Integration of Healthcare in Belgium: Insufficient, but There Is Hope Comment on "Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study"

Abstract

The maturity of integrated care in Belgium is rather low. The reasons are the country’s complex organization, a lack of leadership and finances, an abundance of pilot projects, very long implementation and change processes, a healthcare system driven by providers and different cultures of action. However, new projects and ongoing research can help overcome these barriers. The primary care zones in Flanders, the National Hospital Plan and the Federal Plan to support mental health in particular are luxating opportunities. Well planned research is urgently needed to confirm the hope these projects arouse.

The Tale of Nine Belgian Health Ministers and a Multi-level Fragmented Governance System: Six Guiding Principles to Improve Integrated Care, Responsiveness, Resilience and Equity; A Response to the Recent Commentaries

“…1 In five commentaries, academics, stakeholder representatives and frontline practitioners provided a kaleidoscopic view on the barriers hampering policy initiatives on IC. [2][3][4][5][6] We first comment on the commentaries before taking a step back from the subject of IC and proposing guiding principles towards defragmenting the Belgian health system.…”

“… 11 Values and principles, such as social accountability in which patients participate, responsiveness, equity, sustainability, equitable resilience and bottom up intersectoral action, indicate the need for more inclusive negotiated spaces than the current medico-legal concertation model provides. 4 In Belgium, the Primary Care Zone could be a gamechanger in that it provides room of maneuver for local actors to create and implement a common vision in a context-sensitive way.…”

“…Pro-actively manage power dynamics at the local level. In a predominant medico-centred culture, 4 the composition and capabilities of the overarching Care Council ( ZorgRaad ) of the Primary Care Zone is crucial. Adequate funding should enable a well-resourced team in terms of skill mix, information systems and management capacity so that the Care Councils not only play their coordination and support role, but also take up a local meta-governor role and initiate innovations.…”