Health care systems in developed countries share a common feature, which has been accentuated over the last decade. These health care systems are fragmented due to medical (sub)specialization (i) and to the split between general health care and mental health care (ii) and the rupture between primary and secondary health care settings (iii). Such fragmented health care systems are often not able to deliver what patients are in need for and what standards of care recommend. An important subgroup of patients who specifically suffers from these splits in our current health care systems resulting in either its underutilization or excess utilization are the Complex medically ill being:
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the frail elderly,
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the chronically ill with multiple morbidities, including psychiatric morbidity,
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those who abuse substances and
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patients with persisting functional complaints.
For the care of these patients, the “Chasm”-report is therefore most relevant (1). It states: “Quality problems occur typically not because of failure of goodwill, knowledge, effort or resources devoted to health care, but because of fundamental shortcomings in the ways care is organized. Trying harder will not work; changing systems of care will.” The complex medical patients are the most vulnerable to the deficiencies of a fragmented health care system and most in need.
- Institute of Medicine (2001). Crossing the quality chasm: a new health system for the 21st century. Committee on Quality of Health Care in America. National Academy Press, Washington DC.
See for further details Huyse FJ and Stiefel FC: Preface, in Huyse FJ and Stiefel FC Eds Integrated care for the complex medically ill. Medical Clinics of North America July 2006 Elsevier.