Universität Bielefeld

© Universität Bielefeld

Rural care models (RUCA) − An international perspective


Project management and coordination
Prof. Dr. Doris Schaeffer, Dr. Kerstin Hämel

Project implementation
Janina Kutzner

Cooperation partner
Prof. Dr. Michael Ewers, Charité Berlin

Project funding
Robert Bosch Stiftung

Society in general faces the task of adapting the provision and delivery of health and social care to the increasing number of people with chronic illnesses and long-term care needs. In this process it is important to note that demographic aging progresses unequally not just between, but also within countries, and that rural regions in particular are affected more severely than urban areas. Yet new care models are still usually developed and tested in urban areas, so that problems and opportunities in rural areas are disregarded. Furthermore, existing (planning) considerations in Germany are usually limited to some aspects, especially medical care, and do not cover the full range of care services. While regionally differentiated service planning and delivery for rural areas focused on the participation of local players are still underdeveloped in Germany, other countries have more experience.

In this project, care models in two of these countries – Canada and Finland – are examined in detail. In both countries, care models for rural and remote areas have been promoted by means of different strategies in recent years due to the geography, to settlement structures and to the aging of the rural population. Different regional and local models have also been established because of the decentralised health and social care systems in these countries. This represents a rich source of innovation, but could also draw attention to difficulties.

The aim of the project is to identify and explore innovative models of rural health and social care in Canada and Finland and to analyse them with regard to their applicability to (rural) areas in Germany in terms of both quality and quantity.


  • Literature, document and Internet research on community-based/regional care models in Canada and Finland
  • Semi-structured interviews with representatives from academic research, politics and administration and care providers in Canada and Finland to sound out care models and their opportunities and challenges in greater detail, especially in rural areas
  • Work shadowing (non-participatory observation) in community-based care facilities
  • Identification and presentation of examples of good practice
  • Reflection of the results in view of the situation in Germany and development of recommendations for strengthening regionally differentiated care models.


  • Hämel, K. (2016): Plädoyer für eine regional differenzierte, sektorenübergreifende Versorgung [Plea for regionally-differentiated, cross-sectoral health care]. Public Health Forum 24, Nr. 1, 15-16. doi:10.1515/pubhef-2016-0006
  • Hämel K., Kutzner J., Vorderwülbecke J. (2016). Mobile Versorgungseinrichtungen zur Stärkung der Versorgungssicherheit im ländlichen Raum? Eine Analyse von Konzepten und Implementationsanforderungen. Das Gesundheitswesen 79, Nr. 12, 1012-1018. DOI: 10.1055/s-0041-110677
  • Hämel, K., Schaeffer, D.,  Ewers, M. (2015): Modelle für die Gesundheitsversorgung ländlicher Regionen [Health care models for rural regions]. Ländlicher Raum 3, 82-84
  • Schaeffer, D./Hämel, K./Ewers, M. (2015): Versorgungsmodelle für strukturschwache und ländliche Regionen.Anregungen aus Finnland und Kanada[Care models for disadvantaged and rural regions. Experiences from Finland and Canada].Weinheim/München: BeltzJuventa
  • Hämel, K., Ewers, M., Schaeffer, D. (2015): Versorgungsmodelle für ländliche und strukturschwache Regionen – eine international vergleichende Analyse[Care models for disadvantaged and rural regions – an international comparative analysis]. Das Gesundheitswesen 77, Nr. 08/09, A310. doi:10.1055/s-0035-1563266
  • Hämel, K., Kutzner, J. (2015): Weiterentwicklung der häuslichen Versorgung pflegebedürftiger Menschen.Anregungen aus Finnland [The further development of home care concepts for dependent people.Insights from Finland]. Pflege & Gesellschaft 20, Nr. 1, 53-66
  • Ewers, M./Schaeffer, D./Hämel, K. (2015): Gesundheit unterm Ahornblatt [Health beneath the maple leaf]. G + G.Gesundheit und Gesellschaft 18, Nr. 9, 21-26
  • Hämel, K./Schaeffer, D. (2014): Kommunale Gesundheitszentren in Finnland – Entwicklung und aktuelle Herausforderungen in der ländlichen Primärversorgung [Municipal health centres in Finland - Development and current challenges in rural primary health care]. In: Jahrbuch für kritische Medizin und Gesundheitswissenschaften 50, 11-29
  • Hämel, K./Schaeffer, D./Ewers, M. (2014): Versorgungsgestaltung in ländlichen Regionen. Welche Modelle bieten Finnland und Kanada?[Health care in rural regions – what models do Finland and Canada offer?] Informationsdienst Altersfragen 41, Nr. 6, 13-18
  • Hämel, K., Ewers, M., Schaeffer, D. (2014): Primärversorgungszentren in Finnland und Ontario/Kanada – Ansätze für eine nutzerorientierte Versorgung im Alter und bei chronischer Krankheit [Primary health centres in Finland and Ontario/Canada – approaches to user-oriented care for old age and chronically ill people]. Zeitschrift für Gerontologie und Geriatrie 47, Nr. 1, 61-62. doi:10.1007/391-014-0807-6
  • Hämel, K. (2014): Gesundheit und gesundheitliche Versorgung auf dem Land – internationale Perspektiven [Health and health care in rural areas – international perspectives]. Zeitschrift für Gerontologie und Geriatrie 47, Nr. 1, 95. doi:10.1007/391-014-0807-6
  • Ewers, M./Hämel, K./Schaeffer, D. (2014): Besser pflegen in alternden Gesellschaften.Impulse aus Finnland und Kanada [Improving care in aging societies – impulses from Finland and Canada].Betriebskrankenkassen Magazin für Politik, Recht und Gesundheit im Unternehmen, Nr. 3/2014, 40-47
  • Hämel, K. (2014): Kommunale Gesundheitszentren in Finnland: Modell für eine nutzer- und communityorientierte Primärversorgung!?[Municipal health centres in Finland: Model of a user- and community-oriented primary health care].Dokumentation des 19. Kongress Armut und Gesundheit Gesundheit nachhaltig fördern: langfristig, ganzheitlich, gerecht“
  • Schaeffer, D./Hämel, K./Ewers, M. (2014): Zukunftskonzept Multiprofessionelle Primärversorgungszentren [The future concept of multi-professional primary health care centres].In: Pro Alter 46, Nr. 1, 24-27
  • Hämel, K., Ewers, M., Schaeffer, D. (2013): Versorgungsgestaltung angesichts regionaler Unterschiede [Health care and regional disparities]. Zeitschrift für Gerontologie und Geriatrie 46, Nr. 4, 323-328. doi:10.1007/391-012-0465-5


Prof. Dr. Kerstin Haemel
Institute of Nursing Science at the University of Bielefeld
Universitaetsstrasse 25
D-33615 Bielefeld

Tel.: +49 521 106 3894
Fax: +49 521 106 6437
Email: Kerstin.Haemel@uni-bielefeld.de



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