Analyze the structural fragmentation of healthcare systems across global regions, quantify the transaction costs and capability loss from institutional siloing, and assess evidence for integration models that maintain local autonomy while enabling system-level coordination.

Comparative health systems analysis across 35 countries using WHO health system performance framework. Case study analysis of successful integration models: UK NHS, Taiwan's single-payer system, Rwanda's district health systems. Quantification of coordination failures during COVID-19 using excess mortality data and genomic sequencing coordination failures.

Healthcare systems globally are characterized by deep fragmentation: hospitals compete rather than coordinate; primary care is disconnected from secondary/tertiary; public and private sectors operate in parallel; and international capacity sharing (diagnostics, PPE, vaccines) is ad-hoc despite obvious opportunities for efficiency.

During COVID-19, fragmentation created massive inefficiencies — diagnostic capacity sat idle in some regions while others faced shortages; vaccine distribution followed geopolitical lines rather than epidemiological need.

Rwanda's integration of community health workers into a coordinated district system reduced maternal mortality 71% between 2000-2019, yet this model is rarely exported. The transaction costs of fragmentation are estimated at 5-10% of health spending globally.