Mieke Rijken
Publicatie
Datum
29-11-2025
How to scale up and implement integrated care?
Ginneken, E. van, Struckmann, V., Rijken, M., Bal, R., Rutten-van Molken, M. How to scale up and implement integrated care? Health Policy: 2025, 160, art.nr. 105514.
Lees online
Across health systems, the rise in chronic conditions and multimorbidity has made the limits of our fragmented care systems increasingly visible. Growing numbers of people living with (multiple) chronic conditions have to move between providers, sectors, and administrative systems that are poorly equipped to deliver multidisciplinary, well-coordinated care. Chronic conditions substantially affect individuals’ and families’ quality of life and participation in society. In addition, they challenge the social and financial sustainability of health systems and societies, through high healthcare utilization and cost, increasing health inequalities, and early exit from the workforce. Integrated care is considered an effective approach to improve the quality and efficiency of chronic care and has therefore become a central policy aim in many countries. Yet while the need for integrated care is widely acknowledged, its implementation and scale-up remains uneven. Many promising initiatives remain confined to pilot sites and rely on exceptional leaders, dedicated care professionals, and temporary funding. They are therefore highly vulnerable to changes in policy priorities, administration, and organisational structures. The challenge is not the lack of conceptual frameworks or promising care models. The challenge lies in the work required to build and sustain integration.
This special issue brings together evidence on the processes, negotiations, and structures that support the implementation of integrated care at different levels of the health system. Taken together, the contributions demonstrate that integrated care is not enacted by design alone. It is built through relationships, governance arrangements, organisational cooperation, professional roles and identities, information infrastructures, stable funding, and everyday care practices. Implementing integrated care means creating and maintaining the conditions that allow people and organisations to collaborate over time.
We have structured the papers across three analytical levels—macro, meso, and micro—to illuminate the implementation challenges and the work required to scale integrated care within health systems. At the macro level, the papers emphasise the need for coherent system-wide governance, aligned regulatory and financing frameworks, and sustained policy commitment to create the conditions in which integrated care can be implemented at scale. At the meso level, they highlight the intra- and inter-organisational work involved in redesigning service models, building cross-sector partnerships, developing new workforce arrangements, and establishing the infrastructure needed to support integrated pathways. At the micro level, the papers focus on the practical, relational, and often invisible work undertaken by professionals and service users at the point of care—work that is critical to realising person-centred practice but is frequently under-recognised. Together, these levels illustrate that scaling integrated care is not simply a matter of policy design, but a complex, multi-layered process that requires coordinated effort across the system.
This special issue brings together evidence on the processes, negotiations, and structures that support the implementation of integrated care at different levels of the health system. Taken together, the contributions demonstrate that integrated care is not enacted by design alone. It is built through relationships, governance arrangements, organisational cooperation, professional roles and identities, information infrastructures, stable funding, and everyday care practices. Implementing integrated care means creating and maintaining the conditions that allow people and organisations to collaborate over time.
We have structured the papers across three analytical levels—macro, meso, and micro—to illuminate the implementation challenges and the work required to scale integrated care within health systems. At the macro level, the papers emphasise the need for coherent system-wide governance, aligned regulatory and financing frameworks, and sustained policy commitment to create the conditions in which integrated care can be implemented at scale. At the meso level, they highlight the intra- and inter-organisational work involved in redesigning service models, building cross-sector partnerships, developing new workforce arrangements, and establishing the infrastructure needed to support integrated pathways. At the micro level, the papers focus on the practical, relational, and often invisible work undertaken by professionals and service users at the point of care—work that is critical to realising person-centred practice but is frequently under-recognised. Together, these levels illustrate that scaling integrated care is not simply a matter of policy design, but a complex, multi-layered process that requires coordinated effort across the system.
Across health systems, the rise in chronic conditions and multimorbidity has made the limits of our fragmented care systems increasingly visible. Growing numbers of people living with (multiple) chronic conditions have to move between providers, sectors, and administrative systems that are poorly equipped to deliver multidisciplinary, well-coordinated care. Chronic conditions substantially affect individuals’ and families’ quality of life and participation in society. In addition, they challenge the social and financial sustainability of health systems and societies, through high healthcare utilization and cost, increasing health inequalities, and early exit from the workforce. Integrated care is considered an effective approach to improve the quality and efficiency of chronic care and has therefore become a central policy aim in many countries. Yet while the need for integrated care is widely acknowledged, its implementation and scale-up remains uneven. Many promising initiatives remain confined to pilot sites and rely on exceptional leaders, dedicated care professionals, and temporary funding. They are therefore highly vulnerable to changes in policy priorities, administration, and organisational structures. The challenge is not the lack of conceptual frameworks or promising care models. The challenge lies in the work required to build and sustain integration.
This special issue brings together evidence on the processes, negotiations, and structures that support the implementation of integrated care at different levels of the health system. Taken together, the contributions demonstrate that integrated care is not enacted by design alone. It is built through relationships, governance arrangements, organisational cooperation, professional roles and identities, information infrastructures, stable funding, and everyday care practices. Implementing integrated care means creating and maintaining the conditions that allow people and organisations to collaborate over time.
We have structured the papers across three analytical levels—macro, meso, and micro—to illuminate the implementation challenges and the work required to scale integrated care within health systems. At the macro level, the papers emphasise the need for coherent system-wide governance, aligned regulatory and financing frameworks, and sustained policy commitment to create the conditions in which integrated care can be implemented at scale. At the meso level, they highlight the intra- and inter-organisational work involved in redesigning service models, building cross-sector partnerships, developing new workforce arrangements, and establishing the infrastructure needed to support integrated pathways. At the micro level, the papers focus on the practical, relational, and often invisible work undertaken by professionals and service users at the point of care—work that is critical to realising person-centred practice but is frequently under-recognised. Together, these levels illustrate that scaling integrated care is not simply a matter of policy design, but a complex, multi-layered process that requires coordinated effort across the system.
This special issue brings together evidence on the processes, negotiations, and structures that support the implementation of integrated care at different levels of the health system. Taken together, the contributions demonstrate that integrated care is not enacted by design alone. It is built through relationships, governance arrangements, organisational cooperation, professional roles and identities, information infrastructures, stable funding, and everyday care practices. Implementing integrated care means creating and maintaining the conditions that allow people and organisations to collaborate over time.
We have structured the papers across three analytical levels—macro, meso, and micro—to illuminate the implementation challenges and the work required to scale integrated care within health systems. At the macro level, the papers emphasise the need for coherent system-wide governance, aligned regulatory and financing frameworks, and sustained policy commitment to create the conditions in which integrated care can be implemented at scale. At the meso level, they highlight the intra- and inter-organisational work involved in redesigning service models, building cross-sector partnerships, developing new workforce arrangements, and establishing the infrastructure needed to support integrated pathways. At the micro level, the papers focus on the practical, relational, and often invisible work undertaken by professionals and service users at the point of care—work that is critical to realising person-centred practice but is frequently under-recognised. Together, these levels illustrate that scaling integrated care is not simply a matter of policy design, but a complex, multi-layered process that requires coordinated effort across the system.