Suchergebnisse

En Colombia, el desplazamiento por conflicto armado genera importantes repercusiones económicas y sociales, que afectan, entre otros, a la salud. A pesar de los esfuerzos normativos, el acceso a los servicios de salud de la población desplazada es limitado. Con el objetivo de analizar los factores que desde las instituciones inciden en el acceso potencial de la población desplazada a los servicios de salud, se desarrolló un estudio cualitativo descriptivo, exploratorio, mediante 81 entrevistas individuales semiestructuradas a actores principales. Una insuficiente financiación y dificultades de los proveedores para recibir el pago de las aseguradoras, junto a las indefiniciones y límites del aseguramiento del Sistema General de Seguridad Social en Salud, son las principales barreras al acceso a la atención en salud de la población desplazada. Acceso que también se ve afectado por los numerosos procedimientos establecidos para la atención, la escasa coordinación inter e intrasectorial y los limitados recursos de las instituciones prestadoras de servicios de salud de carácter público. Se requiere una acción gubernamental efectiva que garantice el derecho a la salud en este colectivo. ; In Colombia, the on-going armed conflict causes displacement of thousands of persons that suffer its economic, social, and health consequences. Despite government regulatory efforts, displaced people still experience serious problems in securing access to health care. In order to analyze the institutional factors that affect access to health care by the internally displaced population, a qualitative, exploratory, and descriptive study was carried out by means of semi-structured individual interviews with a criterion sample of stakeholders (81). A narrative content analysis was performed, with mixed generation of categories and segmentation of data by themes and informants. Inadequate funding, providers' problems with reimbursement by insurers, and lack of clear definition as to coverage under the Social Security System in Health pose barriers to access to health care by the internally displaced population. Bureaucratic procedures, limited inter- and intra-sector coordination, and scarce available resources for public health service providers also affect access. Effective government action is required to ensure the right to health care for this population.

Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the ...

This book presents some of the results from the international research project "Impact on equity of access and efficiency of Integrated Health care Networks in Colombia and Brazil (Equity-LA)". Equity-LA was funded by the European Union and had the participation of six institutions from Spain, Belgium, Colombia and Brazil. The project's main objective was to understand the impact of implementing integrated health care networks on access, coordination, efficiency, and equity of access in different Latin American contexts. This study provided results, but also generated new questions that led to Equity LA II project (www.equity-la.eu). Currently undergoing and funded by the European Union, Equity LA II will include data from four additional countries in Latin America (Argentina, Chile, Mexico, and Uruguay) with the objective of broadening this understanding. The analyses described in this work refer exclusively to questions of access, coordination, continuity, and quality of care in health service networks, which are analyzed through a cases study, based on qualitative and quantitative data collected between 2009 and 2012. En este libro se presenta una parte de los resultados del proyecto internacional de investigación "Impacto en la equidad de acceso y la eficiencia de las redes integradas de servicios de salud en Colombia y Brasil (Equity-LA)", financiado por la Unión Europea y en el que participaron seis instituciones de cuatro países, dos europeos (España y Bélgica) y dos latinoamericanos (Colombia y Brasil). La investigación se diseñó con el propósito de mejorar la comprensión sobre el impacto de la implementación de las redes integradas de servicios de salud en el acceso, la coordinación, la eficiencia y la equidad de acceso, en diferentes contextos de Latinoamérica. El estudio además de evidencia, generó nuevas preguntas, que dieron lugar al proyecto Equity LA II (www.equity-la.eu), actualmente en desarrollo, también financiado por la Unión Europea, que profundiza en sus resultados y amplía el análisis a ...

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills. © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive–interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and ...

Background Regional-based Integrated Healthcare Networks (IHNs) have been promoted in Brazil to overcome the fragmentation due to the health system decentralization to the municipal level; however, evaluations are scarce. The aim of this article is to analyse the content of IHN policies in force in Brazil, and the factors that influence policy implementation from the policymakers' perspective. Methods A two-fold, exploratory and descriptive qualitative study was carried out based on (1) content analysis of policy documents selected to meet the following criteria: legislative documents dealing with regional-based IHNs; enacted by federal government; and in force, (2) semi-structured individual interviews were conducted to a theoretical sample of policymakers at federal (eight), state (five) and municipal levels (four). Final sample size was reached by saturation of information. An inductive thematic analysis was conducted. Results The results show difficulties in the implementation of IHN policies due to weaknesses that arise from the policy design and the performance of the three levels of government. There is a lack of specificity as to the criteria and tools for configuring and financing IHNs that need to be agreed upon between involved governments. For their part, policymakers emphasize the difficulty of establishing agreements in a health system with disincentives for collaboration between municipalities. The allocation of responsibilities that are too complex for the capacity and size of the municipalities, the abandonment of essential functions such as network planning by states and the strategic role by the Ministry, the 'invasion' of competences among levels of government and high political turnover are also highlighted. Conclusions The implementation of regional-based IHN policy in Brazil is hampered by the decentralized organization of the health system to the municipal level, suggesting the need to centralize certain functions to regional structures or states and to define better the role of the government levels involved. © 2014 Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

There are few comprehensive studies available on barriers encountered from the initial seeking of healthcare through to the resolution of the health problem; in other words, on access in its broad domain. For Colombia and Brazil, countries with different healthcare systems but common stated principles, there have been no such analyses to date. This paper compares factors that influence access in its broad domain in two municipalities of each country, by means of a cross-sectional study based on a survey of a multistage probability sample of people who had had at least one health problem within the last three months (2163 in Colombia and 2155 in Brazil). The results reveal important barriers to healthcare access in both samples, with notable differences between and within countries, once differences in sociodemographic characteristics and health needs are accounted for. In the Colombian study areas, the greatest barriers were encountered in initial access to healthcare and in resolving the problem, and similarly when entering the health service in the Brazilian study areas. Differences can also be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times. There are also differences according to enrolment status and insurance scheme in Colombia, and between areas in Brazil. The barriers appear to be related to the Colombian system's segmented, non-universal nature, and to the involvement of insurance companies, and to chronic underfunding of the public system in Brazil. Further research is required, but the results obtained reveal critical points to be tackled by health policies in both countries. ; The research leading to these results has received funding from the European Union's Seventh Framework Programme (FP7/2007-2013) under grant agreement nº 223123 which project is entitled/n"Impact on equity of access and efficiency of Integrated Health care Networks (IHN) in Colombia and Brazil" (Equity-LA). Moreover, a grant of the Ministry of Foreign Affairs and Cooperation to Development/n(Spain) was provided to Irene Garcia-Subirats, for the development of the fieldwork (Beca MAEC-AECID 2010e2011 and 2011e2012)

La coordinación asistencial es la concertación de diferentes actividades que son requeridas para atender al paciente a lo largo del continuo asistencial. Se desarrolló un estudio cualitativo para identificar los principales factores que dificultan la coordinación asistencial. Se realizó análisis narrativo del contenido de 32 entrevistas semiestructuradas, desarrolladas a informantes clave de una Empresa Promotora de Salud del régimen Subsidiado. A nivel interno surgen como barreras, las fallas en la comunicación y bajo nivel de colaboración entre profesionales, inadecuadas condiciones de trabajo y problemas para implementar mecanismos de programación. A nivel externo, se destacan fallas en las políticas de regulación de los procesos de contratación asegurador-prestador, de los mecanismos de coordinación y una pobre visión de la atención integral en salud. La existencia de estas barreras desarrollan pérdida de continuidad en la prestación de servicios de salud, requiriéndose la implementación efectiva de mecanismos de coordinación entre los niveles asistenciales. Salud UIS 2011; 43(1): 77-79 ; Care coordination is the agreement of diverse activities requested to attend a patient along care continuum. A narrative analysis of contentment was developed to 32 semi-structured interviews, applied to key informants intentional Selected from a subsidized HCN. Internally arises as barriers, failures in communication and lack of collaboration among professionals, inadequate work conditions and deficiencies in programming mechanisms implementation. External barriers were related with deficient national politics to regulate care provider-insurer contracting, coordination mechanisms and poor view of integrated health. These barriers break the continuity in health care provision. Effective implementation of care coordination is requested among different levels of care. Salud UIS 2011; 43(1): 77-79.

En este libro se presenta una parte de los resultados del proyecto internacional de investigación "Impacto en la equidad de acceso y la eficiencia de las redes integradas de servicios de salud en Colombia y Brasil (Equity-LA)", financiado por la Unión Europea y en el que participaron seis instituciones de cuatro países, dos europeos (España y Bélgica) y dos latinoamericanos (Colombia y Brasil). La investigación se diseñó con el propósito de mejorar la comprensión sobre el impacto de la implementación de las redes integradas de servicios de salud en el acceso, la coordinación, la eficiencia y la equidad de acceso, en diferentes contextos de Latinoamérica. El estudio además de evidencia, generó nuevas preguntas, que dieron lugar al proyecto Equity LA II (www.equity-la.eu), actualmente en desarrollo, también financiado por la Unión Europea, que profundiza en sus resultados y amplía el análisis a cuatro países más de América Latina: Argentina, Chile, México y Uruguay. Los resultados contenidos en esta obra se refieren únicamente a los aspectos de acceso, coordinación, continuidad y calidad de la atención en las redes de servicios de salud, que se analizan mediante un estudio de casos, basado en estudios cualitativos y cuantitativos y cuyos datos se recogieron entre 2009 y 2012. ; This book presents some of the results from the international research project "Impact on equity of access and efficiency of Integrated Health care Networks in Colombia and Brazil (Equity-LA)". Equity-LA was funded by the European Union and had the participation of six institutions from Spain, Belgium, Colombia and Brazil. The project's main objective was to understand the impact of implementing integrated health care networks on access, coordination, efficiency, and equity of access in different Latin American contexts. This study provided results, but also generated new questions that led to Equity LA II project (www.equity-la.eu). Currently undergoing and funded by the European Union, Equity LA II will include data from four additional countries in Latin America (Argentina, Chile, Mexico, and Uruguay) with the objective of broadening this understanding. The analyses described in this work refer exclusively to questions of access, coordination, continuity, and quality of care in health service networks, which are analyzed through a cases study, based on qualitative and quantitative data collected between 2009 and 2012.