Document Type : Commentary
Author
1
MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
2
Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark, Odense, Denmark
Abstract
Impacts of integrated care interventions, particularly on utilisation and financial outcomes, can be mixed, sometimes quite disappointing when compared to expectations. Positive deviants come along occasionally, but it is extremely difficult to unpick exactly why one intervention might “work” where others have not. Choi and Yoo evaluated a programme in Korea, which appears to have increased time older patients discharged from hospital spend at home, reduced their odds of a subsequent emergency admission, and decreased total expenditure, although re-admissions increased. The programme stands out particularly in its breadth of non-traditional care activity, home-based primary care and long-term (social) care services, but also broader activities such as nutrition support (eg, meal delivery), movement assistance, lifestyle education, housekeeping, and even home repair. In this commentary, I discuss this broadening of interventions to capture more social determinants of health, ask where boundaries of each sector/ service should lie, and who should pay for what.
Keywords
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