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Poster Abstracts

The challenges and opportunities of organising care in rural areas


Matthias Mitterlechner

University of St. Gallen, CH
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Around the world, policy makers look for new ways of organising health and social care in rural areas, challenged by urbanisation, demographic aging, chronic diseases, medical-technical progress, skill shortage and limited financial resources. While research has suggested addressing these challenges by creating integrated regional health systems, much uncertainty still exists about the concrete organisation, implementation and impact of these systems. Against this background, this paper analyses how different organisational designs relate to the quality, outcomes and costs of care in rural areas and how they are implemented. Exploring these questions is essential to preserve care delivery in rural areas also in the future.


We conduct a comparative case study in Grisons, a rural alpine Canton in the south-east of Switzerland. To maintain high-quality and affordable care in the future, Cantonal policy makers recently suggested converting the numerous rural mountain valleys into distinct “health regions,” in which local service providers would integrate their activities under the organisational and possibly legal umbrella of a “health centre.” In each region, the health centre would include one or several hospitals, emergency- and home-care organisations, long-term care centres, health prevention and promotion agencies as well as general practitioners. In the paper, we compare two “integrated regions” that have already created a health centre with two “non-integrated regions” that are at an earlier stage, for each region analysing the current organisation of service delivery, its impact on the triple aim of health quality, outcomes and costs as well as implementation challenges. Data are collected through interviews, surveys and documents from individual service providers and the Cantonal health department. The analysis is done in collaboration with a consulting company, starting in May 2019 and ending in December 2019.


At the time of writing, the analysis is still in progress and findings are preliminary. Early evidence suggests that creating health centres may help rural health regions preserve access to care, while per-capita spending is neither lower nor decreasing when compared to non-integrated regions. However, service providers coordinating activities in health centres can benefit from economies of scale and scope, which lower their fixed costs and increase the quality of support and medical care services. These preliminary insights will be deepened and corroborated until December 2019 and presented in their final form at the International Conference on Integrated Care in April 2020.

Discussion and conclusion

In many countries, rural areas are concerned with preserving access to high-quality and affordable care in the future. In view of profound changes like urbanisation, population aging, rapid technological progress and a growing shortage of human and financial resources, research has proposed to build integrated regional health systems without necessarily specifying the concrete organisation, implementation and effects of these systems. Drawing on latest evidence from Switzerland, this paper aims to close this gap in the literature, providing fresh insights into the challenges and opportunities of organising care in rural areas.


How to Cite: Mitterlechner M. The challenges and opportunities of organising care in rural areas. International Journal of Integrated Care. 2021;21(S1):273. DOI:
Published on 01 Sep 2021.


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