What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Katrien Danhieux; Monika Martens; Elien Colman; Edwin Wouters; Roy Remmen; Josefien van Olmen; Sibyl Anthierens

doi:10.5334/ijic.5671

What Makes Integration of Chronic Care so Difficult? A Macro-Level Analysis of Barriers and Facilitators in Belgium

Int J Integr Care. 2021 Oct 29;21(4):8. doi: 10.5334/ijic.5671. eCollection 2021 Oct-Dec.

Authors

Katrien Danhieux^{1

2}, Monika Martens^{1

2}, Elien Colman¹, Edwin Wouters³, Roy Remmen¹, Josefien van Olmen^{1

2}, Sibyl Anthierens¹

Affiliations

¹ University of Antwerp, Family medicine and Population Health, Doornstraat 331, 2610 Wilrijk, BE.
² Institute of Tropical Medicine, Department of Public Health, Kronenburgstraat 43, 2000 Antwerpen, BE.
³ University of Antwerp, Centre for Population, Family & Health, Prinsstraat 13, 2000 Antwerpen, BE.

Abstract

Introduction: Although many countries have been implementing integrated care, the scale-up remains difficult. Macro-level system barriers play an important role. By selecting three key policies, which have implemented integrated care in Belgium over the last 10 years, we aim to go beyond the identification of their specific barriers and facilitators to obtain an overarching generic view.

Methods: 27 participants were purposefully selected, to include all important stakeholders involved on the macro-level in chronic care in Belgium. Semi-structured interviews were guided by a timeline of policies and an inductive thematic analysis was performed.

Results: Barriers and facilitators were identified on both health care and policy level. The major factors restraining the scale-up of integrated care are the fee-for-service reimbursement system, limited data sharing and the fragmentation of responsibilities between different levels of government. Remarkably, these factors strongly interact.

Discussion: This paper highlights the importance of homogenization of responsibilities of governments regarding integrated care and the interdependency of policy and health care system factors. A whole system change is needed instead of the current Belgian model of prolonged search for common ground between conflicting opinions. Political commitment and citizen participation will be crucial.

Keywords: chronic care; governance; health care policy; health care systems; integrated care; stakeholder interviews.

Grants and funding

Elien Colman, Roy Remmen and Sibyl Anthierens coordinated an evaluation project for integrated chronic care projects that was ordered by the Federal Government of Belgium and funded by the NIHDI (https://www.integreo.be/nl/pilootprojecten/evaluatie). As such, these three authors were part of FAITH, which stands for ‘Federated consortium for Appraisal of Integrated care Teams in Health.’ The NIHDI and the Federal Government of Belgium were not involved in the study design or analysis.