医疗保健系统中的垂直整合：文献的系统性综述
Vertical Integration in Healthcare Systems: A Systematic Review of the Literature.
摘要(中文译文)
垂直整合正被各类卫生系统采纳，以提升质量、可及性和效率。本文旨在推进现有的垂直整合研究，引入卫生系统类型作为新视角，以更好地理解其与医疗整合的关系。检索了Web of Science和Scopus中2014年至2024年的英文文献，检索词包括：“垂直整合”“医院护理”“初级保健”“三级保健”“医疗保健”“社会照护”“价格”“成本”“质量”“效率”“可及性”。筛选出与研究相关的领域。采用PRISMA提高本研究的报告质量，并使用STROBE矩阵评估所选文章的完整性。从初始157篇文章中，经筛选和全文分析后，18篇符合纳入标准。其中，13项研究聚焦于私立卫生系统，4项聚焦于国家卫生系统，1项聚焦于国家医疗保险系统。观察到的模式表明，在私立卫生系统中，垂直整合可能与市场集中度增加相关，进而可能导致价格上涨和潜在负面影响。相反，在国家卫生系统中，垂直整合可能与质量、可及性和效率的改善相关。关于国家医疗保险系统中垂直整合的证据仍然有限且尚无定论。垂直整合的结果似乎因卫生系统类型而异。私立系统可能面临与市场力量和成本增加相关的挑战，而国家卫生系统在服务质量和效率方面显示出潜在益处。然而，这些结论基于对异质性研究的叙述性综合。由于数据稀缺，需要进一步研究以阐明国家医疗保险系统中垂直整合的结果。
Abstract
Vertical integration is being implemented in various health systems to improve quality, accessibility, and efficiency. This article seeks to further existing research on vertical integration by introducing the type of health system as a new perspective to better understand how it relates to healthcare integration. Articles in English were searched in Web of Science and Scopus from 2014 to 2024 using the following terms: "Vertical Integration", "Hospital care", "Primary care", "Tertiary care", "Health care", "Social care", "Price", "Cost", "Quality", "Efficiency", "Access". Relevant areas for the research were selected. PRISMA was used to improve the reporting quality of our work, and the STROBE matrix was used for assessing the completeness of the selected articles. From an initial pool of 157 articles, 18 met the inclusion criteria after screening and full-text analysis. Among these, thirteen studies focused on private health systems, four on national health systems, and one on a national health insurance system. Patterns observed indicate that in private health systems, vertical integration can be associated with increased market concentration, which may lead to higher prices and potential negative effects. Conversely, in national health systems, vertical integration might be linked to improvements in quality, access, and efficiency. Evidence regarding vertical integration in national health insurance systems remains limited and inconclusive. The results of vertical integration appear to vary according to the type of health system. While private systems may face challenges related to market power and cost increases, national health systems show potential benefits in service quality and efficiency. However, these conclusions are based on a narrative synthesis of heterogeneous studies. Due to scarce data, further research is needed to clarify the results of vertical integration within national health insurance systems.
如何引用
AMA
Carlos J Afonso-Henriques, Francisco-Jesús Ferreiro-Seoane, Francisco Reyes-Santias. Vertical Integration in Healthcare Systems: A Systematic Review of the Literature.. Portuguese journal of public health. 2026; doi:10.1159/000553358.
APA
Carlos J Afonso-Henriques, Francisco-Jesús Ferreiro-Seoane, Francisco Reyes-Santias (2026). Vertical Integration in Healthcare Systems: A Systematic Review of the Literature.. Portuguese journal of public health. https://doi.org/10.1159/000553358
GB/T 7714
Carlos J Afonso-Henriques, Francisco-Jesús Ferreiro-Seoane, Francisco Reyes-Santias. Vertical Integration in Healthcare Systems: A Systematic Review of the Literature.[J]. Portuguese journal of public health, 2026 doi:10.1159/000553358.
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