1 Integrated Care for Older People: Management and Policy Issues Henk Nies, PhD NIZW, The...
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Transcript of 1 Integrated Care for Older People: Management and Policy Issues Henk Nies, PhD NIZW, The...
1
Integrated Care for Older People: Management and
Policy Issues
Henk Nies, PhD
NIZW, The Netherlandswww.carmen-network.org
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Presentation
The CARMEN network Case/vignette The concept of integrated care Who cares? Who pays? Who decides? Issues to be addressed
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CARMEN: the actors
Users Carers Primary care Acute hospitals Care homes
Social care Purchasers Researchers Consultants Other
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CARMEN: the countries
Belgium Finland Germany Greece Ireland
Italy The Netherlands Spain Sweden UK
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Mrs Costa
78 years widow dementia migrated cleaning women 3 children 1 child abroad
poor contacts minimum old age
pension discharge after mild
stroke difficulties in moving in
the house disagreement children
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Traditional (e.g. questionnaires, reviews)
Descriptive (e.g. structured analyses, cases)
Qualitative (e.g. vignettes)
Internal inputs (subgroups, plenary sessions)
External inputs (e.g. experts’ presentations
MethodsMethods
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‘‘AA well planned and well organised set well planned and well organised set of services and care processes, of services and care processes, targeted at the multiple needs/targeted at the multiple needs/ problems of an individual client, problems of an individual client, or a category of persons with similar or a category of persons with similar needs/problems’needs/problems’
Integrated care (Vaarama, 2001)
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Who cares?
Complicationsqualifications incomparable and
incompatiblewho cares in the homeland?immigrant and refugees as a resource
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Who cares?
Prospectsmore effective use of staffless duplicationflexible employmentjob enrichmentnew rolesless demand
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Who pays? Diversity in long term care:
servicesagencieslocal communityold people themselveslegislative frameworkspolicy levelsprofessional cultures
fragmentation
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Who pays?
Complicationsimbalances in the systemcoverageinter-dependency of health care and social
care, housing, transport etccash benefits: more providers‘buyers power’entitlement of citizens abroad
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Who pays?
Solutions?
debate on Services of General Interest strengthening the voice of older people
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Who decides?
Supply driven systems Final responsibility fragmented: good will Mergers: no choice, no competition,
better integration? Assumptions underlying benefits in cash,
underlying the market mechnisms Buyers power Older people themselves