Ten years of integrated care for the older in France

Abstract

BackgroundThis paper analyzes progress made toward the integration of the French health care system for the older and chronically ill population.PoliciesOver the last 10 years, the French health care system has been principally influenced by two competing linkage models that failed to integrate social and health care services: local information and coordination centers, governed by the social field, and the gerontological health networks governed by the health field. In response to this fragmentation, Homes for the Integration and Autonomy for Alzheimer patients (MAIAs) is currently being implemented at experimental sites in the French national Alzheimer plan, using an evidence-based model of integrated care. In addition, the state’s reforms recently created regional health agencies (ARSs) by merging seven strategic institutions to manage the overall delivery of care.ConclusionThe French health care system is moving from a linkage-based model to a more integrated care system. We draw some early lessons from these changes, including the importance of national leadership and governance and a change management strategy that uses both top-down and bottom-up approaches to implement these reforms.

Hospitalisation à domicile et malades âgés

“…Le développement des établissements d'HAD qui doit accompagner la transition épidémiologique sur le territoire français, nécessitent par ailleurs un changement dans les pratiques professionnelles avec une plus grande diffusion de la culture gériatrique et des interventions multidisciplinaires. Enfin, les établissements d'HAD doivent poursuivre le renforcement des partenariats sur leur territoire avec l'offre de services qui est souvent plé-thorique afin de réduire les fragmentations nombreuses de notre système de santé [8,9] et d'améliorer la qualité des interventions auprès de cette population âgée malade à domicile.…”

Successfully integrating aged care services: A review of the evidence and tools emerging from a long-term care program

“…Four of the articles related to adaptation and implementation in France [15, 16, 28, 29], and one study [30] reported on evidence from both France and Quebec. The 45 articles accessed for this review can be broadly assigned to four categories (Table 1).…”

The French Society of Geriatrics and Gerontology position paper on the concept of integration

“…In France, since the 1960s, numerous public policies have been based on the idea of coordination [6, 7]. Basically, these systems were not intended to transform the missions of existing organisations, but rather their interconnectivity.…”