Coordination and governance mechanisms to enable the conditions for integrated care of chronic conditions

Organizational fragmentation across the care continuum is a major shortcoming in people-centred health services delivery of chronic conditions. In the context of politically motivated reform efforts, public stewards are called to deploy varied governance mechanisms in their efforts to enable the conditions for integrated care. Aim: To depict governance mechanisms used by public stewards in their efforts to enable settings conducive to integrated health services delivery of chronic conditions. Methods: Review of literature on integrated care with a focus on governance mechanisms. Interviews with key informants from selected European Union countries with experience in integrated care implementation efforts. Illustration of regional experiences. Results: Coordination and governance mechanisms for the varied types of integrated care can differ in their degree of formality (from ‘hard’ to ‘soft’). The mechanisms can be catalogued according to these characteristics by each type of integration in at least three dimensions (priority setting, organization and performance measurement). Conclusions: Faced with politically motivated reform efforts, varied coordination and governance mechanisms can be employed by public stewards to maneuver the health services delivery setting towards integrated care of chronic conditions.