Fragmented care – why bother?

I read an article recently in the BMJ Global Health on primary healthcare that warns about fragmentation in how health systems are funded, and fragmentation of patient care that erodes both efficiency and equity.
 
In Australia, we may pride ourselves on a strong public health system – but within general practice, patients are increasingly experiencing fragmented care as a direct consequence of fragmented funding.
 
The result? Poorer outcomes, higher costs, and widening gaps in equity.
 
Take Sarah, a 64-year-old with type 2 diabetes, hypertension, and early-stage chronic kidney disease.
 
Sarah lives in a regional town and visits her GP, who has owned the small practice for many years in this town of 8000 people.
 
Before the clinic reduced its hours, Sarah had regular reviews with her GP, a practice nurse, and visiting allied health professionals under a coordinated care plan.
 
But when the clinic had to cut back, her continuity of care broke down. The diabetes educator’s visits became less frequent, and referrals to a dietitian required out-of-town travel, which Sarah couldn’t afford.
 
Her medication review was delayed because the GP no longer had time to conduct comprehensive chronic disease management appointments.
 
She presented to the local hospital’s emergency department twice in three months – once for a hypoglycaemia, and once for a foot infection.
 
Sarah’s case is an example of a broader problem: fragmented funding creates silos in care, especially when services are funded inconsistently or inadequately through Medicare and incentive programs.
 
As we know, in Australia, funding for general practice is structured around the Medicare Benefits Schedule, which rewards short, episodic consultations.
 
While there are item numbers for chronic disease management, they are rigid, paperwork-heavy, and insufficient for the nuanced and ongoing coordination required for complex care.
 
Moreover, different components of a patient’s care are funded and governed separately, often by different levels of government.
 
The result is a system that makes integration difficult. Patients like Sarah fall through the cracks – not because clinicians don’t care, but because the system isn’t set up to support continuous, team-based care.
 
The fragmentation of care has measurable impacts on outcomes.
 
Studies have consistently shown that patients who experience coordinated, continuous care have lower hospitalisation rates and better chronic disease control.
 
In contrast, fragmented care is associated with delayed diagnoses, medication errors, repeat investigations, and risk of recurrent hospital admissions.
 
Patients in rural and remote areas are particularly vulnerable.
 
Geographic isolation already limits access – but when funding silos mean that services can’t collaborate or coordinate effectively, the burden shifts to patients to piece together their care.
 
Sarah’s story is not rare.
 
It is a symptom of a broader disease – a fragmented system where financing determines care structure, and care structure determines patient outcomes.
 
If we are serious about universal, equitable, high-quality care, then we must address the root cause – and that means reforming how we fund and organise general practice.
 
Only then can we deliver the continuity, coordination and compassion our patients deserve.
 
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fragmentation MBS Medicare Benefits Schedule