• Alex McKeown.
• Department of Psychiatry, Wellcome Centre for Ethics and Humanities, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, Oxfordshire, OX3 7JX, UK.
• Br. Med. Bull. 2023 Jun 21; 146 (1): 4184-18.

IntroductionIntegrated care is an established approach to delivery in parts of the healthcare infrastructure, and an ideal which, it is claimed, should be realized system-wide. Its ethical weight derives from its defence of a view about how healthcare ought to operate. Although the goal of integration is laudable, it is ethically and practically complex, involving trade-offs.Sources Of DataConsiderable evidence attests to widespread enthusiasm for integration, given the need to prevent harm and extend the reach of scarce resources. Equally, evidence increasingly highlights the obstacles to successfully translating this ideal into practice.Areas Of AgreementThe principle that healthcare should be seamless, ensuring that patients do not come to harm through gaps in care enjoys broad agreement. There is a similar consensus that placing the patient's perspective at the centre of decision-making is vital, since this enables identification of these gaps.Areas Of ControversyIntegrating care by making it seamless entails blurring boundaries of care domains. This risks undermining the locus of responsibility for care decisions via confusion about who has ownership of specialist knowledge where domains overlap. There is a lack of consensus about how successful integration should be measured.Growing PointsMore research into the relative cost-effectiveness of upstream public health investment in preventing chronic ill-health caused by modifiable lifestyle factors vs integrating care for people already ill; further research into ethical implications of integration in practice, which can be obscured by the simplicity of the fundamental normative principle guiding integration in theory.© The Author(s) 2023. Published by Oxford University Press.

11 keywords...

hide…