Far from a European vision concerning integrated care, national health and social care systems remain-at best-loosely coupled systems that are facing increasing difficulties, given the current challenges, in particular in long-term care for older persons: increasing marketisation, lack of managerial knowledge (co-operation, co-ordination), shortage of care workers and a general trend towards down-sizing of social care services continue to hamper the first tentative pathways towards integrated care systems.
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Kai Leichsenring (2004) studied this question.
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