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From coordinated care trials to medicare locals: What difference does changing the policy driver from efficiency to quality make for coordinating care?

Gardner, Karen; Yen, Laurann; Banfield, Michelle; Gillespie, James; McRae, Ian; Wells, Robert

Description

The terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural...[Show more]

dc.contributor.authorGardner, Karen
dc.contributor.authorYen, Laurann
dc.contributor.authorBanfield, Michelle
dc.contributor.authorGillespie, James
dc.contributor.authorMcRae, Ian
dc.contributor.authorWells, Robert
dc.date.accessioned2015-12-13T22:16:20Z
dc.identifier.issn1353-4505
dc.identifier.urihttp://hdl.handle.net/1885/70815
dc.description.abstractThe terms coordination and integration refer to a wide range of interventions, from strategies aimed at coordinating clinical care for individuals to organizational and system interventions such as managed care, which contract medical and support services. Ongoing debate about whether financial and organizational integration are needed to achieve clinical integration is evident in policy debates over several decades, from a focus through the 1990s on improving coordination through structural reform and the use of market mechanisms to achieve allocative efficiencies (better overall service mix) to more recent attention on system performance to improve coordination and quality. We examine this shift in Australia and ask how has changing the policy driver affected efforts to achieve coordination?Care planning, fund pooling and purchasing are still important planks in coordination. Evidence suggests that financial strategies can be used to drive improvements for particular patient groups, but these are unlikely to improve outcomes without being linked to clinical strategies that support coordination through multidisciplinary teamwork, IT, disease management guidelines and audit and feedback. Meso level organizational strategies might align the various elements to improve coordination.Changing the policy driver has refocused research and policy over the last two decades from a focus on achieving allocative efficiencies to achieving quality and value for money. Research is yet to develop theoretical approaches that can deal with the implications for assessing effectiveness. Efforts need to identify intervention mechanisms, plausible relationships between these and their measurable outcomes and the components of contexts that support the emergence of intervention attributes.
dc.publisherOxford University Press
dc.sourceInternational Journal for Quality in Health Care
dc.subjectKeywords: article; Australia; case management; centralization; clinical effectiveness; clinical trial (topic); cost control; government; health care cost; health care planning; health care policy; health care quality; health care utilization; integrated health care Health policy; Health system reform; Health-care system
dc.titleFrom coordinated care trials to medicare locals: What difference does changing the policy driver from efficiency to quality make for coordinating care?
dc.typeJournal article
local.description.notesImported from ARIES
local.identifier.citationvolume25
dc.date.issued2013
local.identifier.absfor111700 - PUBLIC HEALTH AND HEALTH SERVICES
local.identifier.ariespublicationf5625xPUB2427
local.type.statusPublished Version
local.contributor.affiliationGardner, Karen, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationYen, Laurann, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationBanfield, Michelle, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationGillespie, James, University of Sydney
local.contributor.affiliationMcRae, Ian, College of Medicine, Biology and Environment, ANU
local.contributor.affiliationWells, Robert, College of Medicine, Biology and Environment, ANU
local.description.embargo2037-12-31
local.bibliographicCitation.issue1
local.bibliographicCitation.startpage50
local.bibliographicCitation.lastpage57
local.identifier.doi10.1093/intqhc/mzs069
dc.date.updated2016-02-24T08:58:23Z
local.identifier.scopusID2-s2.0-84873453016
local.identifier.thomsonID000314707600007
CollectionsANU Research Publications

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