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Coordination of care is one of the hidden dysfunctional aspects of medical care. The problem is that coordination of care is not reimbursed by insurance companies. Providers are expected to do the right thing and contact other providers between clients.

From the outside looking in, that would appear to make sense. Good medical care requires consulting with other providers to ensure everyone is working on the same plan and not against each other.

However, the economic crunch on medicine has been on for the past decade. Physicians and other providers are making less income than at anytime in the past generation. Providers are pushed to be more efficient. The result is that coordination of care gets less attention. This problem promises only to get worse with further cuts in Medicare and insurance reimbursement inevitable. If coordination of care remains non-reimbursed, quality will continue to suffer.

McClatchy Washington Bureau

Elijah Mense, a talkative 5-year old with dark curly hair, is very sick and his family doesn't know exactly why.

They know some of what's wrong. But not everything. So they've been tossed from one specialist to the next. "I learned up here the doctors don't work together," says his mother, Serene Mense.

She has butted up against a serious weakness in the U.S. medical system: Lack of coordination among doctors.

Insurance won't pay a doctor to coordinate care in a complex case, and it's difficult to do. The doctor has to contact all the other doctors involved, see that test recommendations are carried out, and battle with insurance companies over coverage for specific treatments.

Yet a complicated case like Elijah's clearly demands such coordination.