PubMed · 10164944
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R Shinkman. 1997-02-24. Optimizing integrated systems governance.. https://pubmed.ncbi.nlm.nih.gov/10164944/
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BACKGROUND: integration of primary and hospital services has been the subject of health policy in The Netherlands in the 1990s. A bottom-up facilitating approach was chosen to stimulate development of 'transmural care' between traditionally separate sectors. Transmural care has been defined as, care, attuned to the needs of the patient, provided on the basis of co-operation and co-ordination between general and specialised caregivers with shared overall responsibility and the specification of delegated responsibilities'. We conducted a national survey to determine the success of the bottom-up policy and the extent of the development of transmural care. METHODS: a written questionnaire was distributed among members of two national networks of transmural care executives and project coordinators, which are representative for hospitals and home care organisations in The Netherlands. A total of 271 facilities were included in the study representing 71% of hospitals and 63% of the home care organisations in The Netherlands. The questionnaire covered topics as; type of care provided, participants, population, goals and type of evaluation. RESULTS: all hospitals in The Netherlands provide one or more of the seven types of transmural care, however, there is a great variation in the number of facilities per organisation. Most facilities cater to one or more groups of chronically ill patients. Project coordinators experience difficulties finding adequate financing options for the facilities. Evidence on the effects of transmural care on quality and efficiency is lacking. CONCLUSION: the bottom-up approach towards the development of transmural care has been successful but needs to be followed by top-down measures to insure adequate evaluation and encourage wide-spread implementation.
The people of Malaysia generally enjoy a high standard of health. This is largely attributed to the comprehensive range of health services provided by the Government and the private sector at affordable costs. However, there are changing trends that now seriously challenge this status quo. The changing population structure, lifestyle, disease patterns and globalization are causing healthcare costs to rise. New and innovative ways will have to be devised to further improve the health status and at the same time contain costs. Information and Communication Technology (ICT) presents unprecedented opportunities to help the health sector in Malaysia reinvent itself and transform the way health and healthcare is managed and delivered in the future. Malaysia's Telehealth initiative under the Multimedia Super Corridor (MSC) project is designed to realize Malaysia's health vision and goals and meet future health challenges. Multimedia and Internet technology will be fully harnessed to deploy services that will shift the emphasis from episodic management of illness to proactive promotion of lifelong wellness and disease prevention. Health information content and interactive applications will engage the people to work as partners of health with healthcare professionals in maintaining their own health or managing their illnesses.
This paper explores an approach to the implementation and evaluation of integrated health service delivery. It identifies the key issues involved in integration evaluation, provides a framework for assessment and identifies areas for the development of new tools and measures. A proactive role for evaluators in responding to health service reform is advocated.