Fragmentation and integration in health care: the referral process and social brokerage

Abstract

Summary Studies of institutional care raise issues about the transitions that people make as patients moving from one system of care to another. Hospital and Community are unreliable concepts, but they are still useful in understanding a fragmented reality. If we examine the referral process, we see how it is necessary to fit people to a succession of fragmented systems, with separate tasks. How these systems define their different tasks determine the transitions that patients have to make. Ambiguity about task is protective of caring staff. But there are also ways in which care systems can be integrative and take shape around the needs of the individual. There is a need for a kind of social brokerage in the interests of patients to make the best use of integrative care systems. Copyright © 1979, Wiley Blackwell. All rights reserved