Determinants of integrated health care development: chains of care in Sweden

Bengt Åhgren, Runo Axelsson

Research output: Contribution to journalArticlepeer-review

55 Citations (Scopus)


Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development. Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Resistance from the body of physicians was a serious obstacle to such a development. Local health care depends on developed chains of care, but it seems that health care managers do not have the management systems necessary to run these clinical networks, mainly due to a lack of acceptance from the medical profession. This is an impossible situation in the long run, since the number of chains of care is likely to increase as a result of the emerging local health care. Copyright (c) 2007 John Wiley & Sons, Ltd.

Original languageEnglish
Pages (from-to)145-157
Number of pages12
JournalInternational Journal of Health Planning and Management
Issue number2
Publication statusPublished - 2007
Externally publishedYes

Swedish Standard Keywords

  • Health Care Service and Management, Health Policy and Services and Health Economy (30301)


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