Natalia Yavich

Un marco de evaluación de la atención primaria de salud en América Latina

OBJETIVOS: Determinar la pertinencia de aplicar la estrategia canadiense de evaluacion de la atencion primaria de salud (APS) en America Latina y proponer las modificaciones necesarias para llegar a un consenso latinoamericano. METODOS: Se utilizo el metodo Delphi para llegar a un consenso entre 29 expertos comprometidos con el desarrollo o la evaluacion de la APS en America Latina. Se realizaron cuatro rondas virtuales y un encuentro presencial para discutir el modelo logico de evaluacion de la APS, los siete objetivos y los seis factores condicionantes que forman parte de la estrategia canadiense, con sus interrogantes de evaluacion e indicadores. Se calificaron la relevancia y la pertinencia de cada concepto desde el punto de vista de los paises de America Latina. RESULTADOS: Los expertos consideraron los objetivos y los factores condicionantes de la estrategia canadiense altamente pertinentes para evaluar la APS en America Latina, aunque reconocieron la necesidad de modificarlos para aumentar su pertinencia. Los principales cambios fueron la formulacion de una vision y una mision de la APS, la inclusion de nuevos objetivos y factores condicionantes y la reformulacion de los originales. Los objetivos de coordinacion y atencion integral e integrada no lograron un alto nivel de consenso debido a ambiguedades en los enunciados originales y la coexistencia de distintas interpretaciones sobre el significado de ciertas dimensiones de evaluacion referidas en los enunciados. CONCLUSIONES: Se lograron avances significativos en el camino hacia la construccion de un marco de evaluacion para la APS en la Region de las Americas. Es necesario desarrollar indicadores e instrumentos de recoleccion de informacion adecuados y factibles de ser aplicados en distintos contextos.

Construyendo un marco de evaluación de la atención primaria de la salud para Latinoamérica

Objective. To determinate the clarity, relevance and pertinence of a primary health care evaluation strategy for different Latin American health sub-systems. Material and Methods. This strategy was assessed using workshops held with decision makers and administrative managers from a public health organization, a social insurance and a private insurance health organization. The study took place in the province of Santa Fe (Argentina) between May 2006 and May 2007. Results. The strategy was determined to be clear and relevant by all organizations, but highly applicable only in the public case. The social-insurance and private cases questioned the pertinence of objectives related to community participation, intersectoral actions and a focus on social determinants of health, in addition to considering it necessary to restrict the scope of ideas related to universal access and equity with regard to their client population. Discussion. The evaluation of the pertinence of the strategy was explained by the particularities of the institutional context, as well as the goals and survival strategies used by each organization.

Financiamiento, organización, costos y desempeño de los servicios de los subsistemas de salud argentinos

Objective: To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosarios health sub-systems. Materials and methods: The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Results: Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Conclusion: Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

Financiamiento, organización, costos y calidad de la atención en los sub-sistemas de salud argentinos

Objective: To analyze the relationship between health system financing and services organization models with costs and health services performance in each of Rosarios health sub-systems. Materials and methods: The financing and organization models were characterized using secondary data. Costs were calculated using the WHO/SHA methodology. Healthcare quality was measured by a household survey (n=822). Results: Public subsystem:Vertically integrated funding and primary healthcare as a leading strategy to provide services produced low costs and individual-oriented healthcare but with weak accessibility conditions and comprehensiveness. Private subsystem: Contractual integration and weak regulatory and coordination mechanisms produced effects opposed to those of the public sub-system. Social security: Contractual integration and strong regulatory and coordination mechanisms contributed to intermediate costs and overall high performance. Conclusion: Each subsystem financing and services organization model had a strong and heterogeneous influence on costs and health services performance.

Concentración y desigualdades en el financiamiento de las obras sociales posdesregulación: un análisis comparativo de los años 2004 y 2011

In Argentina, during the decade of the 1990s major changes were introduced into the regulatory framework of the national obras sociales, or union-based health coverage plans. Using data from the Federal Administration of Public Income (AFIP) [Administración Federal de Ingresos Públicos], this study evaluates for the years 2004 and 2011: a) the importance of obras sociales within the healthcare system, b) the degree of concentration of this health social security subsystem, and c) the inequalities in the availability of funds among the obras sociales and their beneficiaries. The results show an increased importance of obras sociales within the Argentine health system. The concentration of funds distributed to the most important institutions within the subsystem showed no change, while the concentration of contributors to these institutions slightly increased and that of beneficiaries decreased. Finally, a reduction of the inequalities in funds per beneficiary received by different institutions was observed. This trend can be explained, among other factors, by the attenuation of wage differentials between branches of economic activity and the actions of the so-called Solidarity Redistribution Fund.

Litígio judicial e o direito à saúde na Argentina

This article explores the characteristics of lawsuits for obtaining access to healthcare through the Argentine Supreme Court and reflects on the potential to influence health rights and equity in a context of growing litigation. An analysis of documents from 125 lawsuits with verdicts issued from 1994 to 2013 showed a majority of individual claims (88% of claimants were individual physical persons), and of claimants covered by social security or private insurance (64%) with typical private legal counsel (87% claiming coverage of a medical service). 75% of the verdicts simply ordered the provision of the claimed health services, without highlighting failures in the healthcare system or mandating measures to promote equity and guarantee the right to health for other persons subject to the same situation as the claimant. Thus far, litigation in health has failed to actively promote either health equity, the right to health, or inter-institutional dialogue.El proposito de este trabajo es explorar el perfil del litigio por el acceso a la atencion de la salud, tramitado ante la Corte Suprema de Justicia Argentina, y reflexionar sobre su potencial para influir sobre la equidad y el derecho a la salud, en el marco de un proceso de crecimiento de la judicializacion. Se llevo a cabo un analisis documental de 125 litigios con sentencias dictadas entre 1994 y 2013. Se observo una preeminencia de la reclamacion individual (88% reclamantes personas fisicas individuales), y de reclamantes afiliados a la seguridad social o a seguros privados (64%), con un esquema tipico del derecho privado (87% reclama cobertura de un servicio medico). El 75% de los fallos ordenaron brindar los servicios de salud reclamados, sin visibilizar los fallos del sistema de salud, ni ordenar acciones para promover la equidad y garantizar el derecho a la salud, que alcancen a otras personas sometidas a la misma situacion que el reclamante. La judicializacion, hasta el momento, no esta promoviendo activamente la equidad, el derecho a la salud y el dialogo interinstitucional.

Litigation and the right to health in Argentina

This article explores the characteristics of lawsuits for obtaining access to healthcare through the Argentine Supreme Court and reflects on the potential to influence health rights and equity in a context of growing litigation. An analysis of documents from 125 lawsuits with verdicts issued from 1994 to 2013 showed a majority of individual claims (88% of claimants were individual physical persons), and of claimants covered by social security or private insurance (64%) with typical private legal counsel (87% claiming coverage of a medical service). 75% of the verdicts simply ordered the provision of the claimed health services, without highlighting failures in the healthcare system or mandating measures to promote equity and guarantee the right to health for other persons subject to the same situation as the claimant. Thus far, litigation in health has failed to actively promote either health equity, the right to health, or inter-institutional dialogue.El proposito de este trabajo es explorar el perfil del litigio por el acceso a la atencion de la salud, tramitado ante la Corte Suprema de Justicia Argentina, y reflexionar sobre su potencial para influir sobre la equidad y el derecho a la salud, en el marco de un proceso de crecimiento de la judicializacion. Se llevo a cabo un analisis documental de 125 litigios con sentencias dictadas entre 1994 y 2013. Se observo una preeminencia de la reclamacion individual (88% reclamantes personas fisicas individuales), y de reclamantes afiliados a la seguridad social o a seguros privados (64%), con un esquema tipico del derecho privado (87% reclama cobertura de un servicio medico). El 75% de los fallos ordenaron brindar los servicios de salud reclamados, sin visibilizar los fallos del sistema de salud, ni ordenar acciones para promover la equidad y garantizar el derecho a la salud, que alcancen a otras personas sometidas a la misma situacion que el reclamante. La judicializacion, hasta el momento, no esta promoviendo activamente la equidad, el derecho a la salud y el dialogo interinstitucional.

Litigio judicial y el derecho a la salud en Argentina

This article explores the characteristics of lawsuits for obtaining access to healthcare through the Argentine Supreme Court and reflects on the potential to influence health rights and equity in a context of growing litigation. An analysis of documents from 125 lawsuits with verdicts issued from 1994 to 2013 showed a majority of individual claims (88% of claimants were individual physical persons), and of claimants covered by social security or private insurance (64%) with typical private legal counsel (87% claiming coverage of a medical service). 75% of the verdicts simply ordered the provision of the claimed health services, without highlighting failures in the healthcare system or mandating measures to promote equity and guarantee the right to health for other persons subject to the same situation as the claimant. Thus far, litigation in health has failed to actively promote either health equity, the right to health, or inter-institutional dialogue.El proposito de este trabajo es explorar el perfil del litigio por el acceso a la atencion de la salud, tramitado ante la Corte Suprema de Justicia Argentina, y reflexionar sobre su potencial para influir sobre la equidad y el derecho a la salud, en el marco de un proceso de crecimiento de la judicializacion. Se llevo a cabo un analisis documental de 125 litigios con sentencias dictadas entre 1994 y 2013. Se observo una preeminencia de la reclamacion individual (88% reclamantes personas fisicas individuales), y de reclamantes afiliados a la seguridad social o a seguros privados (64%), con un esquema tipico del derecho privado (87% reclama cobertura de un servicio medico). El 75% de los fallos ordenaron brindar los servicios de salud reclamados, sin visibilizar los fallos del sistema de salud, ni ordenar acciones para promover la equidad y garantizar el derecho a la salud, que alcancen a otras personas sometidas a la misma situacion que el reclamante. La judicializacion, hasta el momento, no esta promoviendo activamente la equidad, el derecho a la salud y el dialogo interinstitucional.

Evaluación del componente infantil del Seguro Público de Salud de la Provincia de Buenos Aires

Objective. Evaluate if the Insurance strengthened the primary care role and enhanced healthcare access and comprehensiveness. Materials and methods. Through a household survey (n=2 413; year 2006) we collected data on utilization of health services by under 8 year old beneficiaries from 8 municipalities. We used hypothesis tests to identify significant differences between municipal profiles of Insurance implementation and beneficiaries grouped by utilization patterns. Results. Although more than 95% of children received medical healthcare in each municipality (using the Insurance and other services), the Insurance utilization varied significantly by municipal profile. Access to comprehensive healthcare and consultation rates were significantly higher for those beneficiaries who used the Insurance along with other health services, compared with those who only used the Insurance services. Use of hospitals was significantly lower within Insurance users. Conclusion. The Insurance was more effective when implemented and used in conjunction with the municipal networks of health services.