1 / 13

IN SEARCH OF AN ORGANISATIONAL STRUCTURE FOR INTEGRATED CARE

IN SEARCH OF AN ORGANISATIONAL STRUCTURE FOR INTEGRATED CARE. The Swedish experience. Runo Axelsson Professor of Health Management. Outline. The Swedish welfare system. Organisational trends in health and welfare services. Implications for integrated care.

lundy
Télécharger la présentation

IN SEARCH OF AN ORGANISATIONAL STRUCTURE FOR INTEGRATED CARE

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. IN SEARCH OF ANORGANISATIONAL STRUCTURE FOR INTEGRATED CARE The Swedish experience Runo Axelsson Professor of Health Management

  2. Outline • The Swedish welfare system. • Organisational trends in health and welfare services. • Implications for integrated care. • Organisational models of integration and collaboration. • Financial co-ordination as a model for integration of welfare services.

  3. The Swedish welfare system • Financing and provision of health and social services is decentralised to regions and municipalities. • Responsibilities are further decentralised to specialised local agencies. • Limited role and influence of the national government. • Employment service and social insurance are responsibilities of national agencies, but decentralised to local branches.

  4. Development of the system • 1930s: Development and consolidation of the Swedish welfare state; child benefits, health and social insurance, pensions. • 1950s: Economic growth and expansion of health care and social welfare. Large-scale hospitals built in most regions. • 1960s: All branches of health care concentrated to the county councils: an integrated health care system on the regional level. • 1990s: Care of the elderly and disabled from the county councils to the municipalities.

  5. Organisational developments • 1930s: Traditional public welfare administration; application of laws, rules and regulations. • 1960s: Centralisation and bureaucratisation; strategic planning and control; industrial ideals. • 1980s: Decentralisation, de-bureaucratisation and service orientation; “small is beautiful”. • 1990s: New Public Management; privatisation, market orientation and commercial ideals. • 2000s: Process orientation, mergers and re-centralisation; “economies of scale”.

  6. Implications for integration • 1930s: Integration of welfare services through a comprehensive legal framework. • 1960s: Integration through the hierarchy and management control of public bureaucracies. • 1980s: Integration through communication and management by objectives. • 1990s: Integration through the real or artificial markets of New Public Management. • 2000s: Integration of processes through development of integration and collaboration.

  7. Continuum of integration (Andersson et al, 2011) Case Management Liaison functions Partnerships Formal agreements Autonomy Mergers Consultation Information exchange Multidisciplinary meetings, teams or working groups Co-location Financial co-ordination

  8. Between autonomy and mergers • Autonomous organisations are providing specialised welfare services. • Specialisation may lead to fragmentation, duplications and waste. • Mergers create large scale organisations. • Increasing size of organisations leads to increasing bureaucracy! • Bureaucratic organisations are divided into specialised departments, who tend to become more and more autonomous.

  9. Spectrum of integration Multidisciplinary meetings, teams and working groups Case management Liaison functions Partnerships Formal agreements Co-location Financial co-ordination Consultation Information exchange Autonomy Mergers

  10. Associations for integration • A number of experiments in the 1990s to im-prove integration in occupational rehabilitation. • Different models were developed for collabora-tion between health care, social service, social insurance and employment service. • The main obstacle was the different budgets; territorial problems of transferring costs etc. • Legislation in 2004 made it possible to create Associations for Financial Coordination. • More than 80 associations have been formed since the legislation was enacted.

  11. Association for Financial Coordination Collaborating organisations Board Manager Groups Meetings Activities

  12. The Swedish experience • The associations for financial coordination are useful organisational structures for integration of different welfare services. • The associations are arenas for collaboration between different welfare organisations. • The financial coordination is eliminating the most difficult obstacle to collaboration. • The associations are flexible organisations for integration with a minimum of bureaucracy. • The associations can be used for integration of other services than occupational rehabilitation.

More Related