Further Studies of Integrated Care Are Desirable
The INTEGRAL Study (1) investigated comprehensively—on the basis of more than 100 indicators—over 10 years the provision of healthcare in the region “Gesundes Kinzigtal,” a nationally and internally recognized project (2), compared with 13 control regions. The authors concluded that overall it was not possible to confirm any improvement in the quality of care, but under the conditions of a shared savings contract, no detrimental developments in the quality of care were observed either (3).
A positive aspect of the study is the long-term observation of the effects over 10 years. The analyzed data, however, date back to only 2015, the relevance of the results is therefore at best of limited value for the current political discussion on healthcare. Healthcare provision in the Kinzigtal from the very beginning placed a strong focus on empowering and involving patients and citizens (3), but this was not part of the evaluation. The selection of indicators focused strongly on process-related outcomes, often also on pharmacotherapeutic outcomes, in the assumption that these can be managed easily in the setting of integrated care. The overlap of this model of care with the existing specific contract for general practitioners in Baden-Württemberg can, however, potentially have disruptive effects. The targeted patient population consists of all members from the participating statutory health insurance providers, independently of their participation in specific care provision programs. For this reason, any expectations of the achievable effects need to be adjusted.
In evaluating this care model, however, one thing needs to be borne in mind: healthcare provision in “Gesundes Kinzigtal” can obviously be delivered to the same quality standard, while under the conditions of the shared savings contract 5–7% of annual healthcare costs can be saved.
For the future development of integrated care models, further studies from a health services research perspective are crucial.
Prof. Dr. med. Dr. phil. Martin Härter
Institut und Poliklinik für Medizinische Psychologie
Conflict of interest statement
The author declares that no conflict of interest exists.
|1.||McClellan M (ed). Case Study: Gesundes Kinzigtal, Germany. Duke Margolis Center for Health Policy, 2016, www.healthpolicy.duke.edu/sites/default/files/2020-08/Case%20Study_Gesundes%20Kinzigtal_2016.pdf (last accessed on 3 December 2021).|
|2.||Hölzel LP, Vollmer M, Kriston L, Siegel A, Härter M: Patientenbeteiligung bei medizinischen Entscheidungen in der Integrierten Versorgung Gesundes Kinzigtal: Ergebnisse einer kontrollierten Kohortenstudie. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 1524–33 CrossRef MEDLINE|
|3.||Schubert I, Stelzer D, Siegel A, et al.: Ten-year evaluation of the population-based integrated health care system „Gesundes Kinzigtal“. Dtsch Arztebl Int 2021; 118: 465–72 VOLLTEXT|