In recent years, healthcare fragmentation has emerged as a significant concern in the international community especially in Malaysia. It refers to the trend of increasing division and conflict in healthcare delivery and healthcare personnel. Healthcare fragmentation has been caused by multi various factors, ranging from economic and political to cultural and social, and it has significant implications for the stability of the national health care systems.

What is Healthcare fragmentation?

Healthcare fragmentation is a term used to describe a complex issue that affects the effectiveness and efficiency of health care systems and it can occur at multiple levels and have various causes and impacts. According to a paper published in the New England Journal of Medicine Catalyst, access to health care is a level-one core equity measures that can help identify healthcare fragmentation. This measure involves comparing the percentage of Medicaid and/or uninsured patients treated by a health care institution with the total percentage of Medicaid and/or uninsured individuals in the relevant city, state, or region. Despite Malaysia’s effort in socio-economic development plans, there still exist issues in equity and accessibility especially for the indigenous groups, rural population and the hard-core poor. This can be seen through quality in term of health services, manpower and equity in terms geographical location and accessibility in term of price and tariff.

The causes of Healthcare Fragmentation

A study published in PubMed Central identified six themes of fragmentation in Health Care System, including political, structural, inter-sectoral, financial, governance, and health agenda-related forms. The study concludes that health system fragmentation existed before the conflict and has worsened as the conflict evolves. A study by Kern LM et al. (2019) mentioned that 40+ causes of fragmentation that participants identified came from all levels of the healthcare system: patients, providers, healthcare organizations and healthcare environments. For example, patient-level causes included preference for the convenience of particular locations, the availability of appointments, and the need for second opinions. Provider-level reasons included the amount of time needed to educate a patient versus referring them to a specialist and increasing sub-specializations. Causes at the healthcare organization level included policies set by the providers such as discharge processes that encourage follow-up with various specialists and insurers’ decisions regarding which providers are “in network.” At the environment level, the rise of urgent care clinics was cited as a factor.

About the author

Dr Darween Rozehan Shah Iskandar Shah is a lecturer at AHIBS with a specialization in Healthcare Industry Development and Healthcare Management. He granted his Master in Public Health from University of Malaya, while Medical Degree and Bachelor of Medical Sciences from Indonesia. Currently he is a PhD Candidate in Environmental Health Engineering at University of Malaya. His area of expertise includes Public and Global Health, Healthcare Policy and Improvement, Environmental Health and Engineering, Sustainable Environment, Sustainable Waste Management, Sustainable Inno-Prenuers, and circular economy.

The effects of Healthcare Fragmentation

The effects of healthcare fragmentation are wide-raging and significant. They include conflict and instability of healthcare delivery, health economic uncertainty and volatility, and the erosion of health care delivery and the health care providers. Fragmentation can cause regional differences in fragmentation patterns, leading to inefficiencies and higher cost. In low- and middle-income countries (LMICs), fragmentation in healthcare financing can restrict progress towards achieving universal health coverage (UHC) and increase inefficiencies.

Major issues related to Healthcare Fragmentation

Healthcare fragmentation is a major issue that can lead to a variety of problems. One issue related to healthcare fragmentation is access to healthcare services which means whether patients can even gain entry to the healthcare system. Another issue related to healthcare fragmentation is healthcare disparities, especially for people of colour and other disadvantages groups. In a few countries, global healthcare system has a tendency to delay or deny high-quality care to those who can least afford its high cost, which contributes to avoidable healthcare disparities.

Fragmentation in healthcare delivery can have spill over effects that cause regional differences in fragmentation patterns. In a theoretical model of care fragmentation, researchers have found better incentives may improve the delivery of healthcare, but only when fragmented care is more costly. Weak coordination among healthcare providers is another issue related to healthcare fragmentation. This makes it harder to clarify responsibilities for ongoing care, and to avoid redundant and unnecessary care. Care fragmentation occurs when the delivery of healthcare is spread across and excessively large number of poorly coordinated providers. Care fragmentation is considerate to be a potentially important source of inefficiency in healthcare delivery.

Ways to solve Healthcare Fragmentation

There are several ways to solve healthcare fragmentation. One approach is to implement care coordination programs that involve multidisciplinary care teams, care managers, and care coordinators. These programs focus on coordinating care across providers and settings, including hospital, clinics, and long-term care facilities. By improving communication and collaboration among healthcare providers, care coordination programs can reduce fragmentation and improve patient outcomes.

Another approach is to implement health information technology (HIT) solutions, such as electronic health records (EHRs) and health information exchanges (HIEs). HIT solutions can facilitate the exchange of patient health information among healthcare providers, reducing redundancies and improving care coordination. Additionally, healthcare organizations can implement value-based care models, which prioritize quality of care over quantity of services provided. Value-based care models incentivize providers to work together to deliver coordinated care, reducing fragmentation and improving patient outcomes.

Healthcare fragmentation is a major challenge that can lead to inefficiencies, high costs, and reduced quality of care. To address healthcare fragmentation, healthcare organizations can implement care coordination programs, health information technology solutions, and other strategies to improve communication and collaboration among healthcare providers and improve patient outcomes.

Kern, L.M., Safford, M.M., Slavin, M.J. et al. Patients’ and Providers’ Views on Causes and Consequences of Healthcare Fragmentation in the Ambulatory Setting: A Qualitative Study. J Gen Intern Med 34, 899–907 (2019).

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