What does productivity mean in integrated care? A scoping review on concepts, measures, and gaps
Abstract
Background: Integrated care is widely promoted to address fragmentation in health and social care systems. A central policy assumption is that integration will improve productivity. However, evidence remains conceptually contested and methodologically heterogeneous, and no consolidated overview exists of how productivity has been defined or measured across integrated care research.
Methods: A scoping review was conducted following established methodological guidance. Peer-reviewed studies and reviews (2010–2025) were included if they examined integrated health and social care in a European context and explicitly linked integration to productivity, efficiency, or resource use. Six databases yielded 2,027. AI tools supported screening and data extraction with full researcher validation. Narrative and thematic synthesis were applied to 30 included studies.
Results: Productivity is operationalised through multiple dimensions: utilisation efficiency, cost-effectiveness, workforce performance, and system-level value. Integration is most consistently associated with reductions in unplanned, high-cost service use in high-need populations. Gains more often reflect resource substitution and avoided escalation than net cost savings. Integrated care can be cost-effective even when short-term costs rise. Several studies report no effects, particularly where integration was structural rather than operational.
Conclusions: Productivity in integrated care is a multidimensional, relational construct. Conventional indicators capture only part of its value, rendering invisible gains such as smoother handovers and reduced client coordination burden. Evaluations should adopt longer time horizons and treat friction and navigation burden as legitimate productivity indicators. Policy should resist short-term efficiency metrics alone.
Key messages: • The productivity of integrated care emerges from connections, not structures.
• Measuring productivity in integrated care requires multidimensional and long-term evaluation frameworks.
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BibTeX
@article{koivisto2026what,
title = {{What does productivity mean in integrated care? A scoping review on concepts, measures, and gaps}},
author = {JP Koivisto and E Liukko and S Majlander and S Launio and K Pasanen},
journal = {The European Journal of Public Health},
year = {2026},
month = oct,
doi = {10.1093/eurpub/ckag169.781},
url = {https://doi.org/10.1093/eurpub/ckag169.781},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - What does productivity mean in integrated care? A scoping review on concepts, measures, and gaps
AU - JP Koivisto
AU - E Liukko
AU - S Majlander
AU - S Launio
AU - K Pasanen
PY - 2026
DA - 2026/10/01
JO - The European Journal of Public Health
DO - 10.1093/eurpub/ckag169.781
UR - https://doi.org/10.1093/eurpub/ckag169.781
AB - Background: Integrated care is widely promoted to address fragmentation in health and social care systems. A central policy assumption is that integration will improve productivity. However, evidence remains conceptually contested and methodologically heterogeneous, and no consolidated overview exists of how productivity has been defined or measured across integrated care research. Methods: A scoping review was conducted following established methodological guidance. Peer-reviewed studies and reviews (2010–2025) were included if they examined integrated health and social care in a European context and explicitly linked integration to productivity, efficiency, or resource use. Six databases yielded 2,027. AI tools supported screening and data extraction with full researcher validation. Narrative and thematic synthesis were applied to 30 included studies. Results: Productivity is operationalised through multiple dimensions: utilisation efficiency, cost-effectiveness, workforce performance, and system-level value. Integration is most consistently associated with reductions in unplanned, high-cost service use in high-need populations. Gains more often reflect resource substitution and avoided escalation than net cost savings. Integrated care can be cost-effective even when short-term costs rise. Several studies report no effects, particularly where integration was structural rather than operational. Conclusions: Productivity in integrated care is a multidimensional, relational construct. Conventional indicators capture only part of its value, rendering invisible gains such as smoother handovers and reduced client coordination burden. Evaluations should adopt longer time horizons and treat friction and navigation burden as legitimate productivity indicators. Policy should resist short-term efficiency metrics alone. Key messages: • The productivity of integrated care emerges from connections, not structures. • Measuring productivity in integrated care requires multidimensional and long-term evaluation frameworks.
SN - 1101-1262
SN - 1464-360X
ER -