Vertical integration in health: An oasis or a mirage?

Abstract

Around the world, countries strive to provide high-quality healthcare while also attempting to control the growth of healthcare spending. In recent decades, vertically integrated care models have been developed and implemented. In Portugal, vertical integration has been achieved through the establishment of local health units. Over 25 years after the founding of the first unit, and more than a decade since the creation of the most recent one, this model was rolled out nationwide in January 2024, promoting the integration of hospitals and primary care centers into a single institutional and management entity. This approach aims to deliver integrated healthcare, ensure continuity of care, strengthen community primary care services, and emphasize health promotion. The primary objectives of this study are to gain a deeper understanding of vertical healthcare integration, particularly in Portugal, and to evaluate the outcomes of this integration model. As an exploratory study, the methodology includes a review of the relevant literature and national legislation on the topic. The literature presents mixed, limited, inconsistent results, with no distinctly positive trend emerging. While the vertical integration model has the potential to realize the expected theoretical benefits, several factors and vulnerabilities must be considered; otherwise, it may transform a potential oasis into a fleeting opportunity mirage.

Keywords

Healthcare / Integrated care / Vertical integration / Health reforms / Local health unit / Portugal

Funding

None.

Conflict of interest

The authors declare they have no competing interests.

References

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