Politiques et données sur la santé

Efficiency of Health Care Delivery: Co-ordination of Care


The OECD Health Division has now released "Improving health system performance through better care coordination" (OECD Health Working Paper No. 30), which covers OECD countries and those EU members that are not members of the OECD. A cycle of study of health care efficiency was completed in 2008. This work examined the potential impact of coordination-of-care policies on efficiency and effectiveness of the health care system.

A shorter version of this paper, entitled "Improving Health Care System Performance Through Improved Coordination of Care", was presented to the joint OECD/European Commission conference "Improving Health-System Efficiency: Achieving Better Value for Money" in Brussels on 17 September 2008.

What is the purpose of this study?

The main objective of this study was to assess the potential for higher efficiency through better care coordination policies, and to identify how governments in OECD countries promote coordination of care.

Why look at coordination of care?

Many OECD countries see coordination of care as a key policy response for achieving more efficient and effective health care delivery, in the context of changes in the patterns of demand and supply of health care.

Technical progress and increased specialisation in medicine are leading to greater fragmentation in supply, while rising numbers of chronically-ill patients are consuming a growing share of total health care spending and are in need of guidance when care comes from different sources during a single episode of care.

Where care coordination leads to more appropriate care (for example, through fewer medical errors, more appropriate medication and less re-hospitalisation), cost efficiency and cost effectiveness will be enhanced as well. To the degree that this leads to higher workforce productivity – e.g. through reduced sick leave – overall economic efficiency will also improve.


The OECD Secretariat has defined coordination of care as system-wide efforts and/or formal policies to ensure that patients receive services that are patient centred, appropriate to their needs and integrated across care settings and over time. Specifically, this study attempts to identify:

  • the importance of coordination problems within individual health care systems and sectors;
  • existing coordination policies, their scope and any evidence of measured impact;
  • institutional and managerial barriers to improved coordination; and
  • experience with coordination programmes such as case and disease management for selected countries. 


The results of this study are based on replies to a detailed questionnaire from 26 countries, supplemented by a review of the literature on the impact of such programmes. The broad result is that, while coordination of care policies seems likely to improve the quality of care (and are therefore valuable in their own right), there is less evidence that they will lead to substantive cost savings.

It also identifies four policy areas which could enhance care coordination:

  • the development of better primary care models;
  • increased resources for primary care;
  • more ICT for data transfer and
  • a greater role for non-physician providers.

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