Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study
Background Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi- stakeholder action and integrated po...
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| Format: | Article |
| Language: | English |
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Kerman University of Medical Sciences
2022-09-01
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| Series: | International Journal of Health Policy and Management |
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| Online Access: | https://www.ijhpm.com/article_4075_dd800fe0558bd8db36c28bcde1a9c209.pdf |
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| author | Monika Martens Katrien Danhieux Sara Van Belle Edwin Wouters Wim Van Damme Roy Remmen Sibyl Anthierens Josefien Van Olmen |
| author_facet | Monika Martens Katrien Danhieux Sara Van Belle Edwin Wouters Wim Van Damme Roy Remmen Sibyl Anthierens Josefien Van Olmen |
| author_sort | Monika Martens |
| collection | DOAJ |
| description | Background Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi- stakeholder action and integrated policies to address social, organisational, and financial barriers. Policy implementation for IC has been little studied, especially through a political lens. This paper examines how IC policies in Belgium were developed over the last decade and how stakeholders have played a role in these policies. Methods We used a case study design. After an exploratory document review, we selected three IC policies. We then interviewed 25 key stakeholders in the field of IC. The stakeholder analysis entailed a detailed mapping of the stakeholders’ power, position, and interest related to the three selected policies. Interview participants included policy-makers, civil servants (from ministry of health and health insurance), representatives of health professionals’ associations, academics, and patient organisations. Additionally, a processual analysis of IC policy processes (2007–2020) through literature review was used to frame the interviews by means of a chronic care policy timeline. Results In Belgium, a variety of policy initiatives have been developed in recent years both at central and decentralised levels. The power analysis and policy position maps exposed tensions between federal and federated governments in terms of overlapping competence, as well as the implications of the power shift from federal to federated levels as a consequence of the 2014 state reform. Conclusion The 2014 partial decentralisation of healthcare has created fragmentation of decisive power which undermines efforts towards IC. This political trend towards fragmentation is at odds with the need for IC. Further research is needed on how public health policy competences and reform durability of IC policies will evolve. |
| first_indexed | 2024-04-10T05:28:46Z |
| format | Article |
| id | doaj.art-23b7d224e2064e719c94ba6745389101 |
| institution | Directory Open Access Journal |
| issn | 2322-5939 |
| language | English |
| last_indexed | 2024-04-10T05:28:46Z |
| publishDate | 2022-09-01 |
| publisher | Kerman University of Medical Sciences |
| record_format | Article |
| series | International Journal of Health Policy and Management |
| spelling | doaj.art-23b7d224e2064e719c94ba67453891012023-03-07T09:11:35ZengKerman University of Medical SciencesInternational Journal of Health Policy and Management2322-59392022-09-011191668168110.34172/ijhpm.2021.584075Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case StudyMonika Martens0Katrien Danhieux1Sara Van Belle2Edwin Wouters3Wim Van Damme4Roy Remmen5Sibyl Anthierens6Josefien Van Olmen7Department of Public Health, Institute of Tropical Medicine, Antwerp, BelgiumDepartment of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumDepartment of Public Health, Institute of Tropical Medicine, Antwerp, BelgiumCentre for Population, Family & Health, Department of Social Sciences, University of Antwerp, Antwerp, BelgiumDepartment of Public Health, Institute of Tropical Medicine, Antwerp, BelgiumDepartment of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumDepartment of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumDepartment of Family Medicine and Population Health (FAMPOP), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, BelgiumBackground Globally, health systems have been struggling to cope with the increasing burden of chronic diseases and respond to associated patient needs. Integrated care (IC) for chronic diseases offers solutions, but implementing these new models requires multi- stakeholder action and integrated policies to address social, organisational, and financial barriers. Policy implementation for IC has been little studied, especially through a political lens. This paper examines how IC policies in Belgium were developed over the last decade and how stakeholders have played a role in these policies. Methods We used a case study design. After an exploratory document review, we selected three IC policies. We then interviewed 25 key stakeholders in the field of IC. The stakeholder analysis entailed a detailed mapping of the stakeholders’ power, position, and interest related to the three selected policies. Interview participants included policy-makers, civil servants (from ministry of health and health insurance), representatives of health professionals’ associations, academics, and patient organisations. Additionally, a processual analysis of IC policy processes (2007–2020) through literature review was used to frame the interviews by means of a chronic care policy timeline. Results In Belgium, a variety of policy initiatives have been developed in recent years both at central and decentralised levels. The power analysis and policy position maps exposed tensions between federal and federated governments in terms of overlapping competence, as well as the implications of the power shift from federal to federated levels as a consequence of the 2014 state reform. Conclusion The 2014 partial decentralisation of healthcare has created fragmentation of decisive power which undermines efforts towards IC. This political trend towards fragmentation is at odds with the need for IC. Further research is needed on how public health policy competences and reform durability of IC policies will evolve.https://www.ijhpm.com/article_4075_dd800fe0558bd8db36c28bcde1a9c209.pdfstakeholder analysisprocessual analysischronic careintegrated carepolicyqualitative research |
| spellingShingle | Monika Martens Katrien Danhieux Sara Van Belle Edwin Wouters Wim Van Damme Roy Remmen Sibyl Anthierens Josefien Van Olmen Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study International Journal of Health Policy and Management stakeholder analysis processual analysis chronic care integrated care policy qualitative research |
| title | Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study |
| title_full | Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study |
| title_fullStr | Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study |
| title_full_unstemmed | Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study |
| title_short | Integration or Fragmentation of Health Care? Examining Policies and Politics in a Belgian Case Study |
| title_sort | integration or fragmentation of health care examining policies and politics in a belgian case study |
| topic | stakeholder analysis processual analysis chronic care integrated care policy qualitative research |
| url | https://www.ijhpm.com/article_4075_dd800fe0558bd8db36c28bcde1a9c209.pdf |
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