[Integration and boundaries between health and social care. 2008 SESPAS Report]

We examine the opportunities to establish integrated services in Spain. The new law on services for disabled people approved by the Spanish Parliament in December 2006 and the Mental Health Plan of the Spanish Ministry of Health are used to illustrate policies that will require a high degree of integration among organizational, financial and clinical levels. In this context, some of the following questions arise: what do we know about the effectiveness of the integration of health and social services? Who should be the targets of integration and what are the structures needed for patient-centered services? Who should be responsible for and manage these services? An outline of Leutz's five criteria for integration is reviewed and the results from international experiences are discussed. We conclude that Spain is at a crossroads for the integration of services for disabled people and people with mental health problems. We recommend that a system of integrated services be organized for people with moderate or severe disability. This system should be decentralized at the levels of local health and social services, with a single budget estimated on a capitation basis. Clinical and financial responsibility should be shared between the interdisciplinary team and the case manager (nursing or social work professionals).