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The Fragmentation of U.S. Health CareCauses and Solutions$
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Einer Elhauge

Print publication date: 2010

Print ISBN-13: 9780195390131

Published to Oxford Scholarship Online: May 2010

DOI: 10.1093/acprof:oso/9780195390131.001.0001

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Curing Fragmentation With Integrated Delivery Systems

Curing Fragmentation With Integrated Delivery Systems

What They Do, What Has Blocked Them, Why We Need Them, and How to Get There From Here*

(p.61) 4 Curing Fragmentation With Integrated Delivery Systems
The Fragmentation of U.S. Health Care

Alain Enthoven

Oxford University Press

This chapter begins with a discussion of the fragmentation of health care delivery and its occurrence at two levels: with the individual patient, and at the community level. It then discusses integrated and coordinated health care delivery systems. It is argued that America could move rapidly to integrated systems if it “opens the markets and levels the playing field” by adopting a reform model like the Wyden–Bennett Healthy Americans Act, the Dutch model, or the one proposed by the Committee for Economic Development (CED), in which everyone would have wide, responsible, individual, and informed choice, and multiple choices among alternative health care financing and delivery systems. Experience shows that when offered such a choice, great majorities of people choose integrated systems. The principles of such reforms are comparatively easy to state. The implementation is, unfortunately, extremely complex.

Keywords:   fragmentation, health care delivery, integrated delivery system, health care system

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