title: Integrated delivery systems: the cure for fragmentation.
abstract: Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.
authors.affiliation: Graduate School of Business, Stanford University, 518 Memorial Way, Stanford, CA 94305-5015, USA. enthoven_alain@gsb.stanford.edu
authors.forename: Alain C
authors.initials: AC
authors.lastname: Enthoven
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D055317:Evidence-Based Practice; D006279:Health Maintenance Organizations / Q000191:economics / Q000458:organization & administration; D006297:Health Services Accessibility / Q000191:economics / Q000592:standards*; D018578:Hospital-Physician Relations; D006801:Humans; D017059:Models, Econometric; D010816:Physician Incentive Plans / Q000191:economics / Q000592:standards*; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods* / Q000458:organization & administration