Does a public single payer system deliver integrated care? A national survey study among professional stakeholders in Denmark

BACKGROUND: Integrated health care delivery is a goal of health care systems; to date there has been limited information on the integration of medical care in practice. PURPOSE: To examine and compare perceptions of clinical integration and to identify associated strategic, cultural, technical and structural factors. DESIGN AND SETTING: A national survey addressed to: all county administrative managers (n=15); all hospital managers (n=44); and randomized selected samples of hospital department physician managers (n=200) and general practitioners (n=700) in Denmark. RESULTS: Several initiatives have been implemented in Denmark to integrate care. Nevertheless, most physicians agree that only half of all patients experience well coordinated pathways. Clinical integration is a strategic priority at the managerial levels, but this is not visible at the functional levels. Financial incentives are not used to encourage coordination. The information communication technology to facilitate clinical integration is perceived to be inadequate. CONCLUSION: The scope for improvement is high due to the structural composition of the system. Increased managerial stewardship, alignment of the financial incentives, and expanded use of information communication technology to link sub-organisations will be a way to move the system forward to meet its explicit goal of providing an integrated delivery of services.