A new framework for integrating health services delivery and long-term care



Kai Leichsenring


Gudrun Bauer, Stefania Ilinca, Ricardo Rodrigues


Juan Tello, WHO Europe (Copenhagen and Almaty)


WHO Europe (Denmark)


The evolution of the scholarly debate on ‘integrated care’ and related initiatives to overcome fragmentation of service delivery has taken various directions and advances over the past two decades. On the one hand, care integration describes efforts focused on better coordination and linkage of services and specializations within the health system, e.g. disease management and related guidelines. On the other hand, concepts of ‘whole system thinking’ and similar approaches to extend the boundaries of the health system to closely connected systems of social care – but also housing, the built environment, etc. – and eventually the emerging system of long-term care triggered a dynamic towards a broader perspective. This was also underlined on an international policy level by the explicit acknowledgement of long-term care (LTC) by WHO in its latest ‘global strategy and plan of action on ageing and health’. In this strategy WHO highlighted as one of the key objectives that Member States are recommended to 'establish and continually improve a sustainable and equitable long-term care system' (WHO, 2016, 19).


This study was commissioned by WHO Europe with the objective to underpin the implementation of its ‘European Framework for Action on Integrated Health Services Delivery’ (EFFA IHSD). The multiple challenges at the interfaces between health systems and long-term care (LTC) were addressed by evidence from experiences and models across Europe to achieve solutions with improved outcomes in terms of quality of care from a patient’s perspective, effectiveness, efficiency and equity.


The study was based on specific applied methodologies encompassing

  • Literature analysis to adapt the existing EFFA IHSD by adding and elaborating on the particular features of LTC that include differences in legal provisions and fragmented funding as well as the specific role of informal carers and various additional stakeholders.
  • Expert interviews and review of existing evidence to provide additional background knowledge on the scope of the study and the meaning of quality of care, effectiveness, efficiency and equity in integrating health and social care systems in LTC, in particular from a user’s perspective.
  • Case studies to apply the adapted Framework to 6 countries (Croatia, Denmark, Germany, Portugal, Romania, Turkey) representing different stages and/or regimes of LTC delivery and to identify the bariiers, enablers and success factors under different systemic conditions.

The findings and policy recommendations were reported to WHO for final editing and publication.


  • Adaptation of the Framework/scoping study
  • Case studies (missions to Croatia, Denmark, Germany, Portugal, Romania, Turkey)
  • Final report

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