Comparing integrated care policy in Europe: does policy matter?

This paper addresses the interplay between integrated care policies and integrated care development in various national contexts. It is based on a secondary analysis of six country reports, written by scientists with expert knowledge on integrated care policies and practices in their respective countries. The country reports are structured according to the same descriptive framework, which includes characteristics of the national health systems, integrated care target groups and providers, coordinating mechanisms and promoting and inhibiting factors. The reports are analysed with help of a neo-institutionalist conceptual framework. This analysis indicates that a clear proactive policy by national government as well as regional and local authorities matters and that a lack of integrated care policies goes hand in hand with a weak primary care sector. However, although an active integrated care policy is necessary, it is not sufficient. It is also needed that all actors involved adequately manage dividing lines in the system and the fragmentation of services, such as lack of coordination, different professional values and interests. Although fragmentation is persistent in European health and social care systems, the endeavours to combat this problem are persistent either.