Integrated care is an international movement for change. With these words Dr Nick Goodwin, IFIC CEO, concluded WCIC3, the 3rd World Congress on Integrated Care which took place on 20 and 21 November in Mexico City. What can we learn from these worldwide developments as discussed at WCIC3?
Until around 1980, many Latin American countries, and other countries such as China, were dictatorships with an emphasis on medical specialist care inside and outside of hospitals. The arrival of some degree of democracy subsequently led to the introduction of market competition in the healthcare sector. This caused greater inequality in access to healthcare and the bankruptcy of state hospitals. In the nineties, health authorities in those countries, supported by WHO statistics, sounded the alarm. They pleaded for: 1) the introduction of a health insurance act and; 2) GPs who work in should also carry out preventive interventions such as vaccinations and screening. Mexico, Brazil and Colombia have been doing this for about twenty years now. According to a Chinese speaker at the congress, China is currently introducing GP care as it exists in the Netherlands and the UK.
After the introduction of integrated primary care, many countries shifted their attention to care for people with chronic conditions. This requires health education and cooperation between primary care and hospitals. Brazil, Colombia, Singapore and Western countries embarked on numerous healthcare programmes for people with diabetes, lung diseases and heart and vascular diseases. In the Netherlands and the United Kingdom this type of care has existed since the nineties.
The presentations at the world congress showed that this approach, aimed at a single specific chronic condition, does not work sufficiently. There are too many citizens with multiple chronic conditions that require more complex approaches to care. Secondly, there are many frail elderly with physical and mental impairments who are also dealing with social problems such as loneliness and neglect. Thirdly, there is a need for general health education and lifestyle advice independent of specific conditions. Many of the presentations in Mexico City mentioned obesity as a significant challenge to population health generally. The world congress showed that, internationally, the search is on for an integrated approach to both medical and social problems.
Countries such as Canada, Brazil, Scotland, Mexico and Catalonia have chosen to integrate legislation for healthcare and social services. This alignment occurs at a local or regional level, but also at the level of individual citizens. If they simultaneously suffer from both physical, mental and social problems, they will be assigned a case manager who has knowledge of both the medical and the social domain.
As of yet, there are very few countries that have integrated social services with primary care, mental health and medical specialists. If the necessity of this integration is also felt in Europe, it is to be expected that both will merge into one act focused on the alignment of health and welfare. I call this the Health and Welfare Act. Whether or not this will happen depends on the success of the aforementioned countries that precede us in this development and on the ambitions of individual countries.
There was a worldwide consensus in Mexico City that there should be more coherence between health and welfare policies. How this can be achieved forms the subject of discussion at the 4th World Congress on Integrated Care which will take place in Wellington, New Zealand 23-25 November 2016 and at the 16th International Conference on Integrated Care in Barcelona, 23-25 May 2016.
Prof Guus Schrijvers
Chairman and Founder
International Foundation of Integrated Care (IFIC)