Overcoming Fragmentation in Health Care

Chronic Care in Austria, Germany and The Netherlands

Published in: Health Economics, Policy, and Law , v. 7, no. 1, Special Issue, Jan. 2012, p. 125-146

Posted on RAND.org on January 01, 2012

by Ellen Nolte, Cécile Knai, Maria Hofmarcher, Annalijn Conklin, Antje Erler, Arianne Elissen, Maria Flamm, Birgit Fullerton, Andreas Sönnichsen, Hubertus Vrijhoef

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The growing recognition of care fragmentation is causing many countries to explore new approaches to healthcare delivery that can bridge the boundaries between professions, providers and institutions and so better support the rising number of people with chronic health problems. This paper examines the role of the regulatory, funding and organisational context for the development and implementation of approaches to chronic care, using examples from Austria, Germany and the Netherlands. We find that the three countries have implemented a range of policies and approaches to achieve better coordination within and across the primary and secondary care interface and so better meet the needs of patients with chronic conditions. This has involved changes to the regulatory framework to support more coordinated approaches to care (Austria, Germany), coupled with financial incentives (Austria, Germany) or changes in payment systems (the Netherlands). What is common to the three countries is the comparative 'novelty' of policies and approaches aimed at fostering coordinated care; however, the evidence of their impact remains unclear.

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