Suchergebnisse

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 ...

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.