Health systems have a role to play not only in preventing disease and promoting health, but also in reducing health inequalities. However, vulnerable groups, such as immigrants, young people, long term unemployed or ethnic minorities, can easily become exasperated by organisational silos which prevent access to health services. Other barriers to accessing health services include the location of the services, waiting lists and out-of-pocket payments for services or medication, which reinforce the social gradient of health inequalities. Health services that are not accessible in case of need, are neither financially viable nor sustainable: they focus on the internal concerns of health services and their organisational structures to the detriment of the patient’s needs.
By Riitta-Maija Hämäläinen
In a recent statement, the Vice-President of the European Commission Valdis Dombrovskis stressed that, “healthcare systems need to be reformed in order to ensure quality healthcare through efficient structures.” In addition to this, the European Commission recognizes that sustainability, affordability and accessibility are key challenges facing European health systems.
One approach to health system reform that may assist in addressing these challenges is integrating health systems and reducing organizational silos. Research evidence shows that spending on health is not directly correlated to better health outcomes. One conclusion from this finding is that spending related to the social determinants of health will reap increased outcomes. Integration can occur between primary and secondary care or between health and social care – however, it may also encompass housing, employment, education and cooperation with third sector organisations.
Ranging from multi-disciplinary teams to full legislative integration, as is the case in Scotland, integration demonstrates a move away from the current model of hospital-based health services and curative care to a more efficient structure that focuses on primary care with greater attention paid to disease prevention and health promotion.
By blurring the organisational boundaries and moving away from being disease orientated, integrated health systems foster a person-centred approach. In that respect, the empowerment of patients and their involvement at every level of the health system are important to ensuring effective self- management, improved health literacy and well-integrated professional support.
This shift not only breaks down the silo nature of health services but moves towards a more holistic approach; focusing on the person and their backgrounds and situation, and allowing different sectors to work together to create an effective supportive system. Integration of health services encourages communities to engage in the local planning of health systems, fostering a co-production approach to health systems, whereby services can be tailored not only to the individual, but to communities. Localised planning allows health systems to consider the needs of the population at local level and therefore use resources to tackle the social determinants of health in the most effective manner. Local planning between health services, social services and services of other sectors also reduces organisational barriers. This creates a more transparent system, where patients and service users can navigate more smoothly through supportive systems, accessing the services they require in a simplified manner. This can help to capture those vulnerable people who may otherwise be unable to navigate each individual service and also lessens the burden of crisscrossing between various services; mitigating the risk of service users dropping out of the system.
Regarding sustainability there is potential for financial savings as well as improved health outcomes. When services are integrated and work in a coordinated manner, there is less wasted time and reduced
duplication of effort through the efficient sharing of financial and human resources. Integration promotes better health outcomes leading to less reliance on acute or emergency care and can support the prevention of unnecessary and costly hospitalisation. Fewer admissions (and more people staying safely at home) significantly reduces the costs in delivering health services as well as being more person centred. Rebalancing the mix of disease prevention and health promotion versus curative services also increases efficiency and increases the sustainability of health systems.
There are numerous potential other areas for macro- and micro-efficiency gains, which can be and are currently being addressed in many EU member states. EuroHealthNet aims to take these examples further in its Technical Working Group on Integrated Health Systems (TWIG-HS).