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¶ … local institutions, there are efforts to systematize healthcare through an integrated offering of services. A patient can receive treatment for cancer, for example, in a multi-faceted way. Counseling for the emotional turmoil created by cancer treatment can be paired with radiation, chemotherapy, and other forms of physical treatments for a variety of types of cancers. There is also a variety of health-promotion programs at many local hospitals, along with efforts to treat illnesses from a purely medical perspective. Fitness classes for seniors, support groups for overeaters, and various health 'expos' that offer on-site testing for heart disease and cholesterol attempt to create a truly integrated healthcare system that addresses the causes as well as the symptoms of unhealthy behaviors.
However, as laudable as these efforts may be, there are still many notable instances of fragmentation. Miscommunication between physicians treating the same patient still occurs, even within the same hospital, despite the existence of electronic records. Often, organizations are so overwhelmed, critical...
Perhaps the most obvious example of fragmentation is the degree to which health insurance companies determine the type of care that is disseminated. Doctors prescribe testing and treatment based upon what insurance companies will cover, not the patient's individual needs. Patients with better insurance get better care, and those who receive more treatment are not necessarily the sickest or the most in need of screening, but are simply the patients with the most comprehensive coverage. Patients may find that their insurance company does not cover tests done by a particular lab within the hospital, even though other types of treatment are authorized by the hospital. This creates waste, confusion, and inefficiency. Insurance companies often support "narrowly evidence-based care of individual diseases, rather than higher level integration of care for prevention, mental health, multi-morbid conditions, and acute concerns" and this influences how care is provided (Strange 2009).
Part II
Perhaps the most common overriding concern in the…
References
Murray, C., Kulkarni, S., et al. (2006). Eight Americas: Investigating mortality disparities across races, counties, and race-counties in the United States. Medicine, 3(8), 260.
Strange, Kenneth. (2009). The problem of fragmentation and the need for integrative solutions.
Annals of Family Medicine 7:100-103. Retrieved September 4, 2011 at http://www.annfammed.org/cgi/content/full/7/2/100
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