Pathways towards health care systems with a chronic-care focus: Beyond the four walls

Increasing health care expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include aging, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most health care systems in developed countries have been designed to cure acute episodes, rather than to manage chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. Hospitals provide much of that health provision and they are in need of adapting to the needs of the population. New models of chronic care provision have been developed to respond to the changing burden of disease, taking into account the role of hospitals. Further, there is considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the international experiences in terms of policy changes and pilot studies focused on testing the feasibility of moving toward chronic care models. In particular, we discuss a framework that identifies and analyzes key prerequisites to achieving high performing chronic care-based health care systems and apply it to various countries and link this proposal with the concept of the boundaryless hospital