As organizational units like hospit

As organizational units like hospitals or clinics become more autonomous, the service
delivery system is at risk of becoming fragmented. Fragmentation may occur among similar
provider configurations (hospitals, ambulatory clinics, or public health programmes) or
between different levels of care. Such fragmentation has negative consequences for both
the efficiency and the equity of the referral system unless explicit policies are introduced to
ensure some sort of integration among the resulting semi-autonomous service delivery
units.
When health services become fragmented, allocative efficiency suffers. For example,
nonclinical health facilities designed to provide public health services in Poland and Hungary
often engage in secondary prevention and a wide range of basic care because they are
not adequately linked to ambulatory care networks. The university hospitals that have recently
been made autonomous in Malaysia provide a wide range of inpatient and outpatient
care for conditions that could have been treated effectively at lower levels in a
community setting. The newly autonomous general practitioners in the Czech Republic
have been quick to buy a large quantity of expensive equipment that is rarely used (59).
When organizational changes among providers cause fragmentation, disillusionment
with a market-oriented system can lead to some vertical and horizontal reintegration, with
more hierarchical control. Armenia, Hungary, New Zealand and the United Kingdom have
recently experimented with such steps. Both the market model and the hierarchical model
present problems; it is important not to forget the shortcomings of the centrally planned
models that were apparent in countries as diverse as Costa Rica, Sri Lanka, Sweden, the
United Kingdom and the former Soviet Union (59).
One way to preserve the virtues of autonomy for providers without fragmentation is via
“virtual integration” instead of traditional vertical integration. Under vertical integration, a
clinic takes orders from a hospital or a government department, limiting its responses to
local needs. Virtual integration means using modern communication systems to share information
quickly and without cumbersome controls. This is particularly valuable for referrals,
and can include nongovernmental providers hard to incorporate under hierarchical
schemes. Bangladesh and Ghana are experimenting with this innovation.

結果 (繁體中文) 1:

組織單位如醫院或診所變得更加自主，服務配送系統處於風險之中變得支離破碎。碎片有可能發生類似提供程式配置 (醫院、 門診或公共衛生方案) 或之間不同層次的護理。這種分裂為兩個有負面的後果效率和公平的轉診制度除非明確的政策被介紹給確保某種之間由此產生的半自治服務交付的集成單位。當健康服務成為碎片時，配置效率遭受。例如，非臨床保健設施旨在提供公共衛生服務在波蘭和匈牙利經常從事二級預防和基本保健的種類繁多，因為他們是不充分地連結到門診醫療網路。最近大學醫院已取得自主在馬來西亞提供範圍廣泛的住院和門診照顧可能已被有效地在較低級別的條件社區環境。在捷克共和國新自治的全科醫生已經快買了大量昂貴的設備是很少使用 (59)。當供應商之間的組織變化產生碎片，幻滅以市場為導向的系統可能導致一些縱向和橫向的重返社會與更多的遞階控制。亞美尼亞、 匈牙利、 紐西蘭和聯合王國有recently experimented with such steps. Both the market model and the hierarchical modelpresent problems; it is important not to forget the shortcomings of the centrally plannedmodels that were apparent in countries as diverse as Costa Rica, Sri Lanka, Sweden, theUnited Kingdom and the former Soviet Union (59).One way to preserve the virtues of autonomy for providers without fragmentation is via“virtual integration” instead of traditional vertical integration. Under vertical integration, aclinic takes orders from a hospital or a government department, limiting its responses tolocal needs. Virtual integration means using modern communication systems to share informationquickly and without cumbersome controls. This is particularly valuable for referrals,and can include nongovernmental providers hard to incorporate under hierarchicalschemes. Bangladesh and Ghana are experimenting with this innovation.

結果 (繁體中文) 2:

作為組織單位，比如醫院或診所變得更加自主，服務
傳遞系統是產生碎片的危險。碎片之間可能會出現類似
提供商配置（醫院，門診部，或公共衛生項目）或
不同級別的護理之間。這些碎片有負面影響為
效率和轉診制度的公平性，除非明確的政策進行了介紹，以
確保某種生成的半自治的服務交付中集成
單位。
當衛生服務變得支離破碎，資源配置效率受到影響。例如，
非臨床醫療設施，旨在在波蘭和匈牙利提供公共衛生服務
經常搞二級預防和廣泛的基礎護理，因為他們
沒有充分掛門診醫療網絡。那最近的大學醫院
已取得自治區在馬來西亞提供廣泛的住院和門診的
照顧，本來是可以有效地在較低級別的處理條件，
社區環境。新自治全科醫生在捷克共和國
已經迅速購買大量昂貴的設備很少使用（59）。
當供應商之間的組織的變化導致碎片，幻滅
與以市場為導向的制度會導致一些垂直和水平重返社會，有
更多的分級控制。亞美尼亞，匈牙利，新西蘭和英國已經
最近嘗試用這樣的措施。無論是市場模型和層次模型
存在的問題; 不要忘了中央計劃的不足之處是非常重要的
車型，在等不同國家哥斯達黎加，斯里蘭卡，瑞典，是明顯的
英國和前蘇聯（59），
以保持自治的美德的一種方式沒有碎片供應商是通過
“虛擬整合”，而不是傳統的垂直整合。在垂直整合，一個
診所從醫院或政府部門採取訂單，限制了其響應
當地需求。虛擬集成是指利用現代通信系統共享信息的
快速，沒有繁瑣的控制。這對於轉介特別有價值，
並且可以包括非政府提供硬下分層納入
計劃。孟加拉國和加納正在嘗試這種創新。

結果 (繁體中文) 3:

由於醫院或診所的組織機構變得更加獨立，服務的交付系統正處於分散的風險。類似的供應商配寘（醫院，門診診所，或公共衛生計畫）之間或不同級別的護理之間發生碎片。這樣的分裂對雙方都有負面的影響效率和轉診制度的公平除非明確政策引入到
確保某種產生的半自治的服務
單元之間的綜合。
當衛生服務變得支離破碎，配寘效率受到。例如，
非臨床健康設施設計提供公共衛生服務在波蘭和匈牙利
經常從事二級預防和廣泛的基礎護理，因為他們是沒有充分連接到動態護理網絡。最近，在馬來西亞的大學醫院提供了一個廣泛的住院和門診病人的護理條件，可以在較低的水准，在一個社區設定有效地治療。