Healthcare systems and governments worldwide are trying to curb rising costs while improving patient care and outcomes. This has led to a growing interest in healthcare integration – i.e., co-ordinating services among providers through formal or informal means. Supporters of integration say that, properly managed, it can yield a healthier population and save money. It can also help minimise hospitalisations, reduce the need for costly rehospitalisations and prevent service duplication.

An impressive 95% of respondents to a global survey conducted by the Economist Intelligence Unit in May 2010 support greater integration within the healthcare delivery system in the next five years. Despite this near-unanimity among respondents, progress towards healthcare integration is patchy.

Successful integration will depend on various elements: the nature and structure of existing healthcare systems; jurisdictions’ perceptions of the urgency of cost and quality issues; and resources allocated to implement it.

The survey, sponsored by KPMG, investigates how government officials in health-related agencies—often the initiators of the process—and hospital administrators expect integration to evolve in their home countries in the next five years. Doctors, insurance providers and life sciences companies were not surveyed, although they also play important roles in integration.

The research examines the barriers to integration and the changes necessary to overcome them. It then explores the role of government, the models that are likely to emerge and the potential impact of integration on healthcare providers. 

Integration efforts in healthcare are at an early stage. Yet some pilot projects have used it successfully to reduce costs and improve quality. Proponents of integration recognise that governments worldwide already play an important role in their country’s overall healthcare system. They argue that governments should take the lead in expanding these pilot projects to implement integration more broadly.

This is already happening in several countries. Although survey respondents are optimistic that change will occur quickly, the feasibility of a five-year timeframe for a deep worldwide shift is open to question. Still, entities such as Baptist Health Systems and Gesundes Kinzigtal GmbH can point to measurable results in a short time period.

Some measures that would promote effective integration include:

• Incentives to encourage integration. Pursuing integration requires breaking down silos in healthcare delivery. Tools can include payment structures that make it advantageous for providers to co-operate to reduce costs, but should also include measures that value quality.
• Technology systems that support integration. Co-ordination among providers requires interoperable systems that enable sharing information securely. This is especially important where care occurs over a period of time. Interoperability standards for healthcare IT can help achieve effective integration.
• Training of providers responsible for care co-ordination. Primary care physicians or other providers responsible for centralising patient care should be trained in skills that are crucial to integration such as patient counselling and guidance. They should also be remunerated for the extra work required to co-ordinate care.
• Pilot projects to test models. Barriers to integration are often country-specific. Pilot projects enable care providers and governments, at relatively low cost, to experiment with models to identify those that are most appropriate for a country’s healthcare environment.
• Allocation of sufficient resources. Implementing integration will require up-front funding. The seriousness of the efforts may be measured by the resources allocated to them.