Sociologický časopis / Czech Sociological Review | DOI: 10.13060/csr.2026.009

Cross-Sectoral Care: Developing a New Framework for Understanding Fragmentation in Social and Health Services

Michaela Veselá Hiekischová ORCID...
Katedra sociální práce, Fakulta sociálně ekonomická, Univerzita Jana Evangelisty Purkyně, Ústí nad Labem

The fragmentation of social and health care is frequently mentioned in scholarly literature as a key obstacle to the integration, quality, and accessibility of care. However, there has yet to be a systematic and comprehensive conceptualisation of this phenomenon. The term ‘fragmentation’ is often used implicitly, without a deeper analysis of the systemic structures and cultural barriers that sustain the fragmentation of care. This article addresses this knowledge gap and proposes a conceptualisation of the fragmentation of social and health care as a multidimensional and multilevel phenomenon. Based on a scoping review of international literature (WoS), coupled with an analysis of Czech expert and strategic documents and exploratory semi-structured interviews with professionals and practitioners, the article presents a conceptual framework of fragmentation. It identifies seven dimensions of fragmentation – (1) institutional, (2) organisational, (3) professional, (4) interpersonal, (5) operational, (6) cultural, and (7) the dimension of initiative and collaboration – and links them to different levels of the care system (macro, meso, micro). The framework is intended to serve as a tool for obtaining a deeper understanding of how and where fragmentation manifests within the structure of care. The proposed framework can be used not only for analytical and research purposes, but also as a basis for policy and organisational interventions. In the Czech context, it represents the first comprehensive attempt to systematically define this phenomenon and its dimensions.

Keywords:
care fragmentation, social and health care, service integration, fragmentation dimensions, macro–meso–micro levels

Received: June 25, 2025; Revised: March 3, 2026; Accepted: March 3, 2026; Prepublished online: March 17, 2026 

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