Are joint health plans effective for coordination of health services? An analysis based on theory and Danish pre-reform results

Martin Strandberg-Larsen,Allan Krasnik,Mikkel Bernt Nielsen

doi:10.5334/ijic.220

Martin Strandberg-Larsen, Allan Krasnik + Show 1 more

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https://doi.org/10.5334/ijic.220

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Abstract

Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. From 2007 a substantial reform has changed the administrative boundaries of the system and a new tool for coordination has been introduced. To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. A SURVEY ADDRESSED TO: all counties (n=15), all municipalities (n=271) and a randomised selected sample of general practitioners (n=700). The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. The development of health plans are dominated by the regional level. At the functional level 27 percent of the general practitioners are not familiar with health plans. Among those familiar with health plans 61 percent report that health plans influence their work to only a lesser degree or not at all. Joint health planning is needed to achieve coordination of care. Efforts must be made to overcome barriers hampering efficient whole system planning. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population.

Highlights

Many health care providers believe that integrated health care services will lead to higher quality care at a lower cost while maintaining or improving the recipients’ health and satisfaction
Even though there is an overall agreement a slightly higher proportion of administrative managers in the counties states that the municipalities have a high or some influence on the development of the health plans than do the municipalities represented by the directors of social and health affairs
It is interesting that the assessment of the relative strengths depend on whether the respondent holds a position in a county or in a municipality, since a higher proportion of the directors of social and health affairs compared to the administrative managers finds that health plans are predominantly decided by the county (87 percent vs. 64 percent, see Table 2)

Summary

Introduction

Many health care providers believe that integrated health care services will lead to higher quality care at a lower cost while maintaining or improving the recipients’ health and satisfaction. In the search for effective strategies for systemic optimisation towards delivery of more coordinated care services, much can be learnt from. Since 1994 formal health plans have been used for coordination of health care services between the regional and local level in Denmark. Purpose: To assess the use of the pre-reform health plans as a tool for strengthening coordination, quality and preventive efforts between the regional and local level of health care. Results: The stakeholders at the administrative level agree that health plans have not been effective as a tool for coordination. At the functional level 27 percent of the general practitioners are not familiar with health plans. Active policies emphasising the necessity of health planning, despite involved cost, are warranted to insure delivery of care that benefits the health of the population

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