Comparación de los costos reales anuales asociados al manejo ambulatorio de pacientes hipertensos del programa cardiovascular en el Hospital Comunitario de Bulnes con el pago de prestaciones de Fonasa / Cost of ambulatory care of hypertensive subjects in a community hospital (bulnes): comparison of activity associated costs to the national health fund (fonasa) estimated payments in the setting of a national cardiovascular care program

Antecedentes: El financiamiento de las prestaciones entregadas a los usuarios de atención primaria portadores de Hipertensión Arterial, esta determinado por un arancel definido por el Fondo Nacional de Salud (FONASA), el cual ha estimado montos a pagar a la institución prestadora, basados en estudios realizados a nivel nacional, los cuales difieren de las estimaciones de gasto real de cada prestación, para lo cual se hace necesario objetivar dicha diferencia de estimación a nivel local. Objetivo: Determinar los costos directos e indirectos reales de las prestaciones entregadas a los usuarios hipertensos de control ambulatorio en atención primaria de salud mediante la metodología de costos asociados a actividades (ABC), para compararlos con los valores asignados por FONASA. Diseño: Estudio Analítico no experimental de enfoque cuantitativo de corte transversal, en que se revisaron 290 tarjetas de control de usuarios hipertensos bajo control en el Hospital Comunitario de Salud Familiar de Bul-nes. Se analizaron específicamente los valores del control Médico, control Enfermera, control Nutricionista, y valores de exámenes: hematocrito, perfil lipídico, glicemia, creatinina plasmática, orina completa, potasio plasmático, electrocardiograma, atención farmacéutica. Resultados: Los costos reales de las prestaciones incluidas en la Guía Clínica GES para el manejo ambulatorio de la Hipertensión Arterial, obtenidos mediante el uso de la metodología ABC fueron significativamente mayores a los establecidos por el FONASA (promedio miles de pesos: Fonasa 21.370; Costo real 39.991,7 +/- 11.999,4; p <0,001). Conclusión: Estos resultados sugieren que existe una diferencia entre lo que FONASA cancela por estas prestaciones y el gasto real en que se incurre por su atención. Si estos valores se acercan, podría obtenerse un mejor financiamiento del programa.

Background: Payments for ambulatory care of hypertensive patients in the national cardiovascular program is defined by FONASA based on national studies. Considerable differences are observed upon confrontation with the real costs involved in a given place. Aim: to determine direct and indirect costs of health care actions in the ambulatory care of hypertensive patients through an activity based cost (ABC) methodology and to compare these with the corresponding payments defined by FONASA Method: In a cross sectional design, 290 records of hypertensive subjects under control at the Community Hospital in Bulnes were analyzed. Costs of doctor, nurse and nutritionist controls were determined along with those related to laboratory tests including hematocrit, lipid profile, glycemia, plasma creatinine, urine analysis, plasma K level and electrocardiogram. Cost of pharmacy was also included. Results: a monthly mean of $ 39 992 +/- 12 000 per hypertensive patient cared was determined through ABC based costs. This is considerable greater than de $ 21 370 determined by FONASA (p<0.001). Conclusion: Payments considered by FONASA are insufficient to cover real costs involved in ambulatory care of hypertensive patients. A better financing of the cardiovascular care program requires these costs and payments to converge.

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