Abstract
PurposeThe purpose is to analyse the relationship between democratic accountability and how sustainable governance is achieved by horizontally integrating care services for older people through collaboration in a coordination body of key leaders from across the health and social care system.Design/methodology/approachThe data and measures come from two surveys with coordination body members in Sweden (politicians, administrators, professionals) from a sample of 73 bodies in 2015 (n = 549) and the same/corresponding 59 bodies in 2019 (n = 389).FindingsThe governance of integrating care scale and the accountability scales repeatedly show consistency among individual members. Systematic progress is found among large coordination bodies: the greater the average perception of governance of horizontally integrating care in 2015, the greater it was in 2019 – and regardless of the period, the stronger the internal administrative or political monitoring and reviewing of the coordination body, the greater its governance (while the relationship to the external monitoring and reviewing is weak). However, the growing importance of external accountability is indirect, shown by stronger correlations between the internal political and external monitoring and reviewing, regardless of size.Research limitations/implicationsThe scales are based on self-reported perceptions that cannot be objectively verified, but they can be linked to changes in outcomes and user experiences in the later stages of the research.Originality/valueRepeatedly verified scales of internal and external accountability for analysing and evaluating governance of integrating care services horizontally, which is useful for improving strategic coordination of integrated care.
Highlights
Integrating care services from the political and strategic perspective of the policy-maker is defined as: “Initiatives seeking to improve outcomes for those with chronic health problems and needs by overcoming issues of fragmentation through linkage or coordination of services of different providers along the continuum of care.” (Nolte and Pitchforth, 2014, p. 6)
Model 1 shows that among the coordination body characteristics, only size significantly determines the level of achieving governance of integrating care services for older people according to the respondents
The analyses of this paper have demonstrated that such long-term success in achieving sustainable governance of integrated care for older people in Sweden is found among previously more successful, large coordination bodies, which are held to account to a higher degree by the collaborating members themselves through the internal check
Summary
Integrating care services from the political and strategic perspective of the policy-maker is defined as: “Initiatives seeking to improve outcomes for those with (complex) chronic health problems and needs by overcoming issues of fragmentation through linkage or coordination of services of different providers along the continuum of care.” (Nolte and Pitchforth, 2014, p. 6). Little is known about the long-term effects of internal and external democratic accountability – across several periods of vertical policy change – in achieving sustainable governance through horizontal integration of care services in strategic coordination bodies. Sweden is interesting from this perspective, with its decentralised system of integrating local social services (290 municipality councils) and regional health care (21 county councils) for older people, achieved through horizontal collaboration in strategic coordination bodies monitored and reviewed by internal checks but increasingly challenged by market, hierarchy and network coordination. Previous research has demonstrated that these coordination bodies contain politicians or administrators with or without health/social care professionals and pensioner organisation representatives, and achieve integrated care depending on their internal administrative or political monitoring and reviewing (Szu€cs, 2018a).
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