Fragmentation of care for frail older people--an international problem. Experience from three countries: Israel, Canada, and the United States

J Am Geriatr Soc. 2001 Dec;49(12):1714-21. doi: 10.1046/j.1532-5415.2001.49285.x.


Cross-national comparisons of healthcare systems can help us to better understand them and to offer possible solutions for problems identified within these jurisdictions. Because multiple discontinuities present in most healthcare systems interfere with the appropriate clinical care of frail older people, we were interested in comparing the situation in three countries with markedly different healthcare systems. At one end of the spectrum we find Canada, with an almost fully socialized system. At the other stands the United States, where market forces are allowed the freest rein in any developed nation. Israel offers an intermediate model with elements held in common with both the U.S. and Canadian systems. Although the problems outlined in this paper can be addressed at the "micro" level, it is through an improvement in the structuring and organization of national systems of care that the appropriate conditions for the care of frail older people can be truly bettered. This international comparison offers insights for policy makers in these three states in particular and other countries in general.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Aged
  • Aged, 80 and over
  • Canada
  • Delivery of Health Care / organization & administration*
  • Female
  • Frail Elderly*
  • Global Health*
  • Humans
  • Israel
  • Male
  • Quality of Health Care / organization & administration*
  • United States