ABSTRACT
A broadly similar challenge with respect to long-term care for the frail elderly can be discerned in the United States, United Kingdom and other developed countries, namely the fragmentation of services, poor coordination between health and social care, and less than optimum quality and cost-effectiveness. Care management has emerged over the past twenty years as one of the linchpins of long-term care. While care management has demonstrated the capacity to at least partially overcome these barriers, there is a growing sense that a more comprehensive model of care is needed to bridge the gap between the medical and social needs of these clients, as well as the resources to address them. Vertically integrated systems of care offer fruitful possibilities in this direction. In addition to examining the logic and conceptual underpinnings of this model, this paper describes and summarises evidence from a representative sample of such projects in the US (Social HMO and PACE), Canada (SIPA), Italy (Rovereto), and Australia (Coordinated Care Trials). The paper concludes with a review of the strategy's promise and lessons, as well as a brief discussion of the implications for integrated care for the frail elderly in England.
