Document Type : Original Article

Authors

1 PhD Candidate, Health Services Management, Department of Health Services Management, Sciences and Research Branch, Islamic Azad University, Tehran, Iran

2 Assistant Professor, Health Services Management, Department of Health Services Management, Sciences and Research Branch, Islamic Azad University, Tehran, Iran

3 Professor, Biostatistics, Department of Health Services Management, Sciences and Research Branch, Islamic Azad University, Tehran, Iran

4 Professor, Planning and Development in Higher Education, Department of Health Services Management, Sciences and Research Branch, Islamic Azad University, Tehran, Iran

5 Associate Professor, Health Services Management, Majlis Research Center, Tehran, Iran

Abstract

Introduction: Integration in the health system has many benefits for patients, providers, and the system itself. This research was conducted to determine the functional and informational variables affecting the integration of Iranian health system in period of years 2017-18.Methods: The present exploratory study was conducted in two phases. In the first phase, factors affecting health system integration were extracted from the literature as well as from interviews with experts in healthcare administration. In the second phase, data from the first phase were integrated, and a model of health system integration was designed resulting in a researcher-made questionnaire. The model was validated through qualitative (i.e., expert opinion), and quantitative (i.e., exploratory and confirmatory factor analysis) approaches. The data were collected from 506 specialists in hospitals in 5 provinces of Iran. Exploratory and confirmatory factor analysis was used to analyze the data.Results: According to the results of exploratory factor analysis in the functional-information dimension, "information management" was the most important item with 0.665 of factor load. Regarding the standard coefficient of confirmatory factor analysis, the effect of the functional-information factor on integration was 0.95. The existence of a referral system, the existence of a decision supporting system, and the management of financial resources, also had the greatest importance in the integration of the health system with 0.79 of factor load.Conclusion: The health system can provide the necessary support for health system integration through management of financial, human, and information resources, as well as the development of information systems and electronic health records, and performance monitoring. It can also integrate clinical, financial, and management information in order to improve the quality of care.

Keywords

  1. Antunes V, Moreira P. Approaches to developing integrated care in Europe: A systematic literature review. J Manag Marketing Healthc 2011; 4(2): 129-35.
  2. Enthoven AC. Integrated delivery systems: The cure for fragmentation. Am J Manag Care 2009; 15(10 Suppl): S284-S290.
  3. Moore KD, Coddington DC. Multiple paths to integrated health care. Healthc Financ Manage 2009; 63(12): 46-54.
  4. Armitage GD, Suter E, Oelke ND, Adair CE. Health systems integration: State of the evidence. Int J Integr Care 2009; 9: e82.
  5. van der Heiden AB. The advantages and disadvantages of insurer-provider integration: What are implications for Dutch health care policy? [MSc Thesis]. Rotterdam, Netherlands: Erasmus Universiteit Rotterdam; 2013.
  6. Gaynor M. Is vertical integration anticompetitive? Definitely maybe (but that's not final). J Health Econ 2006; 25(1): 175-80.
  7. Pike B, Mongan D. The integration of health and social care services [Online]. [cited 2014]; Available from: URL: www.hrb.ie/files/The_integration_of_health_and_social_care_services_2014.pdf
  8. Kodner DL. All together now: A conceptual exploration of integrated care. Healthc Q 2009; 13 Spec No: 6-15.
  9. Contandriopoulos AP. The integration of health care: Dimensions and implementation. Montreal, Canada: GRIS, University of Montreal; 2004.
  10. Lyngso AM, Godtfredsen NS, Frolich A. Interorganisational integration: Healthcare professionals' perspectives on barriers and facilitators within the Danish healthcare system. Int J Integr Care 2016; 16(1): 4.
  11. Veil A, Hebert R. Measuring the integration of services between stakeholders in the continuum of services for the elderly in three territories. In: Hebert R, Tourigny A, Raiche M, Editors. Integration of services for disabled people: Research leading to action; 2008.Edison, NJ: Quebec; 2008.
  12. Billings JR, Malin M. Definitions of integrated care from the stakeholder perspective. In: Billings J, Leichsenring K, Editors. Integrating health and social care services for older persons: evidence from nine European countries. Farnham, UK: Ashgate; 2005. p. 51-78.
  13. Davari M. The economic challenges of the Iranian health system. Health Inf Manage 2011; 8(7): 915-7. [In Persian].
  14. McCarthy D, Mueller K, Wrenn J. Geisinger health system: Achieving the potential of system integration through innovation, leadership, measurement, and incentives. New York, NY: The Commonwealth Fund; 2009.
  15. Curry N, Ham C. Clinical and service integration. The route to improved outcomes. Int J Integr Care 2012; 12: e199.
  16. McCarthy D, Mueller K. Kaiser permanente: Bridging the quality divide with integrated practice, group accountability, and health information technology. New York, NY: The Commonwealth Fund; 2009.
  17. Sibiya MV. A model for the integration of primary health care services in KwaZulu-Natal, South Africa [Online]. [cited 2009]; Available from: URL: https://openscholar.dut.ac.za/handle/10321/453
  18. Pillay Y, Leon N, Wilson T, Asia B, Barron P, Dudley L. Guidelines for functional integration: A key strategy towards the full implementation of the district health system. Pretoria, South Africa: South Africa Department of Health; 2002.
  19. Pillay Y. Guidelines on Functional Integration: What is it and how to Implement and Evaluate it. Pretoria, South Africa: South Africa Department of Health; 2002.
  20. Suter E1, Oelke ND, Adair CE, Armitage GD. Ten key principles for successful health systems integration. Healthc Q 2009; 13: 16-23.
  21. Rosen R, Mountford J, Lewis G, Lewis R, Shand J, Shaw S. Integration in action: Four international case studies: Delivering high-quality integrated care is challenging [Online]. [cited 2011]; Available from: URL: https://www.nuffieldtrust.org.uk/research/integration-in-action-four-international-case-studies
  22. McCarthy D, Mueller K, Wrenn J. Mayo clinic: Multidisciplinary teamwork, physician-led governance, and patient-centered culture drive world-class health care. New York, NY: The Commonwealth Fund; 2009.
  23. Lankhorst EK, Spreeuwenberg C. The Netherlands. In: Nolte E, Knai C, McKee M, Editors. Managing chronic conditions: Experience in eight countries. Geneva, Switzerland: WHO Regional Office Europe; 2008. p. 97.
  24. Ahgren B, Axelsson R. A decade of integration and collaboration: The development of integrated health care in Sweden 2000-2010. Int J Integr Care 2011; 11 Spec Ed: e007.
  25. Brandt S, Hartmann J, Hehner S. How to design a successful disease-management program: Five characteristics can help ensure that a disease-management program achieves its clinical and financial goals. New York, NY: McKinsey & Company; 2010.
  26. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: A comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care 2013; 13: e010.
  27. Thistlewaite P. Integrating Health and Social Care in Torbay: Improving Care for Mrs Smith. London, UK: The King's Fund; 2011.
  28. Ham C. Working Together for Health: Achievements and Challenges in the Kaiser NHS Beacon Sites Programme [Report]. Birmingham, UK: Birmingham City University; 2010.
  29. Ahgren B. Chain of care development in Sweden: Results of a national study. Int J Integr Care 2003; 3: e01.