Development of integrated care in England and the Netherlands: managing across public-private boundaries

Health Policy. 2003 Sep;65(3):227-41. doi: 10.1016/s0168-8510(02)00215-4.


This paper addresses the impact of the public-private mix in the Dutch and English health and social care systems on the development and delivery of integrated care. Integrated care is conceived of as an organisational process of coordination which seeks to achieve seamless and continuous care, tailored to the patients' needs and based on a holistic view of the patient. We describe both systems' structures and characteristics from a historical perspective, which means that developments and processes within the systems are put in the spotlight. We demonstrate that the dividing- or fault-lines, such as the financial split between short-term and long-term care in the Netherlands and the divisions between health and social care as well as between the public, private and voluntary sectors in England have hindered integrated care development and delivery in both countries. Contradictory interests, differences in professional and organisational cultures, power relations, and mistrust between and within these sectors have had a clear impact on integrated care development and delivery within networks of public authorities and public and/or private providers. We explain these phenomena in terms of network theory as a basis for drawing lessons for policy makers and those developing integrated care networks.

MeSH terms

  • Attitude to Health
  • Continuity of Patient Care
  • Culture
  • Delivery of Health Care, Integrated / organization & administration*
  • England
  • Entrepreneurship
  • Health Policy / trends*
  • Humans
  • Interinstitutional Relations*
  • National Health Programs / organization & administration
  • Netherlands
  • Politics
  • Private Sector / organization & administration*
  • Public Sector / organization & administration*
  • State Medicine / organization & administration