The mutualism between chains of care and local care

Introduction: There is a growing interest in compensating for the fragmented delivery of care by promoting integrated care. This movement is a feature of national and local policy, and it is being supported and encouraged amongst care providers. Aims: Discuss the concepts of Swedish integrated care and their impact on care delivery systems. Results: The chain of care concept is commonly regarded as a means to make a care delivery system better adapted to the needs of patients. In many county councils, this transformation is supported by policies focusing on quality and comprehensiveness. Despite several years of experience, a vast majority of the county councils regard themselves as unsuccessful in developing chains of care. In addition, many county councils have changed their delivery systems during recent years and implemented ‘Local Care’, an upgraded familyand community-oriented primary care supported by a flexible hospital system. It is unusual to find a high degree of organisational cohesiveness in the implementation of local care. Instead these solutions are in many cases supposed to be built on chains of care. Conclusions: Chains of care are increasingly regarded as building stones of local care, which means that chains of care are embraced in a context and by conditions more favourable than former non-integrative care delivery systems. In this sense, chains of care may have a renaissance, after assuredly being high on the policy agendas but with several years of modest development results. Thus, local care needs chains of care to evolve and chains of care need the integrative framework of local care to sustain.