Health Service Fragmentation
By Hao Yi Tan
Health service fragmentation refers to healthcare delivery system breakdowns, causing disjointed, inefficient, and ineffective patient care. Health service fragmentation poses significant challenges to healthcare systems' effectiveness and efficiency, leading to several key issues compromising patient care and resource use (1,2). However, many of the health systems in the world today struggle with fragmentation, and often do not have the ability to function as a cohesive, integrated whole (3).
A primary concern from fragmentation is care continuity. In fragmented systems, patients receive treatment from multiple providers across settings without coordination, causing disjointed care, gaps, redundant tests, and conflicting treatment plans, compromising outcomes. Fragmentation also hinders effective communication among providers, leading to misunderstandings, treatment delays, and errors. Service duplication is another issue (4). Fragmented systems contribute to duplicating medical services due to lack of shared information, increasing costs and wasting resources. Therefore, fragmentation leads to inefficiencies and care delivery delays, causing patient dissatisfaction, prolonged wait times, and difficulty navigating disjointed care pathways, diminishing care quality and potentially harming health (5).
Fragmentation compromises care quality, increases medical errors and costs, and exacerbates disparities in healthcare access, particularly affecting vulnerable populations such as low-income individuals, minorities, and rural communities (6). Addressing fragmentation requires comprehensive reforms promoting integration, coordination, and collaboration within healthcare systems to enhance care quality, improve outcomes, and advance health equity.
References
1. Spicer N, Agyepong I, Ottersen T, Jahn A, Ooms G. ‘It’s far too complicated’: why fragmentation persists in global health. Globalization and Health 2020; 16(1): 1-13.
2. Stange KC. The problem of fragmentation and the need for integrative solutions. Annals Family Med; 2009. p. 100-3.
3. Spicer N, Agyepong I, Ottersen T, Jahn A, Ooms G. ‘It’s far too complicated’: why fragmentation persists in global health. Globalization and Health 2020; 16: 1-13.
4. Trinh HQ, Begun JW, Luke RD. Hospital service duplication: evidence on the medical arms race. Health Care Management Review 2008; 33(3): 192-202.
5. Robben SH, Huisjes M, van Achterberg T, et al. Filling the gaps in a fragmented health care system: development of the health and welfare information portal (ZWIP). JMIR Research Protocols 2012; 1(2): e1945.
6. Hutson A, Kaplan M, Ranjit G, Mujahid M. Metropolitan fragmentation and health disparities: is there a link?. The Milbank Qquarterly, 90 (1), 187–207. University of California Berkeley 2012.