Incentives and obstacles towards seamless care pathways in different countries

In a cross country comparison, we try to identify factors which may influence the degree of interaction between inpatient and ambulatory patient care. For three Scandinavian countries, the United states and Switzerland, the IT-systems in hospitals and healthcare regions as well as electronic health records are described and characterized and the results contrasted with the way healthcare is delivered and financed. As a result, the existence of a national patient identifier, a reduction in the number of hospital information systems and a common database for healthcare professionals in inpatient and outpatient care are identified as positive contributors towards seamless care pathways. In comparison, the existence of an Electronic Health Record in the hands of the patient, or the existence of a tax paid healthcare system or the amount of healthcare expenditure do not necessarily contribute to this effect, since they can be observed also in countries with intermediate or improvable linkage between inpatient and outpatient sector. Seamless patient care has no directly visible correlation to life expectancy or preventable mortality.