The Importance of Scale in Integrated Care

This chapter explores the critical yet often ambiguous concept of scale in integrated care networks. While integrated care is increasingly recognized as essential for delivering high-quality, person-centered care, the question of what constitutes a “suitable scale” remains underexplored in empirical research. Drawing on interviews with Dutch healthcare CEOs and network coordinators, the study identifies seven key factors influencing decisions about suitable scales, clustered into three overarching perspectives: the needs of the target population, systemic-organizational principles, and social-relational dynamics. The findings reveal that scale is not a fixed or purely rational construct but is shaped by contextual, normative, and historical factors. The need for dynamic, reflective scaling processes that evolve with changing contexts and demands is also an insightful recommendation. Moreover, CEOs often approach scale from the perspective of their own organization’s survival, conditions, attractiveness, and influence—while network coordinators adopt a perspective in which the network collaboration takes center stage, emphasizing collective goals and systemic coherence. The chapter highlights the importance of aligning these perspectives to avoid inefficiencies and missed opportunities in care delivery. Rather than relying on traditional macro-meso-micro frameworks, the chapter proposes a more nuanced, practice-based understanding of scale that can guide integrated care initiatives. The study offers a heuristic framework to support discussions and decisions about scale in integrated care, emphasizing that suitable scaling needs more attention and is a continuous, negotiated process rather than a one-time decision. In times of permanent resource scarcity, rethinking scale becomes increasingly relevant for sustainable and effective care collaboration in health and social care systems.