System-level coordination problems: impact of the institutional structure

The chapter analyses the challenges, obstacles and solutions for better coordination of healthcare and long-term care systems at the institutional level in cross-national perspective in Germany, the Netherlands, Sweden and Switzerland. The analysis is based on interviews with major stakeholder organizations in the four countries. In none of the countries, institutional conditions and financial regulations provide excellent ground for coordination. Since the two systems had historically developed quite differently in each country, institutional obstacles for better coordination are often country-specific. Yet there are also similar institutional challenges. First, the distribution of tasks and the allocation of financial resources neglect the growing need for coordination. Second, sometimes there is a discrepancy between the competencies ascribed to different organizations and professions and the tasks they are actually performing. In cross-national perspective, the bigger the gap between the institutional settings in healthcare and long-term care is, the more coordination is impeded.