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- Title
Does Integrated Care Carry the Gene of Bureaucracy? Lessons from the Case of Québec.
- Authors
COUTURIER, YVES; WANKAH, PAUL; GUILLETTE, MAXIME; BELZILE, LOUISE
- Abstract
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.
- Subjects
QUEBEC (Quebec); EPIDEMIOLOGICAL transition; BUREAUCRACY; SOCIAL services; DEMOGRAPHIC transition; INTEGRATIVE medicine; NON-communicable diseases; CHANGE management
- Publication
International Journal of Integrated Care (IJIC), 2021, Vol 21, p1
- ISSN
1568-4156
- Publication type
Article
- DOI
10.5334/ijic.5658