Overcoming silos in health care systems through meso-level organisations - a case study of health reforms in New South Wales, Australia

David Peiris; Anne-Marie Feyer; Justine Barnard; Laurent Billot; Tristan Bouckley; Anna Campain; Damien Cordery; Alexandra de Souza; Laura Downey; Adam G Elshaug; Belinda Ford; Hannah Hanfy; Lynelle Hales; Behnoosh Hosseinloui Khalaj; Carmen Huckel Schneider; James Inglis; Stephen Jan; Louisa Jorm; Bruce Landon; Sanja Lujic; John Mulley; Sallie-Anne Pearson; Gill Schierhout; Prithivi Sivaprakash; Cynthia Stanton; Anna Stephens; Deborah Willcox

doi:10.1016/j.lanwpc.2024.101013

Overcoming silos in health care systems through meso-level organisations - a case study of health reforms in New South Wales, Australia

Lancet Reg Health West Pac. 2024 Feb 15:44:101013. doi: 10.1016/j.lanwpc.2024.101013. eCollection 2024 Mar.

Authors

David Peiris¹, Anne-Marie Feyer², Justine Barnard³, Laurent Billot¹, Tristan Bouckley¹, Anna Campain¹, Damien Cordery², Alexandra de Souza⁴, Laura Downey¹, Adam G Elshaug^{5

4}, Belinda Ford¹, Hannah Hanfy⁶, Lynelle Hales⁶, Behnoosh Hosseinloui Khalaj⁷, Carmen Huckel Schneider⁴, James Inglis³, Stephen Jan¹, Louisa Jorm⁷, Bruce Landon⁸, Sanja Lujic⁷, John Mulley¹, Sallie-Anne Pearson⁹, Gill Schierhout¹, Prithivi Sivaprakash⁴, Cynthia Stanton⁶, Anna Stephens², Deborah Willcox²

Affiliations

¹ The George Institute for Global Health, UNSW Sydney, Sydney, Australia.
² NSW Ministry of Health, Sydney, Australia.
³ Northern Sydney Local Health District, Sydney, Australia.
⁴ Menzies Centre for Health Policy and Economics, University of Sydney, Sydney, Australia.
⁵ Centre for Health Policy, University of Melbourne, Melbourne, Australia.
⁶ Sydney North Health Network, Sydney, Australia.
⁷ Centre for Big Data Research in Health, UNSW Sydney, Sydney, Australia.
⁸ Department of Health Care Policy, Harvard Medical School, Boston, MA, USA.
⁹ School of Population Health, UNSW Sydney, Sydney, Australia.

Abstract

Fragmented care delivery is a barrier to improving health system performance worldwide. Investment in meso-level organisations is a potential strategy to improve health system integration, however, its effectiveness remains unclear. In this paper, we provide an overview of key international and Australian integrated care policies. We then describe Collaborative Commissioning - a novel health reform policy to integrate primary and hospital care sectors in New South Wales (NSW), Australia and provide a case study of a model focussed on older person's care. The policy is theorised to achieve greater integration through improved governance (local stakeholders identifying as part of one health system), service delivery (communities perceive new services as preferable to status quo) and incentives (efficiency gains are reinvested locally with progressively higher value care achieved). If effectively implemented at scale, Collaborative Commissioning has potential to improve health system performance in Australia and will be of relevance to similar reform initiatives in other countries.

Keywords: Care coordination; Health system reform; Integrated care.

Publication types

Review