Why We Should Care About Health Care Fragmentation and How to Fix it

This chapter summarizes all the other chapters and links them to a general theory of team production in health care. The chapter defines what fragmentation means, the four levels at which it operates, and shows that it worsens health outcomes and costs. The chapter explains why economic theories of firms and team production confirm the conclusion that there is excessive fragmentation in U.S. health care. The chapter explores various causes of fragmentation, concluding that the underlying causes are legal. Finally, the chapter recommends certain reforms that grow directly out of the analysis, including lifting manifold legal obstacles to integrated care, subsidizing preventive care and the creation of a common system of medical records, and paying health care organizations either by amount of medical benefit they produce or by the number of enrollees they attract, with adjustments for the relevant health risks