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    Proliferation and Fragmentation of Health Professions

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    You have been asked to prepare a speech to deliver to an industry group about the following topic: The unabated continuation of the proliferation and fragmentation of the health professions.

    1. What are the desirable and undesirable aspects of this fragmentation?
    2. Should actions be taken to slow or stop this trend? If so, what should be done and how can it be achieved?
    Please site reference.

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    Solution Preview

    I will answer your questions in the order that you presented them. First, though, this is a large ongoing debate with a massive amount of literature on which to draw from, so these answers will by no means be all-inclusive. However, hopefully we will hit on some of the major points, but ultimately you will have decide what side of the fence you locate yourself. Some argue for integration, while there is some support through international studies that both fragmentation and integration provide the same quality and continuum of care. I will supply ample references for you to draw on as well.

    1. What are the desirable and undesirable aspects of this fragmentation?

    From my readings, there is a clear move away from the fragmentation trend toward a more global integration of health professions and services. Most health professions see an integrated system as an ideal, but this is costly to implement. However, when looking at the desirable versus undesirable aspects, the end results depend on from what side of the debate one stands.

    For example, privatization of health care has definite economic and financial gain for the private companies offering the health care services. However, the effects of privatizing parts of health care services, in the past three decades, has resulted in the health professions being fragmented which leads to fragmentation in financing and providing health care services. As well, moving toard a more interated system costs the government an enormous amount of money to implement, so this could be considered a desirable aspect of fragmentation from an economic perspective (see attachment Healthcare). Let's look at two specific examples.

    - Example One

    In fact, Ontario CUPE (see attachment CUPE Ontario) argues that fragmentation decreases efficiency and equality of care. They say it this way:

    Fragmentation in the health care system must be reduced. Primary care organizations must provide a broad range of health care services and draw on the skills of a range of health care providers: therapists, dentists, nutritionists, nurse practitioners, dental hygienists, doctors, RNs, RPNs, midwives, occupational therapists, optometrists, pharmacists, physiotherapists, laboratory technologists, and social workers. Primary care organizations must be set up to ensure the expansion of the use of non-physician services. To improve efficiency and equality of care, the complete range of primary care services must be funded through our Medicare system."

    Ontario CUPE also argues that fragmentation through "fee-for-service medicine must be replaced." Why? The current piece rate system rewards doctors for providing unnecessary appointments, treatments, prescriptions and referrals. Salaried health care professionals would be more accountable for their services, preventing over-treatment and encouraging teamwork and coordination between providers. To contain costs and prevent the misuse of funds, salaries should be adequate, but capped and in the public domain, with any surplus being redirected to direct service delivery or health promotion or advocacy.

    Thus, according to the Ontario CUPE fragmentation has the potential to decrease efficiency and equality of care, decrease accountability of the Health Profession, and increase the potential of over-treatment and misuse of finds.

    - Example Two

    Let's look at Canada as another example. In the mid-1990s, provincial governments and providers were deterred by the magnitude of change implied by a move towards integrated care. Now that there is some international experience with integrated care and a greater appreciation of its strengths and weaknesses, it is time to move ahead with the Canadian tradition of incremental change.

    There is relatively little literature directly related to performance of integrated health systems as a whole. However, ...

    Solution Summary

    This solution explains the unabated continuation of the proliferation and fragmentation of the health professions, including the desirable and undesirable aspects of this fragmentation, and what actions (if any) should be taken to slow or stop this trend. 2261 words, supplemented with three highly informative articles and two references.