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Fragmentation In Health Care

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I take the term to mean having multiple decision makers make a set of health care decisions that would be made better through unified decision making. Individual decision makers responsible for only one fragment of a relevant set of health care decisions may fail to understand the full picture, may lack the power to take all the appropriate actions given what they know, or may even have affirmative incentives to shift costs onto others. All these forms of fragmentation can lead to bad health care decisions. Fragmentation can occur along many dimensions. Looking at the narrowest dimension, we might be concerned about fragmentation in treating particular illnesses, such as the lack of coordination among the various professionals involved in treating …show more content…

Given that we are talking about medicine, it makes sense to begin by asking: are there sound medical or scientific reasons for the current fragmentation of U.S. health care. The fact that other nations have far more integrated health care systems and hospitals dominated by salaried doctors, and achieve similar or better health results at lower cost, belies any claim that medicine or science inherently requires U.S. levels of disintegration. This same fact seems inconsistent with the claim that the sociology of the medical profession inherently requires such fragmentation. Further, Institute of Medicine studies of the U.S. system have condemned fragmentation because it leads to more medical errors, meaning that, if anything, sound medicine and science cuts in the opposite direction and is being overwhelmed by other causes. This much may seem obvious, but it has an important implication. If medical or scientific reasons are not driving current health care fragmentation, it is unlikely that fragmentation is going to be cured by studies that show how it leads to medical errors, by analyses demonstrating medically optimal team methods, or by new information technologies that help hospitals and physicians coordinate better. Those may help at the margins, but to really tackle fragmentation we are going to have to address the underlying structural cause that has been driving U.S. health care to levels of disintegration that are medically

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