ABSTRACT
Background: In recent years, the healthcare sector has experienced accelerated progress in terms of the inclusion of Information and Communication Technologies (ICTs) in its procedures and formalities. However, public administrations have been unable to adapt to the peculiarities of the most vulnerable groups. This leads to marginalization of at-risk groups within the healthcare system and contributes to the widening of the so-called digital divide. Methods: Based on the analysis of the literature, three dimensions have been constructed to identify the level of inclusion of web portals: the perception of quality, the perception of usability, and the importance attributed to their content. In order to obtain data on each of these dimensions, a study was designed based on the user test methodology as a central element (identifying and evaluating 11 vulnerable groups) and, in parallel, a survey of the general population and heuristic tests. Results: A high percentage of vulnerable people at risk of social exclusion are not receiving adequate healthcare due to the digitalization of the system and the implementation of scarcely inclusive health web portals, which pose significant barriers in service provision for the 11 selected collectives. Meanwhile, the general population is being introduced to eHealth benefits, although the latter did not have high levels of digitization or a broad portfolio of services. Conclusions: The general population has a relatively positive perspective of eHealth services, but only a minority of them make intensive use of them, and they are not widespread in Spain as a whole. Meanwhile, the population at risk of exclusion lacks the skills and resources to make real use of eHealth, needing "digital intermediaries" from the social sphere to achieve results. eHealth policies are not taking into account people with higher levels of marginalization, aggravating their exclusion and the digital divide.
ABSTRACT
OBJECTIVE: To examine the approach adopted by the health plans of the autonomous communities of Spain, verifying the weight given to the concept of equity; to detect referenced communities or situations, as well as to distinguish the perspective of approaching it, from access, equity or equalization. METHODS: Qualitative study, of content analysis using Nvivo12, carried out in 2020 on health plans in force since 2019 in the different regions (autonomous communities) of Spain. Sixteen current regional health plans were compiled to establish base categories (equity, accessibility and equality) and determine associated terms using Nvivo12, from which a content analysis was performed. RESULTS: The concept of equity is not emphasized in the regional health plans and its relevance is surpassed by the concepts of accessibility and equality. The use of these three concepts is associated with various categories indicating circumstances, conditions or groups to which the plans give greater attention. CONCLUSIONS: The results obtained coincide with previous studies on the contents and orientation of health plans, revealing a discrete presence of the concept of equity in the approaches adopted, although this does not undermine the alignment of health policies with the visions emanating from transnational organizations. It is detected the existence of a group to which special attention is given from the accessibility approach, the population with functional diversity.
Subject(s)
Health Equity , Health Policy , Brazil , Health Services Accessibility , Humans , SpainABSTRACT
ABSTRACT OBJECTIVE: To examine the approach adopted by the health plans of the autonomous communities of Spain, verifying the weight given to the concept of equity; to detect referenced communities or situations, as well as to distinguish the perspective of approaching it, from access, equity or equalization. METHODS: Qualitative study, of content analysis using Nvivo12, carried out in 2020 on health plans in force since 2019 in the different regions (autonomous communities) of Spain. Sixteen current regional health plans were compiled to establish base categories (equity, accessibility and equality) and determine associated terms using Nvivo12, from which a content analysis was performed. RESULTS: The concept of equity is not emphasized in the regional health plans and its relevance is surpassed by the concepts of accessibility and equality. The use of these three concepts is associated with various categories indicating circumstances, conditions or groups to which the plans give greater attention. CONCLUSIONS: The results obtained coincide with previous studies on the contents and orientation of health plans, revealing a discrete presence of the concept of equity in the approaches adopted, although this does not undermine the alignment of health policies with the visions emanating from transnational organizations. It is detected the existence of a group to which special attention is given from the accessibility approach, the population with functional diversity.
RESUMEN OBJETIVO: Examinar el enfoque adoptado por los planes de salud de las comunidades autónomas de España verificando el peso otorgado al concepto de equidad; detectar a qué colectivos o situaciones se hace referencia; así como distinguir la perspectiva de abordaje del mismo, desde el acceso, la igualación o la equiparación. MÉTODOS: Estudio cualitativo, de análisis de contenido mediante Nvivo12, realizado en 2020 sobre planes de salud en vigencia a fecha de 2019 en las diferentes regiones (comunidades autónomas) de España. Se han recopilado 16 planes de salud regionales vigentes para establecer categorías base (equidad, accesibilidad e igualdad) y determinar términos asociados a través de Nvivo12, a partir de los que se realizó un análisis de contenido. RESULTADOS: El concepto de equidad no resulta destacado por los planes de salud autonómicos y su relevancia es superada por los conceptos de accesibilidad e igualdad. El empleo de estos tres conceptos está asociado a diversas categorías que connotan circunstancias, condiciones o colectivos a los que los planes prestan mayor atención. CONCLUSIONES: Los resultados obtenidos coinciden con estudios previos sobre los contenidos y orientación de los planes de salud, revelando una presencia discreta del concepto de equidad en los enfoques adoptados, sin que ello menoscabe el alineamiento de las políticas de salud respecto de las visiones emanadas de organizaciones transnacionales. Se detecta la existencia de un colectivo al que se presta especial atención desde el enfoque de accesibilidad, la población con diversidad funcional.
Subject(s)
Humans , Health Equity , Health Policy , Spain , Brazil , Health Services AccessibilityABSTRACT
Resumen Ofrecer un análisis pormenorizado de la evolución e implantación de las Tecnologías de la Información y la Comunicación (TIC) en el ámbito sanitario -eSalud- en España, atendiendo a los principales servicios implementados, su situación actual y sus perspectivas de futuro, así como a su posible impacto en el sistema sanitario y particularmente en sus usuarios. Se ha revisado la literatura científica sobre eSalud para identificar los servicios implementados más extendidos y sus características. En función de esa información se ha diseñado y administrado una encuesta a nivel estatal a usuarios del sistema nacional de salud de España (SNS) para conocer su percepción sobre los servicios recibidos y los obstáculos existentes para su pleno desarrollo. Los resultados fueron contrastados con otras fuentes secundarias. Existen servicios plenamente implementados y con un elevado nivel de uso; otros todavía permanecen en una fase más inicial. Se confirma una asimetría en los servicios ofertados por las administraciones de salud de las Comunidades Autónomas. Se confirma que el sistema sanitario español ha experimentado un importante avance tecnológico, orientando la eSalud hacia la oferta de servicios centrados en la equidad, la calidad y la eficiencia, aunque todavía subsisten obstáculos a superar.
Abstract This article aims to offer a detailed analysis of the evolution and implementation of Information and Communications Technology (ICT) in the health sector -eHealth- in Spain. Considering the main services implemented, their current situation and future prospects, as well as their possible impact on the health system and particularly on their users. The scientific literature on eHealth has been reviewed to identify the most widely implemented services and their characteristics. Based on this information, a statewide survey has been designed and administered to users of the Spanish National Health System (SNS) to learn about their perception of the services received and the existing obstacles to their full development. The results were contrasted with other secondary sources. Some services are fully implemented and have a high level of use; others are still at an early stage. It is also confirmed an asymmetric evolution of services delivered by Spanish regional health organizations. It is confirmed that the Spanish health system has experienced an important technological improvement, focusing eHealth towards the delivery of services which highlight equity, quality and efficiency, although there are still obstacles to overcome.
