Policy Lessons

Work Package 13: Policy lessons

  • The overall objective of WP 13 is to define policy lessons that promote the development of excellent care to people with (multiple) chronic conditions. We aim at ‘better policies for better chronic care’. Conditions that have become public health priorities typically have one or more of the following characteristics :(1) large burden, (2) major impact with respect to health consequences and/or costs, and (3) the potential for prevention. Declaring a health problem an issue of public health has a number of implications for research, policy and practice; this is the case for the growing need for chronic care provision. In a time of substantial budget stress (the amount of money spent on medical care is increasing faster than the gross domestic product (GDP) in most countries), moving a society toward better health for people with chronic conditions is difficult as the complexity of the change process is substantial. Many stakeholders are at play when it comes to changing the health care system towards ‘better policies for better chronic care’. This work package therefor targets prime ministers, ministers of health, patient representatives, political parties, parliamentarians, health managers and administrators, UN agency heads and the leaders of large advocacy organizations, among others.

  • Since integrated care remains a construct with variable interpretation, we put forward the notion of excellent care as the conceptual backbone to this work package. Excellent care is essentially integrated, people-centered and values a bio-psycho-social approach to care emphasizing the importance of equity, and high-quality interventions across the life course and the entire health continuum and aims at better care experiences, health outcomes, and with a more efficient use of resources. What is very essential to excellent care is that it focuses on those aspects of care that are directly and intrinsically important to people, rather than the inputs and outputs that might be used to deliver those outcomes. It thus focuses on outcomes that are both objective and intrinsically subjective recognizing that objective evidence about people’s life circumstances can be usefully complemented by information about information how people experience their lives. It also considers the distribution of chronic care outcomes across the population as an important feature to reflect in measurement, including disparities associated with age, gender, education and income.

  • In this work package we will consider two basic approaches to developing health policies. The first, which is cautious and careful (a small idea and a small intervention or even a big idea and a small intervention), is more likely to be tested and implemented because institutions and professionals will not be threatened by the magnitude of the change. But this approach runs the risk of discrediting the concept that is being tested because what is being implemented is too limited, or circumscribed. The second approach is disruptive and daring (big idea and big intervention). It can adequately test a concept, but the concept may be dismissed as infeasible.

  • Five major lessons have been learnt so far from project Integrate. These lessons can be summarized as 1) ‘it is about excellent care’, 2) ‘it is about disruptive innovation’, 3) ‘it is about leadership, 4) it is about ‘multifaceted intervention strategies’, and 5) ‘it is about the broader picture of well-being’. Each of these lessons learned will be described in full detail, complemented by a well-defined set of policy recommendations that target the improvement of chronic care provision.

Contact Details

For more information on this work please contact:

Dr Liesbeth Borgermans
Professor of Chronic Care,
Department of Family Medicine,
Vrije Universiteit Brussel
liesbeth.borgermans@vub.ac.be