Competition supports integrated care (?)

Integrated Care (INIC) organized a study visit for a group of 75 Europeans to Kaiser Permanente (KP) in San Francisco, USA. Kaiser Permanente is a care organization that encloses a health insurance company (''Kaiser''), primary health care doctors and medical specialists (''Permanente''), and hospitals (''Kaiser Hospital Trust''). These three divisions work closely together and are exclusive partners. The 8.2 million insured persons of Kaiser all visit Permanente doctors and Kaiser Hospitals. Alan Enthoven was one of the KP hosts of the group of 75 Europeans. He is the inventor of the term managed competition w1x and editor of the recent book ''Toward a 21 Century st Health Care System'' w2x. During the study visit he explained, ''The integration within KP of primary health care and hospital care and between prevention and treatment is devils driven: since the 1990s it is driven by competition. This also counts for the emphasis on self management by patients and the use of Health Information Technology''. Because of this devil, KP is now an integrated care organization delivering one third of the NHS admissions per 1000 persons above 65 years for x (?) chronic conditions w3x. So a (preliminary) conclusion could be: competition supports integrated care. Then why is KP only concentrated in California? If the KP model is so competitive, why is it not disseminated to the rest of the USA and to European countries such as Germany and Holland that work with insurance companies, group practices and hospitals trusts? Alan Enthoven gives the answer w2x: ''Within the KP model the Kaiser insured persons have to go to the doctors of Permanente. Their free choice is limited. They feel limited because they think that competencies of individual doctors are more important than the integrated systems in which these doctors work. Above that, most doctors think in terms of prices per consult and not in terms of a whole program in which they play one of the professional roles''. Both arguments explain why the introduction of the KP model in European countries and the rest of the USA appears so difficult. Are there other solutions to support integrated care by competition? In a competitive health services world, selling points of products and services are important. These selling points are arguments with which clients can be seduced, convinced or pushed to use the services. Sometimes these selling points are not the main purpose i.e. to promote …