way” to achieve coordination. A variety of strategies must be tried in different communities.
- Development of collaborative and interorganizational relationships among providers has met with limited success.
- Little consideration has been given to the coordination of services at the community and individual levels.
- There have been very few systematic attempts to monitor and evaluate integrated health systems as they have evolved.
- There is not a single capitation formula that is appropriate in all settings.
Strategies for Moving Ahead
Given these lessons learned, where does Canada go from here? Although there is no one model for achieving coordinated care at the community level, following are six inter-related strategies that can be adapted to different circumstances to improve the patient-care experience.
- Focus on the individual. Greater attention needs to be given to one’s experience with the health care system.
- Start with primary health care. Primary health care is one of the building blocks of integrated health care. It is the first level of care and should be the first point of contact with the health services system.
- Share information and exploit technology. Health care in Canada has been slow to embrace the broad advances in information management. Yet, to achieve more integration of care, improve processes and enhance collaboration among providers, information must be shared across the system.
- Create virtual coordination networks at the local level. Virtual networks that facilitate coordination wiithout the necessity of sharing assets can and should be developed.
- Develop practical needs-based funding methods. Models for appropriate needs-based funding must be developed and agreed upon by stakeholders. Canada should be at the forefront of research and development into new methods of funding health care.
- Implement mechanisms to monitor and evaluate. Systematic mechanisms need to be developed to monitor and evaluate the impact of large-scale organizational change.
Conclusion
In the mid-1990s, provincial governments and providers were deterred by the magnitude of change implied by a move towards integrated care. Now that there is some international experience with integrated care and a greater appreciation of its strengths and weaknesses, it is time to move ahead with the Canadian tradition of incremental change. If we focus on the individual, start with primary care, share information and exploit technology, create virtual coordination networks at the local level, develop practical needs-based funding methods and implement mechanisms to monitor and evaluate, we believe that progress will be made in creating a genuine and effective model of integrated health care in Canada
This article was written by Peggy Leatt, PhD; George H. Pink, PhD; and Michael Guerriere, MD, MBA, and reprinted with permission from: HealthCarePapers – “New Models for the New Health care,” Vol. 1 No. 2. To view this issue in its entirety, visit www.longwoods.com