Vertical integration in healthcare systems: a systematic review of the literature

Background: 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. Method: 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. Results: From an initial pool of 157 articles, eighteen 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. Conclusion: 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.