Implementing integrated diabetes systems in Europe

EFPIA commissioned a report to The Economist Intelligence to assess the level of integrated diabetes systems in 28 European countries.

The “integrated diabetes systems” concept and the missing piece of the puzzle: financial integration

What exactly is meant by “integration”? Services are usually described as being either horizontally or vertically integrated. Horizontal integration is when organisations offering similar services work alongside each other—for example diabetes specialists coordinating with eye specialists to ensure people with diabetes get regular eye check-ups. Vertical integration occurs when the different levels of health services coordinate—for example general practitioners and diabetes specialists.

We use the term “integrated diabetes systems” as a concept that brings together all aspects of diagnosis, treatment, care and health promotion. This is vertical and horizontal integration in action, with the aim of reducing health service fragmentation to ensure a better coordinated care pathway for people with diabetes. Integration of care has been widely implemented and discussed, focusing on barriers and enablers such as the human factors. The enablers of integrated systems—in particular integrated IT and finance systems— have been less well studied. Therefore this report focuses on IT and financial integration.

Our research reveals gaps in implementation and finance

Our policy scorecard assesses the level of integrated diabetes systems in 28 European countries, focusing on relatively understudied system enablers in integrated health IT systems and aligned finances. The scorecard identifies that while there is a good foundation of integrated diabetes systems policy, effective implementation of such policy is hampered by the lack of key enabling elements, such as integrated health IT systems and integrated finances. For integration to truly work there needs to be some element of budgetary integration, but less than half of the included countries had integrated diabetes funding in place and few had incentives in place for providers to encourage integration. This lack of financial integration is impeding the creation of effective integrated diabetes systems, and therefore hampering the promise of better outcomes and reduced costs.

The gaps in the enablers of the implementation of integrated diabetes systems identified in the scorecard and explored in this report have been translated into policy priorities.

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