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Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec

INTRODUCTION: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines...

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Autores principales: Couturier, Yves, Wankah, Paul, Guillette, Maxime, Belzile, Louise
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Ubiquity Press 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588895/
https://www.ncbi.nlm.nih.gov/pubmed/34824562
http://dx.doi.org/10.5334/ijic.5658
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author Couturier, Yves
Wankah, Paul
Guillette, Maxime
Belzile, Louise
author_facet Couturier, Yves
Wankah, Paul
Guillette, Maxime
Belzile, Louise
author_sort Couturier, Yves
collection PubMed
description INTRODUCTION: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? DESCRIPTION: Since the 1960s, the health system of Québec has undergone four major structural and progressively integrative transformations, characterized as – modernization, shock of reality, explicit integration, and centralization phases. DISCUSSION: Although integration efforts progressively transformed Québec’s health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. CONCLUSION: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context.
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spelling pubmed-85888952021-11-24 Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec Couturier, Yves Wankah, Paul Guillette, Maxime Belzile, Louise Int J Integr Care Policy Paper INTRODUCTION: Demographic and epidemiological transitions of industralized countries mean health systems have to integrate health and social services to respond to the changing needs of their populations. Efforts to integrate care involve important policy and structural changes. This paper examines whether integration efforts are lost in translation during the bureaucratic appropriation of models, or, in an allegorical way, do they reveal genes of bureaucracy? DESCRIPTION: Since the 1960s, the health system of Québec has undergone four major structural and progressively integrative transformations, characterized as – modernization, shock of reality, explicit integration, and centralization phases. DISCUSSION: Although integration efforts progressively transformed Québec’s health and social services system, embedded bureaucracies impeded the realisation of these projects. Notably, inadequate change management strategies and lack of integrated funding models hindered integration efforts. Furthermore, there was variability in government prioritisation and support of different aspects of the model by making some components happen, helping others happen and letting others happen. CONCLUSION: Drawing insights from bureaucratic obstacles to integration efforts may improve implementation strategies. This paper highlights important policy and administrative challenges that have to be taken into consideration in improving the implementation of integrated care initiatives in a real-life context. Ubiquity Press 2021-11-08 /pmc/articles/PMC8588895/ /pubmed/34824562 http://dx.doi.org/10.5334/ijic.5658 Text en Copyright: © 2021 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
spellingShingle Policy Paper
Couturier, Yves
Wankah, Paul
Guillette, Maxime
Belzile, Louise
Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title_full Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title_fullStr Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title_full_unstemmed Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title_short Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec
title_sort does integrated care carry the gene of bureaucracy? lessons from the case of québec
topic Policy Paper
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8588895/
https://www.ncbi.nlm.nih.gov/pubmed/34824562
http://dx.doi.org/10.5334/ijic.5658
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