• health system
• primary care
• integration

Having a healthcare system that’s a public strategic asset rather than a business run for profit allows for a degree of coordination and optimal use of resources.1

This remark by David Fisman, an epidemiologist at the University of Toronto, reflects the views of many policy makers and clinical professionals globally about the relative merits of different organisational models of healthcare for managing the COVID-19 pandemic. COVID-19 emerged in China in November 2019 and was declared a pandemic by the WHO on 11 March. At the time of writing, on 27 July 2020, more than 16.11 million cases of the virus have been reported globally, resulting in more than 64 6641 deaths. Without doubt, responding to this crisis has placed an unprecedented demands on the expertise of public managers, notably those associated with healthcare. But as the opening quotation implies, it may be that these demands are far greater in systems where healthcare services are substantially commercialised and where the emphasis is on competition and fragmentation rather than integration. If this is the case, then how have policy makers and managers dealt with this organisational challenge and what can we learn from their initial responses?

The challenge of how to overcome fragmentation in health services and adopt a system-wide perspective has been one of the most significant wicked problems facing policy makers, managers and clinical leaders around the world. In any healthcare system, rising costs and resource constraints linked to more complex patient needs (associated with population gaining) demand effective collaboration between different parts of a healthcare value chain: public health, primary/community care and specialist hospital services. Ideally this would involve a ‘continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services’ (p10).2

But while this change is urgently needed (perhaps now more than …