Introduction

For many years, there have been calls for developing integrated service delivery models to improve poorly coordinated, complex and inefficiently delivered social and health care to older people, yet few providers have moved successfully in this direction. Providing integrated health and social care for older people continues to be an important item on social policy agendas at the highest levels, including of the World Health Organization (WHO), European Union (EU) and individual countries. Take, for example, efforts around integrated care coming out of the WHO European Office for Integrated Health Care Services and research activities such as PROCARE (Billings and Leichsenring, 2005) stemming from the EU’s Fifth Framework Programme ‘Ageing Population and Disabilities’. Considerable work has been done to articulate policy initiatives and research to support this aim.

A large part of the literature has been devoted to describing the models of care, and significantly less to actually evaluating the evidence in terms of the clinical and cost benefits of these, or to articulating how to design policies that facilitate integrated care. In this chapter, all three topics are addressed. Integrated care is reviewed with an eye towards describing some of the common aspects of existing models and what they hope to achieve, evaluating the results, and making recommendations to policy-makers about how they might help remove barriers that exist so that generally small demonstration efforts might become scalable national models.

Integrated care and its rationale

No common definition of integrated care exists. Indeed, the terms ‘integrated care’, ‘coordinated care’, ‘continuum of care’ and others are often used interchangeably. Different authors emphasise different aspects of the design of integrated care. Yet integrated care is consistently seen by many as the answer to the fragmentation and inefficiency that characterise many health and supportive care systems. ‘Like a Rorschach test’, Kodner and Spreeuwenberg write, ‘integrated care has many meanings; it is often used by different people to mean different things. It is most frequently equated with managed care in the US, shared care in the UK, transmural care in the Netherlands and other widely recognised formulations such as comprehensive care and disease management’ (2002, p 1).