Around the world, only a few health care providers deliver integrated care effectively. Their experiences offer useful lessons for organizations that want to pilot integratedcare programs.
What does it take to make integrated care work?
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Jenny Grant
Two interrelated factors—the growing prevalence of chronic diseases and population aging—are placing a heavy burden on health systems. In all parts of the world except Africa, chronic diseases are by far the leading cause of death and disability, and they now account for 75 percent of global health care spend (an amount that is likely to increase in coming years).1 Furthermore, in almost every country, the proportion of people age 60 or older is growing far faster than any other age group, a result of both longer life expectancy and declining fertility rates.2 As people grow older, they are more apt to suffer from chronic diseases, but aging alone can increase their frailty—and their need for health care. If the health care needs of the chronically ill and elderly are not adequately addressed, the consequences for both patients and health systems could be severe. The failure to appropriately manage disease often leads to worsening patient health; the failure to provide patients with carefully coordinated care can allow small problems to escalate into medical emergencies. Both scenarios can result in unnecessary hospitalizations, increased mortality, and higher health system costs.
system and social services can allow elderly patients to “fall through the cracks” because neither side understands the full extent of the patients’ problems. Care fragmentation also frustrates patients, who find it difficult to navigate among the various providers and often feel that there is no one person who can help them get all essential services. Although closer care integration offers patients significant benefits, it is hard for most health systems to provide. To date,