%0 Journal Article
%T Integrated care management: the experience of Kaiser Permanente and the Veterans health administration in the USA
%A Borges Da Silva Ge
%A Borges Da Silva R
%J Revue M¨Śdicale de l'Assurance Maladie
%D 2005
%I 
%X With a review of the literature, we described the integrated care management experiences of Kaiser Permanente (KP) and the Veterans health administration (VHA) in the USA. These types of healthcare organisation (a non-profit HMO [health maintenance organization] and a public institution) enable cost control, compatible with a high quality of care. We analysed the innovations that they provide in terms of organisation and care practices and the principles to be retained in order to improve the efficiency of the French system. The KP and VHA results can be attributed to: - A practice founded on evidence based medicine and disease management, recently adapted to chronic condi-tions. In comparison with the NHS in the United Kingdom, KP has only a third of the amount of short-stays and hospital stay durations are 20% shorter. - A single management and the absence of a sealed financial envelope. - An organisation involving integration at all levels: joint administrative management with doctors, integration of an insurance system with a care system, outpatient care with hospital care, prevention with curative care (managed care and case management). This organisational consistency enables interdependent players to see the point and advantage in coordinating their practices and working together as a team. In France, integration is slow to be established as a necessity for healthcare players. However, active disease management of the 7.5 million patients with a long-term condition could bring a drive for change. As the Haut conseil pour lĄŻavenir de lĄŻassurance maladie (French high council for the future of health insurance) suggests, there is an opportunity to be seized by the insurance medicine system with the protocolisation of care for these patients.
%K community health services/organization and administration
%K practice guideline
%K delibery of health care
%K integrate managed care
%K efficiency
%K disease management
%K evidence based medicine
%K quality of health care.
%U http://www.ameli.fr/fileadmin/user_upload/documents/Gestion_integree_des_soins.pdf