Collaborating while competing? The sustainability of community-based integrated care initiatives through a health partnership

In this single case study, we retrospectively explored how local health-care providers in Amsterdam collaborated for more than 30 years, interacting with the changes to the national health-care system. In-depth analysis of interviews, documents and literature focused on the complex relationship between the activities of this health partnership, its nature and its changing context.The findings revealed that the partnership itself was successful and sustainable over time, although the partnership lost its initial broad explorative nature and narrowed its strategic focus towards care of the elderly. Furthermore, the realized projects – although they enforced integrated care – lost their community-based character. This declining scope of community-based integrated care seems to have been influenced by the incremental introduction of regulated competition in Dutch health care. This casts doubts on the ability of health partnerships to apply a vision of community-based integrated care within the context of competition.Collaborating health-care providers can build seamless continuums of care in a competitive environment, although these will not automatically maximize community health with limited resources. Active policies with regard to health system design, incentive structures and population-based performance measures are warranted in order to insure that community-based integrated care through health partnerships will be more than just policy rhetoric.To improve performance in health care, providers should target their services to the health needs, beliefs and values of the populations they are intended to serve. This orientation enables them to offer an appropriate set of services that maximizes population health given the available resources [1-3]. According to this logic, providers must collaborate and integrate their services, as most health needs cannot be met by any single provider working alone [4-7]. This calls for integration of public health functions, medica