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Communities as co-producers in integrated care

Communities as co-producers in integrated care Integrated care has become too much a professionals’ concept, in research and theory development, as well as in practice, especially in high-income countries. The current debate on integrated care is dominated by norms and values of professionals, while most of the care is provided by non-professionals. The paradigms of integrated care for people with complex needs need to be reconsidered. It is argued that non-professional care and care by local communities need to be incorporated as a resource and a co-producer of care. It seems fair to assume that the community as such can take a more prominent role in organising and delivering health and long-term care. This implies redefining professional and non-professional responsibilities and boundaries. The boundary between public and private space is losing its significance, as is the distinction between formal and non-formal care. It also requires renegotiating and transforming orga- nisational boundaries. This has consequences for legislation, funding and professional qualifications, as well as for management and governance. It challenges current professional identities as well as identities of service users, their informal carers and citizens. It may also require new types of funding, including non-monetary currencies, time-sharing and social impact bonds. The challenge is that big, that it needs to be addressed at its smallest scale: the citizen in his social network and local community, being co-producer of really integrated care. Keywords integrated care, community, co-producer, professional ‘service user’, ‘patient’ and ‘client’). These organisa- Introduction tional structures should consist of professional and non-professional people who provide care, treatment Being involved in integrated care at local, regional, and support. In fact, they very often do consist of profes- national and international levels for more than 20 years, sional and non-professional care providers, but usually I have come to the conclusion that this field has they do not function as well as integrated systems. become too much professionalised in high-income Western countries. Although it is a young branch of The issue is that the current debate on integrated care health services research, it mirrors itself too much to is a professional debate. It is very much dominated by established practices in ‘traditional’, non-integrated norms and values of professionals. It looks as if care health care. The basic paradigms of integrated care provision is only a responsibility of professionals, need to be reconsidered in order to make a significant whereas about 75–80% of all care is provided by infor- contribution to health and well-being of people with mal carers [1,2]. Informal care is an enormous source complex needs. Complex needs require answers that of care, especially in long-term care. are often provided by complex and fluid organisational structures, meeting the idiosyncrasy and dynamics of The current body of knowledge on integrated care pri- the person (by professionals often referred to as: marily focuses on professional service integration at This article is published in a peer reviewed section of the International Journal of Integrated Care 1 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ the clinical (or service), professional, organisational should therefore aim at a supportive environment. and system levels e.g. [3–7]. Integrated care is tradi- And when this equilibrium is achieved, they do not con- tionally conceived as a form of inter-professional and sider themselves as a ‘patient’, but as a ‘citizen’, mem- inter-organisational collaboration, where integration ber of a community, or as a person [13,14]. This community is not a passive condition, it often is an can be horizontal and vertical e.g. [8,9]. actor, that actively engages, or a resource for strength- But is this the full picture? In my view, we need to ening the individual’s equilibrium. include non-professional and community resources and structures as co-producers of health and social Ecological approaches care in order to achieve sustainable care. This implies that we need to reconceptualise integrated care to Second, it is quality of life that counts, rather than qual- include the community as a resource and a co-producer ity of care as such. This concept relates to indepen- of care. This holds in particular for people with long-term dence, autonomy, participation, personal fulfilment complex and multiple needs. In addition to this reality and dignity [15,16]. Schalock and Verdugo [17] argued of care provision, there are at least three other good that quality of life in people with mental retardation is reasons to justify this view. associated with emotional well-being, interpersonal relationships, material well-being, personal develop- Changing concept of health ment, physical well-being, self-determination, social inclusion and rights. It seems fair to assume that these First, the current concept of health as defined by the domains are also relevant to other categories of people WHO in 1948 appears to be outdated. As Huber et al. with long-standing, complex conditions, such as frail [10] argue, the conceptualisation of health as ‘a state older people [18]. In fact, these categories apply to all of complete physical, mental and social well-being people, irrespective disease or impairment. Quality of and not merely the absence of disease or infirmity’ in life, in its full range, implies a holistic approach [10]. fact declares the vast majority of our population as If this is the case, we need more ecological approaches. unhealthy, with over-medicalisation as the obvious Schalock and Verdugo [17] propose a distinction of risk. ‘It minimises the role of the human capacity to micro-, meso- and macro-systems. The first – the cope autonomously with life’s ever-changing physical, micro-system – is the immediate social setting, such as emotional and social challenges and to function with the family, peers and the work-setting, people who fulfilment and a feeling of well-being with a chronic dis- directly affect the person’s life. The second – the ease or disability’ [10], p. 236]. meso-system – refers to the neighbourhood, the com- Ageing with multiple chronic illnesses becomes the munity, service organisations and other agencies that norm for most people. As life expectancy is increasing directly affect the micro-system. The third – macro – sys- in most countries, life expectancy without illness is tem is the overall pattern of culture, socio-political decreasing [11,12]. According to the new definition, trends, the economic system and society-related factors ‘health’ should be conceived as the ‘ability to adapt that affect people’s lives. In other words, in order to be and self manage in the face of social, physical, and effective, health care professionals and organisations emotional challenges’ [10], p. 235. Our twenty-first cen- should operate in a person’s ecology in order to be rele- tury society with proper housing conditions, opportu- vant to quality of life. They are, in fact, part of this ecol- nities for good nutrition, healthy life styles, high levels ogy, not a separated entity. So engaging the community of education, social security and (assistive) technology in which people live is in fact working in and with peo- enables compensation mechanisms more than ever ple’s ecology to support or even strengthen their coping before. capabilities and resilience. Therefore, integrated care for people with complex needs should aim at strengthening coping capabilities, Populations taking the lead resilience and supportive conditions in the physical, mental and social domain to enable an (adapted) equi- Third, there is growing interest in population- and area- librium [10,13]. Therefore, the solution to health pro- oriented strategies. These usually imply developing blems and impairments often lies outside the realm of integrated service delivery for specific populations, but professional health care and in the community or in without taking these populations themselves as an society. In daily life, the community or society consists actor or co-producer of health and well-being. This of kin, neighbours, volunteers, other people in the interest goes hand-in-hand with discussions on allocat- neighbourhood, local associations, churches, firms, ing funding based on outcomes at population level etc. Integrated care to people with complex needs [6,19]. In fact, we see services and policy-makers trying This article is published in a peer reviewed section of the International Journal of Integrated Care 2 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ to manage populations or communities with a prefer- Conclusions ence to use terms as ‘population management’, with- out questioning themselves, how populations or In order to provide personalised care to people with communities can manage services and policy-makers. complex needs, professional care providers need to share responsibilities with service users, their informal In my own country, the Netherlands, we see a rapidly carers and local communities. The boundary between increasing interest in citizens’ initiatives, organising public and private space is losing its significance [23], and purchasing their own care and support. Local com- as is the distinction between formal and non-formal. It munities – or populations – take the lead and develop themselves according to cooperative principles. This requires renegotiating or – better – transforming organi- trend reflects the discontent with existing services, but sational boundaries and opening up these boundaries. also concerns for the quality of the local community It has consequences for legislation, funding and profes- and taking responsibility [e.g. [20]. And recently, where sional qualifications, as well as for management and care homes are being closed because of budget cuts governance. It also challenges current professional by central government, we see small communities tak- identities as well as identities of service users, their ing action and considering adopting some of these informal carers and citizens. homes. The seeming paradox is, that health care organisations and professionals can take a lead in these processes. Consequences for integrated care If they understand how sharing responsibilities works and how a concept such as ‘engaging the community’ In the conceptualisation of integrated care, we should works for people in the neighbourhood, we have a lot incorporate communities and their members as co- to win. It may also require new types of funding, including producers of health and well-being. In high-income non-monetary currencies, time-sharing and social impact countries, care for people with complex needs is often bonds. seen as a specialised professional and institutionalised (or highly standardised) domain. In terms of organisa- Hierarchical, rule-based ways of organising need to be tional responsibilities, it is strictly separated from the replaced by more fluid, network-like and consensus- informal domain and from the community. In fact, we based ways of working. It will often be associated with have organised professional care outside the commu- ‘messy’ issues that do not fit current organisational or nity. This segregation has led to alienation and disen- professional practices [24]. gagement of citizens from care. The challenge of care for people with complex needs is It seems fair to assume that the community as such that big, that we need to address it at its smallest scale: can take a more prominent role in organising and deli- the citizen in his social network and local community, vering health and long-term care. There are examples being co-producers of really integrated care. of community engagement from other countries such as Finland, Denmark and the UK. Follow-up of these examples in which communities are actually co- About the author producing, instead of being an object of an intervention are scarce [21,22]. Moreover, they are not incorporated Henk Nies, PhD, is member of the Executive Board in our theorising on integrated care. of Vilans, the Netherlands Centre of Expertise for Long-term Care. He is also professor of Organisation If we do so, we need to redefine professional and non- and Policy Development in Long-term Care at VU Uni- professional responsibilities and boundaries. Organisa- versity in Amsterdam. Throughout his career he has tional boundaries are moving, dependent of personal, worked between the boundaries of policy, practice social, organisational and local resources; the available and research. His primary field of interest is care for capabilities and conditions. Fluid organisational struc- older people, and in particular issues regarding inter- tures with blurring boundaries are emerging. They are organisational collaboration, quality management hard to align with traditional principles of governance and policy development. Henk Nies has worked in in health care with fixed boundaries. Existing agree- several international projects, amongst others as ments on professional responsibilities, standards, scientific director in CARMEN, a FP5 project of the guidelines, privacy regulations, payments, etc. need European Commission, and as a member of the to be renegotiated and new uncertainties of profes- Scientific Management Team of INTERLINKS, a FP7 sionals and non-formal actors need to be dealt with. Integration should be in fact conceived as redefining programme. Henk Nies has published several books boundaries, instead of ‘difference management’ as and many articles and blogs, in the Netherlands and Gobet and Emilsson [23] typify it. abroad. This article is published in a peer reviewed section of the International Journal of Integrated Care 3 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ References 1. Colombo F, Llena-Nozal A, Mercier J, Tjadens F. Help wanted? Providing and paying for long-term care. Paris: OECD Health Policy Studies; 2011. 2. Broese van Groenou MI. Informele zorg 3.0: schuivende panelen en een krakend fundament. [Informal care 3.0: moving panels and a cracking foundation]. Amsterdam: Vrije Universiteit; 2012. [inaugural lecture]. [in Dutch]. 3. Glasby J. Understanding health and social care. Bristol: Policy Press; 2003. 4. Vaarama M, Pieper R, editors. Managing integrated case for older persons. Helsinki/Dublin: Stakes/EHMA; 2005. 5. Nies H. Managing effective partnerships in older people’s services. Health and Social Care in the Community 2006;14(5): 391–9. 6. Valentijn P, Schepman S, Opheij W, Bruijneels M. Understanding integrated care: a comprehensive conceptual framework based on the integrative function of primary care. International Journal of Integrated Care 2013; Jan–Mar. Available from: URN:NBN:NL:UI:10-1-114415. 7. Goodwin N, Dixon A, Anderson G, Wodchis W. Providing integrated care for older people with complex needs. Lessons from seven international case studies. London: The King’s Fund; 2014. 8. Gröne O, Garcia-Barbero M. Integrated care. A WHO position paper of the WHO office for integrated health care services. International Journal of Integrated Care 2001 June 1; 1: ISSN 1568-4156. Available from: http://www.ijic.org. URN: NBN:NL:UI:10-1-100270. 9. Kodner D, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care 2002 Nov 14; 2: ISSN 1568-4156. Available from: http://www.ijic.org/. URN:NBN:NL:UI:10-1-100309. 10. Huber M, Knotnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011; 343(4163):235–7. 11. Jagger C, Matthews R, Matthews F. The burden of diseases on disability-free life expectancy in later life. Journal of Gerontology 2007;62A(4):408–14. 12. Mackenbach J. Ziekte in Nederland. Gezondheid tussen politiek en biologie. [Illness in the Netherlands. Health between pol- itics and biology]. Amsterdam: Elsevier/Mouria; 2010. [in Dutch]. 13. Plaats van der A. Geriatrie, een spel van evenwicht. [Geriatrics: a game of balance]. Nijmegen, PhD thesis; 1993. [in Dutch]. 14. De Maeseneer J, van Weel C, Daeren L, Leyns C, Decat P, Boeckxstaens P, et al. From “patient” to “person” to “people”: the need for integrated, people centered health care. The International Journal of Person Centered Medicine 2012;2(3):601–14. 15. Nies H, Leichsenring K, Mak S. The emerging identity of long-term care systems in Europe. In: Leichsenring K, Billings J, Nies H. editors. Long-term care in Europe. improving policy and practice. Basingstoke: Palgrave MacMillan; 2013. p. 19–41. 16. OECD/European Commission. A good life in old age? Monitoring and improving quality in long-term care. Paris: OECD Health Policy Studies, OECD Publishing; 2013. Available from: http://dx.doi.org/10.1787/9789264194564-en. 17. Schalock RL, Verdugo-Alonso ML. Handbook on quality of life for human services practitioners. Washington, DC: American Association for Mental Retardation; 2002. 18. Nies H. Key elements in effective partnership working. In Glasby J, Dickinson H. editors. International perspectives on health and social care: partnership working in action. Chichester: Wiley-Blackwell; 2009. p. 56–67. 19. Berenschot L, van der Geest L. Integrale zorg in de buurt. Meer gezondheidsresultaat per euro. [Integrated care in the neighbourhood. More health outocome per Euro]. Utrecht: Nyfer; 2012. [in Dutch]. 20. Baetens T. Ik is niks. Over vitale coalities rond wonen, zorg en leefbaarheid. [‘I’ is nothing. About vital coalitions around housing, care and liveability.] Den Haag: SEP; 2013. [in Dutch]. 21. Wagner L. Two decades of integrated health care in Denmark. Tidsskrift for Sygeplejeforskning 2006;2:13–20. 22. Blomfield M, Cayton H. Community engagement: a report for the Health Foundation. London: The Health Foundation; 2009. 23. Gobet P, Emilsson T. Integration as ‘Boundary Redefinition Process’. In Leichsenring K, Billings J, Nies H. editors. Long-term care in Europe. Improving policy and practice. Basingstoke: Palgrave MacMillan; 2013. p 118–39. 24. Williams P. The competent boundary spanner. Public Administration 2013;80(1):103–24. This article is published in a peer reviewed section of the International Journal of Integrated Care 4 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png International Journal of Integrated Care Unpaywall

Communities as co-producers in integrated care

Nies, Henk
International Journal of Integrated Care – Jun 30, 2014
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1568-4156
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10.5334/ijic.1589
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Abstract

Integrated care has become too much a professionals’ concept, in research and theory development, as well as in practice, especially in high-income countries. The current debate on integrated care is dominated by norms and values of professionals, while most of the care is provided by non-professionals. The paradigms of integrated care for people with complex needs need to be reconsidered. It is argued that non-professional care and care by local communities need to be incorporated as a resource and a co-producer of care. It seems fair to assume that the community as such can take a more prominent role in organising and delivering health and long-term care. This implies redefining professional and non-professional responsibilities and boundaries. The boundary between public and private space is losing its significance, as is the distinction between formal and non-formal care. It also requires renegotiating and transforming orga- nisational boundaries. This has consequences for legislation, funding and professional qualifications, as well as for management and governance. It challenges current professional identities as well as identities of service users, their informal carers and citizens. It may also require new types of funding, including non-monetary currencies, time-sharing and social impact bonds. The challenge is that big, that it needs to be addressed at its smallest scale: the citizen in his social network and local community, being co-producer of really integrated care. Keywords integrated care, community, co-producer, professional ‘service user’, ‘patient’ and ‘client’). These organisa- Introduction tional structures should consist of professional and non-professional people who provide care, treatment Being involved in integrated care at local, regional, and support. In fact, they very often do consist of profes- national and international levels for more than 20 years, sional and non-professional care providers, but usually I have come to the conclusion that this field has they do not function as well as integrated systems. become too much professionalised in high-income Western countries. Although it is a young branch of The issue is that the current debate on integrated care health services research, it mirrors itself too much to is a professional debate. It is very much dominated by established practices in ‘traditional’, non-integrated norms and values of professionals. It looks as if care health care. The basic paradigms of integrated care provision is only a responsibility of professionals, need to be reconsidered in order to make a significant whereas about 75–80% of all care is provided by infor- contribution to health and well-being of people with mal carers [1,2]. Informal care is an enormous source complex needs. Complex needs require answers that of care, especially in long-term care. are often provided by complex and fluid organisational structures, meeting the idiosyncrasy and dynamics of The current body of knowledge on integrated care pri- the person (by professionals often referred to as: marily focuses on professional service integration at This article is published in a peer reviewed section of the International Journal of Integrated Care 1 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ the clinical (or service), professional, organisational should therefore aim at a supportive environment. and system levels e.g. [3–7]. Integrated care is tradi- And when this equilibrium is achieved, they do not con- tionally conceived as a form of inter-professional and sider themselves as a ‘patient’, but as a ‘citizen’, mem- inter-organisational collaboration, where integration ber of a community, or as a person [13,14]. This community is not a passive condition, it often is an can be horizontal and vertical e.g. [8,9]. actor, that actively engages, or a resource for strength- But is this the full picture? In my view, we need to ening the individual’s equilibrium. include non-professional and community resources and structures as co-producers of health and social Ecological approaches care in order to achieve sustainable care. This implies that we need to reconceptualise integrated care to Second, it is quality of life that counts, rather than qual- include the community as a resource and a co-producer ity of care as such. This concept relates to indepen- of care. This holds in particular for people with long-term dence, autonomy, participation, personal fulfilment complex and multiple needs. In addition to this reality and dignity [15,16]. Schalock and Verdugo [17] argued of care provision, there are at least three other good that quality of life in people with mental retardation is reasons to justify this view. associated with emotional well-being, interpersonal relationships, material well-being, personal develop- Changing concept of health ment, physical well-being, self-determination, social inclusion and rights. It seems fair to assume that these First, the current concept of health as defined by the domains are also relevant to other categories of people WHO in 1948 appears to be outdated. As Huber et al. with long-standing, complex conditions, such as frail [10] argue, the conceptualisation of health as ‘a state older people [18]. In fact, these categories apply to all of complete physical, mental and social well-being people, irrespective disease or impairment. Quality of and not merely the absence of disease or infirmity’ in life, in its full range, implies a holistic approach [10]. fact declares the vast majority of our population as If this is the case, we need more ecological approaches. unhealthy, with over-medicalisation as the obvious Schalock and Verdugo [17] propose a distinction of risk. ‘It minimises the role of the human capacity to micro-, meso- and macro-systems. The first – the cope autonomously with life’s ever-changing physical, micro-system – is the immediate social setting, such as emotional and social challenges and to function with the family, peers and the work-setting, people who fulfilment and a feeling of well-being with a chronic dis- directly affect the person’s life. The second – the ease or disability’ [10], p. 236]. meso-system – refers to the neighbourhood, the com- Ageing with multiple chronic illnesses becomes the munity, service organisations and other agencies that norm for most people. As life expectancy is increasing directly affect the micro-system. The third – macro – sys- in most countries, life expectancy without illness is tem is the overall pattern of culture, socio-political decreasing [11,12]. According to the new definition, trends, the economic system and society-related factors ‘health’ should be conceived as the ‘ability to adapt that affect people’s lives. In other words, in order to be and self manage in the face of social, physical, and effective, health care professionals and organisations emotional challenges’ [10], p. 235. Our twenty-first cen- should operate in a person’s ecology in order to be rele- tury society with proper housing conditions, opportu- vant to quality of life. They are, in fact, part of this ecol- nities for good nutrition, healthy life styles, high levels ogy, not a separated entity. So engaging the community of education, social security and (assistive) technology in which people live is in fact working in and with peo- enables compensation mechanisms more than ever ple’s ecology to support or even strengthen their coping before. capabilities and resilience. Therefore, integrated care for people with complex needs should aim at strengthening coping capabilities, Populations taking the lead resilience and supportive conditions in the physical, mental and social domain to enable an (adapted) equi- Third, there is growing interest in population- and area- librium [10,13]. Therefore, the solution to health pro- oriented strategies. These usually imply developing blems and impairments often lies outside the realm of integrated service delivery for specific populations, but professional health care and in the community or in without taking these populations themselves as an society. In daily life, the community or society consists actor or co-producer of health and well-being. This of kin, neighbours, volunteers, other people in the interest goes hand-in-hand with discussions on allocat- neighbourhood, local associations, churches, firms, ing funding based on outcomes at population level etc. Integrated care to people with complex needs [6,19]. In fact, we see services and policy-makers trying This article is published in a peer reviewed section of the International Journal of Integrated Care 2 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ to manage populations or communities with a prefer- Conclusions ence to use terms as ‘population management’, with- out questioning themselves, how populations or In order to provide personalised care to people with communities can manage services and policy-makers. complex needs, professional care providers need to share responsibilities with service users, their informal In my own country, the Netherlands, we see a rapidly carers and local communities. The boundary between increasing interest in citizens’ initiatives, organising public and private space is losing its significance [23], and purchasing their own care and support. Local com- as is the distinction between formal and non-formal. It munities – or populations – take the lead and develop themselves according to cooperative principles. This requires renegotiating or – better – transforming organi- trend reflects the discontent with existing services, but sational boundaries and opening up these boundaries. also concerns for the quality of the local community It has consequences for legislation, funding and profes- and taking responsibility [e.g. [20]. And recently, where sional qualifications, as well as for management and care homes are being closed because of budget cuts governance. It also challenges current professional by central government, we see small communities tak- identities as well as identities of service users, their ing action and considering adopting some of these informal carers and citizens. homes. The seeming paradox is, that health care organisations and professionals can take a lead in these processes. Consequences for integrated care If they understand how sharing responsibilities works and how a concept such as ‘engaging the community’ In the conceptualisation of integrated care, we should works for people in the neighbourhood, we have a lot incorporate communities and their members as co- to win. It may also require new types of funding, including producers of health and well-being. In high-income non-monetary currencies, time-sharing and social impact countries, care for people with complex needs is often bonds. seen as a specialised professional and institutionalised (or highly standardised) domain. In terms of organisa- Hierarchical, rule-based ways of organising need to be tional responsibilities, it is strictly separated from the replaced by more fluid, network-like and consensus- informal domain and from the community. In fact, we based ways of working. It will often be associated with have organised professional care outside the commu- ‘messy’ issues that do not fit current organisational or nity. This segregation has led to alienation and disen- professional practices [24]. gagement of citizens from care. The challenge of care for people with complex needs is It seems fair to assume that the community as such that big, that we need to address it at its smallest scale: can take a more prominent role in organising and deli- the citizen in his social network and local community, vering health and long-term care. There are examples being co-producers of really integrated care. of community engagement from other countries such as Finland, Denmark and the UK. Follow-up of these examples in which communities are actually co- About the author producing, instead of being an object of an intervention are scarce [21,22]. Moreover, they are not incorporated Henk Nies, PhD, is member of the Executive Board in our theorising on integrated care. of Vilans, the Netherlands Centre of Expertise for Long-term Care. He is also professor of Organisation If we do so, we need to redefine professional and non- and Policy Development in Long-term Care at VU Uni- professional responsibilities and boundaries. Organisa- versity in Amsterdam. Throughout his career he has tional boundaries are moving, dependent of personal, worked between the boundaries of policy, practice social, organisational and local resources; the available and research. His primary field of interest is care for capabilities and conditions. Fluid organisational struc- older people, and in particular issues regarding inter- tures with blurring boundaries are emerging. They are organisational collaboration, quality management hard to align with traditional principles of governance and policy development. Henk Nies has worked in in health care with fixed boundaries. Existing agree- several international projects, amongst others as ments on professional responsibilities, standards, scientific director in CARMEN, a FP5 project of the guidelines, privacy regulations, payments, etc. need European Commission, and as a member of the to be renegotiated and new uncertainties of profes- Scientific Management Team of INTERLINKS, a FP7 sionals and non-formal actors need to be dealt with. Integration should be in fact conceived as redefining programme. Henk Nies has published several books boundaries, instead of ‘difference management’ as and many articles and blogs, in the Netherlands and Gobet and Emilsson [23] typify it. abroad. This article is published in a peer reviewed section of the International Journal of Integrated Care 3 International Journal of Integrated Care – Volume 14, 30 June – URN:NBN:NL:UI:10-1-114789 – http://www.ijic.org/ References 1. Colombo F, Llena-Nozal A, Mercier J, Tjadens F. Help wanted? Providing and paying for long-term care. Paris: OECD Health Policy Studies; 2011. 2. Broese van Groenou MI. Informele zorg 3.0: schuivende panelen en een krakend fundament. [Informal care 3.0: moving panels and a cracking foundation]. Amsterdam: Vrije Universiteit; 2012. [inaugural lecture]. [in Dutch]. 3. Glasby J. Understanding health and social care. Bristol: Policy Press; 2003. 4. Vaarama M, Pieper R, editors. Managing integrated case for older persons. Helsinki/Dublin: Stakes/EHMA; 2005. 5. Nies H. Managing effective partnerships in older people’s services. Health and Social Care in the Community 2006;14(5): 391–9. 6. Valentijn P, Schepman S, Opheij W, Bruijneels M. Understanding integrated care: a comprehensive conceptual framework based on the integrative function of primary care. International Journal of Integrated Care 2013; Jan–Mar. Available from: URN:NBN:NL:UI:10-1-114415. 7. Goodwin N, Dixon A, Anderson G, Wodchis W. Providing integrated care for older people with complex needs. Lessons from seven international case studies. London: The King’s Fund; 2014. 8. Gröne O, Garcia-Barbero M. Integrated care. A WHO position paper of the WHO office for integrated health care services. International Journal of Integrated Care 2001 June 1; 1: ISSN 1568-4156. Available from: http://www.ijic.org. URN: NBN:NL:UI:10-1-100270. 9. Kodner D, Spreeuwenberg C. Integrated care: meaning, logic, applications, and implications – a discussion paper. International Journal of Integrated Care 2002 Nov 14; 2: ISSN 1568-4156. Available from: http://www.ijic.org/. URN:NBN:NL:UI:10-1-100309. 10. Huber M, Knotnerus JA, Green L, van der Horst H, Jadad AR, Kromhout D, et al. How should we define health? BMJ 2011; 343(4163):235–7. 11. Jagger C, Matthews R, Matthews F. The burden of diseases on disability-free life expectancy in later life. Journal of Gerontology 2007;62A(4):408–14. 12. 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