Organizational Fragmentation and Care Quality in the U.S. Healthcare System

Abstract

T he financing and provision of health care in the United States is distributed across a variety of distinct and often competing entities, each with its own objectives, obligations, and capabilities. These fragmented organizational structures lead to disrupted relationships, poor information flows, and misaligned incentives that combine to degrade the quality of health care in important ways. Many goods and services can be readily financed and provided through a series of unconnected transactions, but in health care, close coordination improves both health outcomes and the efficiency with which good outcomes are achieved.In discussing the effect of organizational fragmentation on the quality of health care, it is helpful to separate the financing of health care from the provision of care. Medical expenditures over a lifetime are often large, lumpy, and uncertain, y Randall Cebul is Professor

Competition in Health Care Markets

“…Thus, the returns to developing new care modalities that result in higher quality and/or lower cost care are likely to be modest. Cebul et al (2008) also consider organizational issues in health care. They point to sociological factors, legal barriers, and issues with information (the compatibility and deployment of information technology specifically) as the key reasons for the inefficient organization of this sector.…”

Standardized information for living liver donors

“…Accordingly, standardization can help to resolve the inherent fragmentation in the educational process between providers within the health care system. 5 Web-based educational tools are touted as effective approaches for fostering comprehension within the informed consent process in other clinical contexts. 6 Indeed, there is increasing support for such Web-based consent interventions within the field of surgery.…”

Cost savings through molecular diagnosis for hereditary hemorrhagic telangiectasia

“…The second time period was three years because private health insurance providers in the United States focus on a relatively brief time frame due to the mobility of consumers from one plan to another. 13 The results clearly demonstrate an economic benefit for clinical molecular screening, whether the clinical screening is conducted into adulthood or for a relatively brief period.…”

“…These calculations for a single screening visit are relevant to insurance providers in the US health-care market, where consumers change insurers, on average, less than every 5 years. 13 …”