Scholarly record
MAIN BARRIERS TO HEALTH AND SOCIAL CARE INTEGRATION IN THE CZECH REPUBLIC: A QUALITATIVE STUDY
Abstract
Background: Fragmentation of health and social care systems requires intense coordination among various stakeholders in order to provide continuity of care that reflects needs of patients, especially those with complex needs. Almost two decades of trials to approach problems of care fragmentation and poor outcomes for patients by policy makers and professionals in the Czech Republic have not lead to any substantial change in the way how care is provided. The objective of this study was to identify the main barriers to effective integration of health and social care in the Czech Republic. Methods: A qualitative study consists of thematic analysis of literature and policy documents relating to topics of care integration/coordination from 2000 to 2016. Further on we carried out 16 semi-structured interviews with key health and social care stakeholders (professionals, policy makers, experts) that have been involved in the policymaking processes or have executive functions within the healthcare sector. We used P. Valentijn at al. (2015) typology to assess their attitudes about 37 components of integrated care (IC) and their development in the Czech Republic. Results: Mind map depicting the major topics shared by the stakeholders such as financing (130), change (96) and willingness to change (65), communication and cooperation (85). The attributes of IC considered of utmost most importance and the most developed in the Czech Republic are: trust (9.2/4.9), assessment of complex needs (9.1/4.1), team cooperation within one provider (8.6/4.7). The least developed aspects of IC in the Czech Republic are considered: shared health and social care strategy and financing (1.8;1.6), financing for care coordination (2.0), support for new models of care, change management, visionary leadership, sharing of information and use of communication technologies (2.5 2.9). Conclusion: Separate systems of financing and legislation of healthcare and social care were considered to be the chief obstacle to effective health and social care integration. However, the main weakness of existing system was poor communication, cooperation and fear of change among healthcare (the ministry, health insurance companies) and social care stakeholders, silo-mindsets and particular interests that feed inability to reach a consensus on the macro level. However, positive experience (although limited) with care integration exists at the micro-meso level based on the proactive approach of local stakeholders.
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