Acceso y satisfacción con servicios curativos: análisis de casos en afiliados al régimen contributivo y afiliados al régimen subsidiado en un barrio estrato 2 - Cali, Colombia / Access and satisfaction related to curative services: Case analysis of the contributory regime and members of the subsidized regime in a strata 2 neighborhood. Cali, Colombia / Acesso e satisfação com serviços curativos: Análise de casos em filiados ao régime contributivo e filiados ao régime subsidiado em um bairro de estrato socioeconômico 2. Cali, Colômbia

Este estudio presenta un análisis de casos para identificar diferencias en el acceso a servicios curativos entre afiliados al régimen contributivo y afiliados al régimen subsidiado. A nivel poblacional, alrededor de una décima parte de la población siente la necesidad y demanda un servicio curativo, y se atiende al 97,8%. Se trata de una investigación descriptiva de corte transversal, las variables fundamentales se operacionalizaron teniendo en cuenta la necesidad atendida. Se consideraron casos quienes presentaron un problema de salud en el último mes, consultaron un servicio formal y fueron atendidos. Los resultados muestran diferencias entre los regímenes en el acceso y en la satisfacción; por ejemplo, con relación a medicamentos, los reclamaron el 87,8% del régimen contributivo y el 55,9% del régimen subsidiado, diferencias estadísticamente significantes. Se encontraron barreras administrativas y económicas y características de los servicios que afectan el acceso a la atención y la calidad en ambos regímenes, y se evidenció vulneración del derecho fundamental a la atención en salud.

This study presents a case analysis to identify differences in access to curative services among people affiliated to the contributive and subsidized system. At the population level, around a tenth of the population feels the need and demand a healing service, 97.8% being treated. Descriptive, cross-sectional investigation; fundamentals variables were operationalized taking into account the need serviced. Cases were considered, those presenting a health problem in the last month, consulted a formal service and were treated. The results show differences between the regimes of access and satisfaction; for example, in relation to the medicines they claimed 87.8 % of contributive and subsidized 55.9 %, statistically significant differences. Administrative and financial barriers were found; and characteristics of the services that affect access to care and quality in both regimes, demonstrating infringement of the fundamental right to health care.

Este estudo apresenta análise de casos para identificar diferenças no acesso a serviços curativos entre filiados ao regime contributivo e filiados ao regime subsidiado. No nível populacional, perto de uma décima parte da população sente necessidade e demanda cualquer serviço curativo, e é atendido o 97,8%. Trata-se de pesquisa descritiva de tipo transversal, as variáveis fundamentais foram operacionalizadas levando em conta a necessidade atendida. Consideraram-se casos que apresentaram problema de saúde no último mês, pediram um serviço formal e foram atendidos. Os resultados mostram diferenças entre os regimes no acesso e satisfação; por exemplo, no que diz respeito a medicamentos, foram pegados pelo 87,8% do regime contributivo e o 55,9% do regime subsidiado, diferenças estatisticamente significantes. Encontraram-se barreiras administrativas e económicas e características dos serviços que afetam o acesso ao atendimento e qualidade em ambos os regimes e evidenciou-se violação do direito fundamental de atendimento em saúde.

Acceso a los servicios preventivos en los regímenes contributivo y subsidiado de salud en un barrio estrato dos de la ciudad de Cali / Access to preventive services in contributive and subsidized regimes of health in a (slums) stratum two neighborhood of the city of Cali / Acesso aos serviços preventivos nos regimes bairro marginal (estratificação colombiana numero dois) da cidade de Cali

Se presenta el componente de acceso a servicios preventivos del estudio que tuvo como objetivo identificar las diferencias en el acceso a los servicios de salud entre población afiliada al régimen contributivo y subsidiado de un barrio estrato dos de Cali. Estudio de prevalencia transversal, diseño probabilístico, muestras complejas, estratificado, polietápico. Se encuestaron 2165 personas.Se estudió esta población según variables de algunos modelos de medición de acceso y uso de servicios. Hay diferencias significativas con respecto a la necesidad de consultar servicios preventivos, siendo la prevalencia más alta en el régimen contributivo. Menos de una quintaparte de la población siente la necesidad, expresa y usa servicios preventivos. El análisis por edad, sexo y tipo de programas muestra frecuencias muy bajas de uso. Este hallazgo, dramático para la salud pública, amerita la revisión de la relevancia social de los programas preventivos y el estado actual de oferta de éstos...

Component of access to preventive services of the study that aimed to identify differences in access to health services among people affiliated to the contributive and subsidized systemin a slums area of Cali was presented. Cross-sectional prevalence study, probabilistic design, complex samples, stratified, multistage sampling. 2165 people were surveyed. This populationwas studied according to variables in some measuring to access to and use of services models. There are significant differences in respect to the need of consulting preventive services, beingin the contributory scheme the highest prevalence. Less than a fifth of the population feels the need, express and uses preventive services. Analysis of age, sex and type of programs shows very low frequency of use. This finding, dramatic in the case of public health, warrants the review of the social importance of preventive programs and the current state of its supply...

Apresenta-se componente de acesso aos serviços preventivos do estudo que teve como escopo: identificar as diferenças no acesso aos serviços da saúde na população afiliada ao regime contributivoe subsidiado num bairro marginal de Cali (estrato 2). Estudo de prevalência transversal; desenho probabilístico, amostras complexas, estratificado, polietápico. Entrevistaram-se 2.165pessoas, segundo variáveis de alguns modelos de medição de acesso e uso de serviços. Respeito à necessidade de consulta de serviços preventivos tem diferenças significativas, estando a maisalta prevalência no regime contributivo. Menos da quinta parte da população sente a necessidade, expressa e usa os serviços preventivos. A análise por idade, sexo e tipo de programas apresenta freqüências muito baixas de uso. Esta descoberta dramática para a saúde pública merece a revisão da relevância social dos programas preventivos e o estado da oferta destes...

Participación social en salud: conceptos de usuarios, líderes comunitarios, gestores y formuladores de políticas en Colombia. Una mirada cualitativa / Social participation in health: user community leaders, managers and policy makes in Colombia. A qualitative view

Fundamento: Las reformas del sector salud llevadas a cabo enColombia durante la década de los noventa incluyen políticas quepromocionan la participación social en el sistema de salud, consideradaesencial para el buen funcionamiento. El objetivo de este artículoes analizar el sentido y significado de la participación en saludpara los diferentes actores sociales involucrados en la implantaciónde la política en Colombia.Métodos: Se realizó un estudio cualitativo, descriptivo, de tipoexploratorio, a través de grupos focales (GF) y entrevistas individualessemi-estructuradas (E) a diferentes actores sociales: 210 usuarios(GF), 40 líderes comunitarios (GF), 3 formuladores de políticas (E)y 36 entre el personal de salud (E). Se hizo un análisis narrativo decontenido. El área de estudio la constituyeron los municipios Tuluá yPalmira en Colombia.Resultados: El concepto de participación presentó diferentessentidos según el actor analizado: usuarios y líderes articulaban elconcepto alrededor de aportar ideas, estar en espacios sociales, la solidaridady con frecuencia, la utilización de los servicios de salud. Elpersonal de salud otorgaba sentido de participación social a las actividadesde las instituciones con la comunidad, así como al uso de losservicios y la vinculación al sistema de salud. Los formuladores depolíticas lo dotaban de un sentido de evaluación y control de los serviciosde salud por parte de la comunidad, para mejorar su calidad.Conclusiones: Los distintos conceptos de participación muestrandiferencias entre el sentido de la política y lo que entienden y asumenlos diversos agentes sociales en su interacción con los servicios desalud. Estos diferentes conceptos han de ser tenidos en cuenta paraconseguir la vinculación entre la sociedad y los servicios de salud

Background: Health sector reforms taking place in Colombiaduring the Nineties included policies to promote social participationin the health system, which is considered essential to its functioning.The aim of this article is to analyse the meaning and the significanceof participation in health for the different social actorsinvolved in implementing policies in Colombia.Methods: A qualitative, descriptive, exploratory study wascarried out using focal groups (FG) and semi-structured individualinterviews (I) of the different social actors: 210 users (FG), 40 communityleaders (FG), 3 policy makers (E) and 36 healthcare professionals(E). A carried out analysis was content up of the contents.The study area corresponded to the municipalities of Tulua and Palmirain Colombia.Results: The concept of participation was interpreted differentlydepending on the actor studied: for users and leaders the conceptreferred to contributing ideas, presence in social spaces, solidarityand frequently, and use of the health services. Healthcare professionalsconsidered the activities carried out by institutions togetherwith the community as social participation, the use of services andaffiliation to the health system. Policy markers considered participationto concern evaluation and control of the health services by thecommunity, to improve its quality.Conclusions: The different concepts of participation reveal differencesbetween the content of the policy and how it is understoodand interpreted by the different social actors in their interaction withthe health services. These different perspectives must be taken intoaccount to develop a link between society and the health services

[Social participation in health: user community leaders, managers and policy makers in Colombia. A qualitative view]. / Participación social en salud: conceptos de usuarios, líderes comunitarios, gestores y formuladores de políticas en Colombia. Una mirada cualitativa.

BACKGROUND: Health sector reforms taking place in Colombia during the Nineties included policies to promote social participation in the health system, which is considered essential to its functioning. The aim of this article is to analyse the meaning and the significance of participation in health for the different social actors involved in implementing policies in Colombia. METHODS: A qualitative, descriptive, exploratory study was carried out using focal groups (FG) and semi-structured individual interviews (I) of the different social actors: 210 users (FG), 40 community leaders (FG), 3 policy makers (E) and 36 healthcare professionals (E). A carried out analysis was content up of the contents. The study area corresponded to the municipalities of Tulua and Palmira in Colombia. RESULTS: The concept of participation was interpreted differently depending on the actor studied: for users and leaders the concept referred to contributing ideas, presence in social spaces, solidarity and frequently, and use of the health services. Healthcare professionals considered the activities carried out by institutions together with the community as social participation, the use of services and affiliation to the health system. Policy markers considered participation to concern evaluation and control of the health services by the community, to improve its quality. CONCLUSIONS: The different concepts of participation reveal dif ferences between the content of the policy and how it is understood and interpreted by the different social actors in their interaction with the health services. These different perspectives must be taken into account to develop a link between society and the health services.