Policy by Pilot? Learning From Demonstration Projects for Integrated Care; Comment on “Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study”

Document Type : Commentary

Author

Family Health Centers at NYU Langone, Brooklyn, NY, USA

Abstract

Analysis of policy implementation for chronic disease in Belgium highlights the difficulties of launching experiments for integrated care in a health system with fragmented governance. It also entreats us to consider the inherent challenges of piloting integrated care for chronic disease. Sociomedical characteristics of chronic disease –political, social, and economic aspects of improving outcomes – pose distinct problems for pilot projects, particularly because addressing health inequity requires collaboration across health and social sectors and a long-term, life-course perspective on health. Drawing on recent US experience with demonstration projects for health service delivery reform and on chronic disease research, I discuss constraints of and lessons from pilot projects. The policy learning from pilots lies beyond their technical evaluative yield. Pilot projects can evince political and social challenges to achieving integrated chronic disease care, and can illuminate overlooked perspectives, such as those of community-based organizations (CBOs), thereby potentially extending the terms of policy debate.

Keywords


  1. Berwick DM, Nolan TW, Whittington J. The triple aim: care, health, and cost. Health Aff (Millwood). 2008;27(3):759-769. doi:1377/hlthaff.27.3.759
  2. Martens M, Danhieux K, Van Belle S, et al. Integration or fragmentation of health care? Examining policies and politics in a Belgian case study. Int J Health Policy Manag. 2021. doi:34172/ijhpm.2021.58
  3. De Winter M. Reshaping health care governance using pilot projects as public policy implementation instruments: the case of integrated care pilot projects for chronic patients in Belgium. Int Rev Public Policy. 2020;2(3):317-341. doi:4000/irpp.1422
  4. Rocco P, Kelly AS. An engine of change? The affordable care act and the shifting politics of demonstration projects. RSF. 2020;6(2):67-84. doi:7758/rsf.2020.6.2.03
  5. Chait N, Glied S. Promoting prevention under the affordable care act. Annu Rev Public Health. 2018;39:507-524. doi:1146/annurev-publhealth-040617-013534
  6. World Health Organization (WHO). Framework for Countries to Achieve an Integrated Continuum of Long-Term Care. WHO; 2021. https://www.who.int/publications/i/item/9789240038844.
  7. Minkman MMN. Longing for integrated care: the importance of effective governance. Int J Integr Care. 2017;17(4):10. doi:5334/ijic.3510
  8. Thelen K. Historical institutionalism in comparative politics. Annu Rev Polit Sci (Palo Alto). 1999;2(1):369-404. doi:1146/annurev.polisci.2.1.369
  9. Mannatt, RWJF. Caring for the Whole Child: A New Way to Finance Initiatives to Improve Children’s Health and Well-Being. Mannatt and the Robert Wood Johnson Foundation; 2020. https://www.manatt.com/Manatt/media/Documents/Articles/RWJF-Manatt-Caring-for-the-Whole-Child-Issue-Brief_12-1-20.pdf.
  10. Stuckler D, Reeves A, McKee M. Social and economic multipliers: what they are and why they are important for health policy in Europe. Scand J Public Health. 2017;45(18 Suppl):17-21. doi:1177/1403494817707124
  11. Wang G, Grosse SD, Schooley MW. Conducting research on the economics of hypertension to improve cardiovascular health. Am J Prev Med. 2017;53(6 Suppl 2):S115-S117. doi:1016/j.amepre.2017.08.005
  12. Gore R, Dhar R, Mohaimin S, et al. Changing clinic-community social ties in immigrant-serving primary care practices in New York city: social and organizational implications of the affordable care act’s population-health-related provisions. RSF. 2020;6(2):264-288. doi:7758/rsf.2020.6.2.12
  13. Skinner D, Franz B, Kelleher K, Penfold R. Community perceptions of hospitals and shared physical space: a qualitative study. Cult Med Psychiatry. 2018;42(1):131-158. doi:1007/s11013-017-9546-7
  14. Gugushvili A, Bulczak G, Zelinska O, Koltai J. Socioeconomic position, social mobility, and health selection effects on allostatic load in the United States. PLoS One. 2021;16(8):e0254414. doi:1371/journal.pone.0254414
  15. Felland L, Lipson D, Heeringa J. Examining New York’s Delivery System Reform Incentive Payment Demonstration: Achievements at the Demonstration’s Midpoint and Lessons for Other States. Centers for Medicare & Medicaid Services; 2018.
  16. Weller W, Drazek S, Greene R, et al. Final Interim Evaluation Report by the Independent Evaluator of the New York State Delivery System Reform Incentive Payment (DSRIP) Program. State University of New York at Albany; 2019. https://www.albany.edu/chsr/reports/dsrip_08_2019.pdf.
  17. Taylor LA, Byhoff E. Money moves the mare: the response of community-based organizations to health care's embrace of social determinants. Milbank Q. 2021;99(1):171-208. doi:1111/1468-0009.12491
  18. Brodkin EZ, Kaufman A. Policy experiments and poverty politics. Soc Serv Rev. 2000;74(4):507-532. doi:1086/516423

Articles in Press, Corrected Proof
Available Online from 22 May 2022
  • Receive Date: 04 February 2022
  • Revise Date: 17 May 2022
  • Accept Date: 18 May 2022
  • First Publish Date: 22 May 2022