Integrated care bridges the care gap

In 2011 the US National Health Expenditure is estimated to amount to $ 9,216 per capita: that is 17.0% of Gross Domestic Product (GDP) w1x. The authors Heffler c.s. give the warning that for 2001 health spending grew faster than expected. In that year and in 2002 the real health spending growth, that is growth without inflation, is expected to average 6.6% per year. Nevertheless they used as a yearly growth rate 3.8% for the period 2001–2011 because of a continued impact of managed care. Also in Europe there are signs that health care will grow faster than was expected until now. Europe as a whole will increase its expenditure on health care from 8% of GDP to 10.72% in 2005–6 w2x. The Blair Government in the United Kingdom envisages a much higher growth for the National Health Services than in previous years; a financial impulse of 6.5 bn Euro is expected by 2005 w2x. In the Netherland, the economic institute Nyfer expects that a real health expenditure growth of 11 bn Euro is necessary in the next 4 years w3x. It will be difficult for the populations in the USA, Europe and especially the UK and The Netherlands to accept that faster growth is necessary to stay healthy. Their resistance will be high, whether the expenditures are financed by private insurances, out-of-pocket (USA), taxation (UK) or social insurances (The Netherlands). From this perspective, having better health means less private consumption on for instance housing, travelling and leisure activities. And yet those categories have a higher priority in the short term. Thus, a widening of the care gap can be expected in the period 2001– 2011 between the needs of care and the supply of care. The answers by professionals to bridge the care gap vary from country to country. In the USA, managed care has become popular and has diminished care costs, but the quality of care is doubtful, as has been shown by Robinson and Steiner w4x whose book is discussed in this journal w5x. Nevertheless, the old fashioned Health Maintenance Organization Kaiser Permanente (HMO) has, for the same per capita amount of money, better performances than the NHS in England w6x although their cost calculations are not the strongest part of their publication w7x. In the UK, a NHS led by primary health care is seen as the best instrument to bridge the care gap, as is …