Coordinating Healthcare and Long-term Care: A FourCountry Comparison

Background: This comparative study examines responsibilities for coordination of healthcare and long-term care (LTC) in Germany, the Netherlands, Sweden, and Switzerland. As populations age, frailty and multimorbidity are increasing, leading to greater care needs and coordination of care between sectors. We analyze how coordination responsibilities among healthcare professionals and organizations vary between different healthcare and LTC systems and what strategies are used for better coordination. Methods: Fifty qualitative expert interviews were conducted with participants from local government agencies, social health insurances, various healthcare organizations, and professionals directly involved in healthcare and LTC provision. Data were analyzed with qualitative content analysis. The comparative research is based on existing healthcare and LTC typologies. Results: This study shows the need for clear lines of responsibilities and financial allocation to minimize fragmentation of care coordination. Sweden and the Netherlands assign formal coordination roles to general practitioners (GPs), district nurses, and municipal services. Germany’s approach heavily relies on the family, and in Switzerland, public and private LTC providers are often responsible for coordination. Digital technologies are increasingly used for communication and coordination. In Germany and Switzerland, where GPs have no gatekeeping role and primary healthcare centers are less developed, older GPs are unwilling to invest in digitalization. In Sweden and the Netherlands, where GPs coordinate primary healthcare and referrals to specialists, there is a strong interest in digitalization to improve communication and coordination. Still, digital systems for healthcare and LTC are not fully harmonized. Conclusion: The comparative study shows the need for clear responsibilities, systemic support, and financial recognition of care coordination to facilitate patient-centered care coordination. Digital technologies and in particularly integrated electronic records across sectors are reported as important tools that can facilitate care coordination across healthcare and LTC.