There are three factors that affect the overall quality of healthcare, according to a US Primary Care Policy Fellowship in 1994. “Three barriers to healthcare are shared by all vulnerable populations: inaccessibility of care, fragmentation of care, and cultural insensitivity on the part of care providers”. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #3, 1994) In looking at health care fragmentations, it is also important to consider inaccessibility and cultural insensitivity as a whole in assessing this healthcare disability. Each populations has it own set of vulnerabilities that set in motion a chain of fragmentation in the healthcare system. Populations such as patients with physical disabilities, mental disabilities, cultural differences, geographic separation, or limited economic resources due to system limitation are unable to enter the health care system efficiently. (Campos-Outcalt D, Fernandez R, Hollow W, paragraph #2, 1994)   Extenuating factors that are meant to improve the overall care of the patient soon become barriers to quality health care.

For example, a 19-year-old female with a 2-year-old son is presented at an urgent care center with strong case of depression and the inability to keep food down. Upon testing she is found to be 2 months pregnant. She is promptly referred to the Welfare department to apply for Medicaid. She has not finished school and is unable to fill out all the forms needed to get adequate care. About two weeks after her visit to the ER she is informed that Medicaid will cover her. With some difficulty she is finally able to locate a provider that will take Medicaid. At the same time her two year old has had no well-baby check ups and is behind on all vaccinations. The system becomes more fragmented when she is found to have complications that if caught earlier in the pregnancy could have been treated. 

Due to the complication, her current provider will no longer see her out of fear that it is outside the scope of his practice. This then forces her to search for another provider that will see her with the complication.  Three weeks have gone by and she is able to get a referral to a specialized OB practice that will take on her care. Problems arise when Medicaid will only pay for two ultrasounds, leaving her with the choice to pay for the additional ultrasounds herself or forego the needed care. Late in her pregnancy she is referred to the WIC office to monitor her and her toddler’s dietary needs. Again more paper work is required, and to complicate things further the WIC office is across town and due to a lack of transportation she is unable to make all her appointments. 

As she gets closer to the delivery date she become so frustrated with the system that she considers abortion, which in her case is easer to get than to have the baby and care for it. The problem with the system is that the fragmentation is subtle and while important to the healthcare system is cumbersome and cryptic to the patient. Is quality healthcare at risk due to the due to the rise of specializations in the health industry? Yes, the system set in place to organize and develop the flow of care often obstructs and inhibits quality patient care. Patients are often faced with difficult decisions on whether or not to receive care and even at times where to go to get the necessary care. Notable care issues quickly arise in vulnerable populations that are unable to adapt to the fragmented complexities of the healthcare system. Fragmentation of healthcare soon leads to poorer patient outcomes. (Linda Mann, paragraph #1, 2004)

What are the desirable and undesirable aspects of this fragmentation?   Notable desirable aspects of fragmentation are better long-term care within specialized fields such as mental health, cardiology and diabetic care. In some healthcare systems, patients can be diagnosed with special need such as Coumadin therapyand Pneumonia without even entering the healthcare system. (Linda Mann, paragraph #10, 2004)

 Undesirable effects are mostly due to a lack of communication within and outside the healthcare system. Patient records are not freely released to providers, not affording providers with key information with respect to patient care. Should actions be taken to slow or stop this trend? Action should be made on a consolidated effort to streamline the health care system with an effort to reduce fragmenting. The more the system fragments the farther it isolates itself from the patient. By working to reduce communication problems and by opening the system between specialized care and routine care there will be a greater opportunity to homogenize the care given regardless of the source. 

In time there will be benefits from fragmentation but it will come more fluidly as the levels of information flow are streamlined and patients are given greater freedom in choice of care. Patients do benefit from knowledge and the patient’s choice of specialized care or general care should be a right. Moreover, the health care system should focus on the needs and rights of its patient base, giving a great range of latitude to vulnerable populations most affected by system-wide fragmentation. The rewards of opening and specializing are to the great benefit of both the patient and the healthcare system. However, this should never come at the expense of the overall quality of patient care.

References:

Campos-Outcalt D, Fernandez R, Hollow W, et al. (1994). Providing quality health care to vulnerable populations. US Public Health Service Primary Care Policy Fellowship. Retrieved 05/05/05 1600 from, www.primarycaresociety.org/1994d.htm

Griffith, J. R. & White, K.R. (2002).  The well managed healthcare organization(5^th ed.). Chicago, IL: Health Administration Press.

Linda Mann. (2004). From “silos” to seamless healthcare: bringing hospitals and GPs

back together again. Retrieved 05/04/05 1500 from, http://www.mja.com.au/public/issues/182_01_030105/man10274_fm.html