Five Laws for Integrating Medical and Social Services: Lessons from the United States and the United Kingdom

Abstract

Because persons with disabilities (PWDs) use health and social services extensively, both the United States and the United Kingdom have begun to integrate care across systems. Initiatives in these two countries are examined within the context of the reality that personal needs and use of systems differ by age and by type and severity of disability. The lessons derived from this scrutiny are presented in the form of five "laws" of integration. These laws identify three levels of integration, point to alternative roles for physicians, outline resource requirements, highlight friction from differing medical and social paradigms, and urge policy makers and administrators to consider carefully who would be most appropriately selected to design, oversee, and administer integration initiatives. Both users and caregivers must be involved in planning to ensure that all three levels of integration are attended to and that the borders between medical and other systems are clarified.

Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes

“…Whether or not these improved health outcomes can be achieved within the existing cost structures available for the care of patients with chronic illness is yet to be definitively determined. 13 Whatever may be the outcome of our experiments with coordinated care and chronic disease self-management programs, the Australian health system appears to be no longer able to afford to deliver costly acute health services at the current rate of escalation. Strategies therefore need to be found to reduce demand for acute care services, especially when this demand can be moderated through early intervention programs.…”

Integration, Coordination and Multidisciplinary Care: What can These Approaches Offer to Australian Primary Health Care?

“…Integration was seen to be the development of more comprehensive approaches to care provision that depended on formal relationships or structural arrangements to organise and deliver that care. This working definition drew upon the key differences identified by Leutz (1999 …”

Health service integration: a case study in change management

“…The WHO 4 has argued that integrating health services can be adversely affected 9 in a national study of GP and hospital integration, found that stakeholder involvement, leadership and change agent characteristics, time and flexibility, resources and incentives and communication were critical integration success factors. Leutz 10 devised five "laws of integration" from his extensive experiences with integrated health services in the United Kingdom and United States: 1. Seek to assist the neediest clients without disadvantaging any other groups; 2.…”