New care service landscape-challenging integrated care

Introduction: National health and care reforms during recent years have increased municipality’s responsibility for developing integrated health and care services in collaboration with hospitals as well as individual users.  Experiences from Norway are in line with international studies, showing that aging patients are discharged from the hospital “quicker and sicker”, leaving increased caring task on the municipality. These new tasks causes changes in the care service delivery. This paper examines changes in the Norwegian care service landscape.

Method/theory: Literature review using the “care stairs” as analytical framework.

Results: The Norwegian care service landscape is characterized by a high level of specialization. This results in a number of different levels of services, aimed at users with different care needs, reaching from health promotion to intensive medical treatment and follow-up. Also within the same level of care, services are specialized towards a diversity of user groups (eg. Dementia, palliative patients, neurological patients etc.).

Discussions: This increased specialization may lead to new interfaces between different care service levels, which challenges the request for integrated care. These challenges may stem from different rules, institutional logics, funding streams and institutional and professional cultures.

Conclusions: The reforms, which have transferred tasks and responsibilities from the specialist health services to the municipalities, in order to enhance integrated care, has led to increased specialization and fragmentation in the municipal care services.

Suggestions for future research: Coordination of care between different service levels within municipal care are, so far, sparsely described or explained in the research literature.  We need more knowledge on how using various instruments such as procedures, documentation systems and the use of coordinators can facilitate integrated care. We are now in the initial phase of a project, looking at these questions.