A variety of factors influence health and well-being, some of which are not directly amenable to medical treatment. Consequently, integrated health and social care is increasingly seen as a key strategy for improving population health and lowering costs. However, barriers remain between healthcare and community services, despite long-standing efforts to overcome them. These include geographical and administrative decentralization, funding and governance structures, and eligibility criteria and user charges.
In addition, there are important ethical dilemmas that arise when integrating healthcare with social care, such as confidentiality, privacy and risk taking. These are not only at play in the clinical domain but also in the wider workplace. This is especially the case where professional caregivers work with people who are experiencing complex and multiple care needs.
Despite these challenges, national policies have catalyzed a series of initiatives to test new models for integration, with the ultimate aim of increasing health and decreasing costs. In the United States, this has largely been driven by Medicaid, the public insurance program for Americans with low incomes. In particular, recent innovations have focused on implementing accountable care organizations to improve quality and outcomes and aligning incentives with social services providers. However, there remains a need to better understand how to improve integration across all populations and develop more evidence of what works. To do this, it is essential to invest in critical enablers such as data infrastructure and workforce training. Moreover, it is vital to address the inherent differences in care delivery and organizational culture between healthcare and social service sectors. health and social care