Broadening the Boundaries of Integrated Care in Response to Necessity: Where Are the Limits for Each Sector, and Who Should Pay for What? Comment on "The Effect of Integrated Care After Discharge From Hospitals on Outcomes Among Korean Older Adults"

TL;DR

This commentary explores the effectiveness and cost implications of a broad integrated care program for older adults in Korea, highlighting the need to define sector boundaries and funding responsibilities.

Contribution

The paper introduces a comprehensive analysis of a Korean integrated care program's unique breadth and raises questions about sectoral limits and cost-sharing.

Findings

The Korean program increased time at home and reduced emergency admissions among older adults.

The program included non-traditional services like meal delivery and home repair.

Despite benefits, re-admissions increased and total expenditure decreased.

Abstract

Impacts of integrated care interventions, particularly on utilisation and financial outcomes, can be mixed, sometimes quite disappointing when compared to expectations. Positive deviants come along occasionally, but it is extremely difficult to unpick exactly why one intervention might "work" where others have not. Choi and Yoo evaluated a programme in Korea, which appears to have increased time older patients discharged from hospital spend at home, reduced their odds of a subsequent emergency admission, and decreased total expenditure, although re-admissions increased. The programme stands out particularly in its breadth of non-traditional care activity, home-based primary care and long-term (social) care services, but also broader activities such as nutrition support (eg, meal delivery), movement assistance, lifestyle education, housekeeping, and even home repair. In this commentary, I discuss this broadening of interventions to capture more social determinants of health, ask where boundaries of each sector/service should lie, and who should pay for what.