Competing policies? Experiences from the implementation of an integrated health and social care organization for older people in Sweden
Par Schon | Stockholm Gerontology Research Centre and Aging Research Centre
Background and objective: Coordination problems are common between authorities and providers of health and social care services for older people. The problems reflects a lack of coordinated care planning and communication between care providers. There are also boundary disputes between the service providers regarding care provision and funding responsibilities. The aim of this study is to describe an integrated health and social care organization for older people in Sweden and how it was implemented and the development and experiences up to date.
Data and methods: Both quantitative and qualitative data were collected between 2011 and 2015 in Norrtälje municipality, Sweden. The results are analysed using a theoretical framework based on the concepts of institutional logics and logic multiplicity.
Results: The Norrtälje project started in 2006. In 2010 a customer choice system was introduced, which complicated the integration process. Multiple service providers led to an increase in communication problems. Norrtälje took the opportunity to develop their customer choice model in a way that improved cooperation and integrated care services. The results also showed that both the logics of integrated care and customer-choice are manifested in the organisation and provision of home-based care through different goals, principles and practices. The organisation incorporates different components of the logics which ultimately brings possibilities for both compatibility and contradiction. The coexistence of integrated care and customer-choice has resulted in challenges related to user-responsiveness and fragmentation in care provision resulting in lack of continuity and deficiencies in communication.
Policy implications: An advantage for the service providers was that they were financed by a joint organization with the municipality being able to coordinate care services without complicated financial negotiations with the county council. We can also conclude that integrated care is the dominant logic, albeit with some tensions, which is evident in the organisational foundation of the home-based care. However, the use of customer-choice has complicated the process of integrated care by advocating provider diversity and the notion of older people as consumers.