Integrated Care : Contexts and Structure

对欧盟综合卫生与社会保健服务提供体系的原型-综合保健进行了为期40年的分析与评价，并与日本的“千喜-保胜保健”体系进行了比较。澄清了四个事实。第一，整合医疗政策的形成有三个方向和路径：WHO的整合初级卫生模式、美国的关键路径和欧洲国家的医疗制度改革。一体化医疗模式与其后继的护理协调模式是在全球快速老龄化社会时代卫生与社会服务体系改革的一体化方法论。其次，分析芬兰和瑞典的实践，整合护理是一种服务工程创新，为更多的生活质量提供服务。它包括在服务过程中巧妙应用信息和通信技术、人力资源开发、服务工作的组织以及服务创造过程中的其他相关要素方面的创新。第三，整合在实践中分为一方面是机构层面，另一方面是临床过程中的多专业协调。认为服务对象和服务对象的完整性与服务过程的完整性应分开理解。第四，也是最后一点，综合护理是以服务工程为导向的创新，因此，与日本的Chiiki-Hokatsu不同，新的公共或公私伙伴关系对未来支持性卫生和社会服务结构的关键问题受到了愤怒。

Integrated Care as a prototype of comprehensive health and social care service provision system in EU has been analyzed and assessed for 4years aided research period, with a comparative view with Japanese "Chiiki-Hokatsu Kea" system. Four facts have been clarified. Firstly, there are three streams and paths of policy formation towards Integrated Care : WHO model of integrated primary health, American originated critical pathways, and medical system reforms in European countries. Together with its successor Care-coordination model, Integrated Care is just integrated methodology of health and social services system reform in the era of globally fast aging society. Secondly, analyzing Finnish and Swedish practices, Integrated Care is a service engineering innovation for the more QOL affording service provision. It contains innovations in smart application of ICT in the service process, human resource developments, organization of service works, and other related elements within the process of service creation. Thirdly, integration is divided in practice into institutional level on the one hand and multi-professional coordination in the clinical process on the other. It is evaluated that integrity in target and object of the services and integrity in the process of service clinics are to be separately understood. Fourthly and lastly, Integrated Care is rather service engineering oriented innovation, so that critical issue of the new public or public private partnership towards the future structuration of supportive health and social services is outraged unlike of Japanese Chiiki-Hokatsu.