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 SustainableDevelopment. Health service integration is seen by World Health Organization as an essen-tial requirement to achieve UHC. However, to date the debate on service integration hasfocused on perceived benefits rather than empirical impact. We conducted a global reviewin a systematic manner searching for empirical outcomes of service integration experimentsin 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 stafffrom different disciplines; patients and medical staff; care package for one medical condi-tion; care package for two or more medical conditions; specialist stand-alone services withGP services; community locations. We showed that it is possible to integrate services indifferent human development contexts delivering positive outcomes for patients and clin-icians without incurring additional costs. However, the improved outcomes shown wereincremental rather than radical and suggest that integration is likely to enhance alreadywell established systems rather than fundamentally changing the outcomes of care.