Can service integration work for universal health coverage? Evidence from around the globe.
Universal health coverage (UHC) is at the heart of the new 2030 Agenda for Sustainable Development. Health service integration is seen by World Health Organization as an essential requirement to achieve UHC. However, to date the debate on service integration has focused on perceived benefits rather than empirical impact. We conducted a global review in a systematic manner searching for empirical outcomes of service integration experiments in UHC countries and those on the path to UHC. Sixty-seven articles and reports were found. We grouped results into a unique integration typology with six categories - medical staff from different disciplines; patients and medical staff; care package for one medical condition; care package for two or more medical conditions; specialist stand-alone services with GP services; community locations. We showed that it is possible to integrate services in different human development contexts delivering positive outcomes for patients and clinicians without incurring additional costs. However, the improved outcomes shown were incremental rather than radical and suggest that integration is likely to enhance already well established systems rather than fundamentally changing the outcomes of care.
University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK. Electronic address: g.dalgetty@leeds.ac.uk.
Gillian
G
Lê
John Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, United States. Electronic address: rosemary.morgan@jhu.edu.
Rosemary
R
Morgan
University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK. Electronic address: J.Bestall@leeds.ac.uk.
Janine
J
Bestall
University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK. Electronic address: I.Featherstone@leeds.ac.uk.
Imogen
I
Featherstone
University of York, Enterprise House, Innovation Way, Heslington, York YO10 5NQ, UK. Electronic address: tjfv@hotmail.com.
Thomas
T
Veale
University of Leeds, 101 Clarendon Road, Leeds LS2 9LJ, UK. Electronic address: T.R.A.Ensor@leeds.ac.uk.
Tim
T
Ensor
D003695:Delivery of Health Care; D019033:Delivery of Health Care, Integrated; D014943:Global Health; D006297:Health Services Accessibility / Q000191:economics / Q000639:trends; D006801:Humans; D064890:Social Determinants of Health; D019472:Universal Health Insurance / Q000191:economics / Q000458:organization & administration*
Global review; Service integration; Universal healthcare coverage