Integrated Health Service Delivery Networks: Concepts, Policy Options and a Road Map for Implementation in the Americas

Abstract

[Executive Summary]. Health systems in the Americas are characterized by highly fragmented health services. Experience to date demonstrates that excessive fragmentation leads to difficulties in access to services, delivery of services of poor technical quality, irrational and inefficient use of available resources, unnecessary increases in production costs, and low user satisfaction with services received. Health services fragmentation manifests itself in multiple ways at the different levels of the health system. Regarding the overall performance of the system, fragmentation is evident in the lack of coordination across the different levels and sites of care, duplication of services and infrastructure, unutilized productive capacity, and the provision of health services at the least appropriate location, particularly hospitals. Regarding the experience of system users, fragmentation is apparent in the lack of access to services, loss of continuity of care, and failure of services to meet users’ needs...