The ratio of GDP that Europe has delivered to healthcare has increased by 26% in the last 15 years. Unfortunately, despite these investments, many change efforts in healthcare are neither sustainable nor successful. The main challenge that the healthcare industry is currently facing is that of gurending a synergistic combination of quality improvement and cost rationalisation. The problem is that these two objectives have a contradictory nature, and are tremendously difficult to attain simultaneously. Most of tensions perceived within healthcare could be tackled and effectively overcame through a trans-disciplinary focus on both health and social care issues. In fact, since health is an individual state, a range of activities and enabling factors are essential for its maintenance. Such activities are part of normal living, and include a balanced diet, physical exercise, and socialization. All European countries have a system of social care support to assist vulnerable persons. But in almost every country this provision is separated from healthcare not just in delivery, but also in legislation, funding and organization. The end results are that:
- We do not exploit the potential lying at the intersection of healthcare and social care;
- The tensions perceived in both these industries by those aiming to reconcile quality improvement and cost rationalisation are exacerbated or difficultly reconcilable.
Starting from the aforementioned considerations, many authors call for focusing on what we call socio-care, i.e. the integration of healthcare and social-care industries. Three are the main reason for this shift of focus:
- Many services present in both industries are technically good, but fragmented, delivered in isolation, and each with its own standards and goals: as a consequence, citizens are left poorly served, confused when individual services work to different aims and priorities, and frustrated when service delivery clashes and they have to negotiate with schedule-driven providers;
- There is increasing specialism within both health and social care services: in each sector, not only is increasing specialism seen as key to quality of service, but regulations and qualifications support this. If intrinsically this may be good—with the presence of adequate expertise, procedures, training and skills—, it reinforces fragmentation of provision, and creation of more silos of specialist knowledge and records;
- Those fighting for reforming the two industries have few weapons for systemic change. There are very few system architects that have the scope and power to reconfigure the elements of the health and social care systems—with a sense of the interconnectedness of the different pathways to be considered.
DECI will focus on how developing a reshaped overview of holistic socio-care services, and will study the mechanism through which integrate and harmonize the organisation and delivery of health and social care services. Today, it is very expensive to receive socio-care services from highly trained professionals. Without the largesse of well-heeled employers and governments that are willing to pay for much of it, most solutions for independent living are inaccessible to most of elderly people. Three elements seem to have the potential — if well and coherently designed — of making these services affordable and effective. In the middle of these pillars are of course a host of regulatory reforms and new industry standards that EU commission has to develop to facilitate the interactions among the participants in the disrupted socio-care industry. From this viewpoint, DECI can constitute a first important empirical setting in which start developing these regulations and standards.