The Consumer’s Role in Co-ordination: making sense of transitions in health care

There is an international trend towards integrated health care delivery systems (Lomas, 1996; WHO, 1996). An integrated delivery system is a network of organisations that provides or arranges to provide a co-ordinated continuum of services to a defined population and is willing to be held clinically and fiscally responsible for the outcomes and the health status of the population served (Shortell et al., 1996). In Canada health regions were created in Alberta, in June 1994 by merging previously independent organisations responsible for acute care, continuing care, home care and public health under a single board with a single administrative structure. Health regions in Alberta exhibit many of the features of integrated delivery systems. There has been a consolidation of hospital services, which is an example of horizontal integration — the co-ordination of functions, activities or operating units that are at the same stage in the process of delivering services (Gilles et al., 1993). More significantly regions also include vertical integration — co-ordinating, linking or incorporating activities or entities at different stages of the process of producing and delivering care (Conrad, 1993) which is evident in the organisational linkages between acute care and community-based services.