Abstract
The issue of integrated care and inter-sectoral collaboration is on the health policy agenda in many countries. Yet, there is limited knowledge about the effects of the different policy instruments used to achieve this. This paper studies co-location as a driver for cross-sectoral collaboration with general practitioners (GPs) acting as coordinators in a municipal health centre. The purpose of the health centre, which is staffed by health professionals from municipal, regional and private sectors, is to provide primary health services to the citizens of the municipality. Co-locating these professionals is supposed to benefit e.g., elder citizens and patients with chronic diseases who frequently require services from health professionals across administrative sectors.Methodologically, the analysis is based on qualitative data in the form of semi-structured interviews with the health professionals employed at the health centre and with administrative managers from municipal and regional government levels.The study finds that co-location does not function as a driver for cross-sectoral collaboration in a health centre when GPs act as coordinators. Cross-sectoral collaboration is hampered by the general practitioners’ work routines and professional identity, by organisational factors and by a lack of clarity concerning the content of collaboration with regard to economic and professional incentives.
Highlights
The municipal level of government in Denmark is responsible for health services in the primary care sector such as nursing homes, home care and home nursing, while the responsibility for rehabilitation services is shared between the regional and municipal levels
Personal relations, trust and communication as drivers for cross-sectoral collaboration The only example of cross-sectoral collaboration that did not exist before the creation of the health centre occurs in the intersection of the general practitioners (GPs) and the municipal home nursing and rehabilitation units
One GP [GP1] said: ‘...it is really nice that I have gotten to know “Bridget” [municipal health professional] that I call on the phone
Summary
The municipal level of government in Denmark is responsible for health services in the primary care sector such as nursing homes, home care and home nursing, while the responsibility for rehabilitation services is shared between the regional and municipal levels. Primary sector health services paid for by the regional government level include, inter alia, self-employed GPs, chiropractors, chiropodists, otolaryngologist and rheumatologists, who are remunerated according to a fee-for-service scheme [1]. This shared responsibility between local and regional government causes coordination challenges [2]. On-going reforms in the hospital sector have been and continue to drive the movement towards fewer, larger
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