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1.
Int J Health Econ Manag ; 24(1): 57-80, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37691041

RESUMO

Brazil's private health insurance market is the second largest in the world, behind only the United States, making it a valuable source of real-world evidence. This paper documents how physicians' inpatient reimbursement fees vary in the country and explores the relationship between these fees and the market share of health providers and health insurance companies. We implement a fixed-effects panel regression and take advantage of an unprecedented database that contains national administrative records of inpatient procedures paid by health insurance companies in 2016. We find a positive correlation between reimbursement for ICU procedures and provider market share. Conversely, we observe a negative correlation with insurers' market share. Additionally, we document substantial variation in procedure prices, both across and within Brazilian states, and observe that more competitive markets in Brazil tend to have higher population and GDP levels. Overall, our research enhances our understanding of the price setting dynamics of physician reimbursement fees in the context of a developing country. The insights gained from this study can assist policymakers in formulating appropriate regulations to ensure appropriate access to healthcare services.


Assuntos
Seguro Saúde , Médicos , Estados Unidos , Humanos , Brasil , Seguradoras , Pacientes Internados
2.
BMJ Glob Health ; 7(Suppl 6)2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-36379588

RESUMO

BACKGROUND: Colombia's universal health coverage programme has enrolled 98% of the population, thereby improving financial protection and health outcomes. The right to participate in the organisation of healthcare is enshrined in the 1991 Colombian Constitution. One participatory mechanism is the legal and regulatory provision that citizens can form user associations. This study examines the functionality of health insurance user associations and their influence on citizen empowerment and health insurance responsiveness. METHODS: The mixed methods study includes document review (n=72), a survey of beneficiaries (n=1311), a survey of user associations members (n=27), as well as interviews (n=19), focus group discussions (n=6) and stakeholder consultations (n=6) with user association members, government officials, and representatives from insurers, the pharmaceutical industry, and patient associations. Analysis used a content-process-context framework to understand how user associations are designed to work according to policy content, how they actually work in terms of coverage, public awareness, membership, and effectiveness, and contextual influences. FINDINGS: Colombia's user associations have a mandate to represent citizens' interests, enable participation in insurer decision-making, 'defend users' and oversee quality services. Insurers are mandated to ensure their enrollees create user associations, but are not required to provide resources to support their work. Thus, we found that user associations had been formed throughout the country, but the public was widely unaware of their existence. Many associations were weak, passive or entirely inactive. Limited market competition and toothless policies about user associations made insurers indifferent to community involvement. CONCLUSION: Currently, the initiative suffers from low awareness and low participation levels that can hardly lead to empowered enrollees and more responsive health insurance programmes. Yet, most stakeholders value the space to participate and still see potential in the initiative. This warrants a range of policy recommendations to strengthen user associations and truly enable them to effect change.


Assuntos
Seguradoras , Seguro Saúde , Humanos , Colômbia , Cobertura Universal do Seguro de Saúde , Participação da Comunidade
3.
Inquiry ; 58: 469580211020187, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34166144

RESUMO

This article presents an exploratory model to classify public attitudes towards health systems financing and organization. It comprises 5 factors (pay-as-you-use, solidarity, willingness to contribute, mixed financing, and public provision) measured by 17 indicators, selected through Exploratory Structural Equation Modeling (ESEM) applied to a sample of Chilean adults. Based on this model, cluster analysis proposed 2 groups: "Taxes-public" and "Insurance-choice," representing 47% and 53% of interviewees, respectively. The results show differences between groups concerning the evaluation of both health care providers and insurers. The second cluster tends to evaluate them more harshly, showing less willingness to contribute further, less solidarity, more agreement with the current financing arrangement in terms of the mixture and its insurance (as opposed to purchasing of service based on health problems), and more support for choice of provider. These results highlight the need to consider people's attitudes in the public discussion of health systems financing.


Assuntos
Seguradoras , Assistência Médica , Adulto , Atitude , Chile , Programas Governamentais , Humanos
4.
Gac Med Mex ; 155(5): 563-564, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31695240

RESUMO

Conflicts of interest are situations in which judgment and integrity of medical decisions or actions are influenced by a secondary interest, often of an economic nature. The Committee of Ethics and Transparency in the Physician-Industry Relationship of the National Academy of Medicine of Mexico recognizes that these conflicts occur in health professionals' daily life, but also in public and private institutions that provide health services, as well as in the academy and in research activities. Therefore, it is necessary to identify conflicting situations and always act in accordance with the patient's interest.


Los conflictos de interés son situaciones en las que el juicio y la integridad de las decisiones o acciones médicas son influidas por un interés secundario, frecuentemente de tipo económico. El Comité de Ética y Transparencia en la Relación Médico-­Industria de la Academia Nacional de Medicina de México reconoce que estos conflictos ocurren en la vida diaria de los profesionales de la salud, pero también en las instituciones de servicios de salud públicas y privadas, así como en la academia y en la investigación. Por ello, es necesario identificar situaciones de conflicto y actuar siempre de acuerdo con el interés del paciente.


Assuntos
Códigos de Ética , Conflito de Interesses , Comissão de Ética , Ética Médica , Indústria Farmacêutica/ética , Humanos , Seguradoras/ética , Relações Médico-Paciente/ética , Relações Profissional-Família/ética
5.
Int J STD AIDS ; 30(7): 696-702, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31046613

RESUMO

The aim of this study was to evaluate the cost derived from the hospitalization of people living with HIV (PLHIV) in Colombia between 2011 and 2015. This is an analysis of the direct cost of PLHIV hospitalization from the perspective of an insurer of the Colombian General Social Security System. The costs were calculated in Colombian pesos and corrected for inflation on the basis of the 2017 Consumer Price Index of the Bank of the Republic of Colombia. It was converted to US dollars at the Market Representative Exchange Rate of the same year. We analyzed 1129 hospitalizations in 612 PLHIV, of which 12% started with a diagnosis of HIV during the same hospitalization, with the majority in the AIDS stage (63%). The median overall cost of hospitalizations was US$1509 (25th and 75th percentiles: US$711-US$3254), being even higher in patients with AIDS and as the CD4 T lymphocyte count decreased. The cost derived from the medical care of PLHIV increases as the clinical control of the disease worsens, and it is a key indicator of the impact of the strategies implemented for the timely identification of the infection and subsequent management of the disease.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções por HIV/tratamento farmacológico , Custos de Cuidados de Saúde/estatística & dados numéricos , Hospitalização/economia , Seguradoras , Infecções Oportunistas Relacionadas com a AIDS/economia , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Adulto , Colômbia/epidemiologia , Efeitos Psicossociais da Doença , Análise Custo-Benefício/estatística & dados numéricos , Custos e Análise de Custo , Feminino , Infecções por HIV/economia , Infecções por HIV/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade
6.
Am J Ind Med ; 61(11): 893-900, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30284313

RESUMO

OBJECTIVE: To determine whether investment in preventive measures by a Colombian insurer reduces rates of work-related injuries and results in positive returns from these investments. METHODS: The study is based on monthly panel data of 2011-2015 of 303 medium and large companies affiliated with a private insurer in Colombia. We undertook regression modeling analysis to assess the effectiveness of incremental investments in occupational health and safety (OHS) prevention measures. The cost-benefit analysis is from the insurer's perspective. RESULTS: Investment in OHS per full-time equivalent was statistically significant at the 1% level. We estimated that 4919 injuries were averted through these investments, resulting in the avoidance of $3 949 957 in costs. Our results suggest that the investments were worth undertaking from the insurer's perspective. CONCLUSIONS: This paper provides new empirical evidence on the effectiveness and cost-benefit of OHS investments in a middle-income country. Incremental investment in OHS can be effective and cost-beneficial.


Assuntos
Seguradoras/economia , Investimentos em Saúde/economia , Saúde Ocupacional/economia , Traumatismos Ocupacionais/economia , Gestão da Segurança/economia , Colômbia , Análise Custo-Benefício , Humanos , Traumatismos Ocupacionais/prevenção & controle
7.
Value Health Reg Issues ; 11: 1-8, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27986193

RESUMO

BACKGROUND: In Colombia, HIV and AIDS constitute one of the major diseases of high cost to the health system, making necessary health risk management of patients with this disease through comprehensive health care programs with their respective evaluation of results. OBJECTIVE: To evaluate the relative cost-effectiveness of a care program for patients with HIV/AIDS affiliated to a health insurer in Colombia, comparing their results in three Health care provider (HCP). METHODS: The study population corresponded to a cohort of patients older than 18 years with HIV/AIDS and affiliated to a health insurer in Colombia during 2011 and 2012. A cost-effectiveness and cost-utility analysis of a health care program for this population was performed on the basis of a Markov model, in which quality-adjusted life-years (QALYs) and life-years gained were assessed. This analysis was conducted from the insurer perspective. The time horizon was life expectancy. A discount rate of 3% was applied. RESULTS: Drugs accounted for 80.54% of care costs. The average annual cost of patients in health state 5 was 3 times higher than that of patients in state 1. HCP A compared with HCP B generated an additional 1.53 QALYs, with a rate of incremental cost-effectiveness of $2400 per QALY gained. HCP C showed a dominated behavior. The variables that most influence the uncertainty were the cost of HCP A in health state 5 (55.52%) and the cost of HCP B in state 3 (27.51%). CONCLUSIONS: HCP A is a very cost-effective option considering a threshold of 1 time the per-capita gross domestic product.


Assuntos
Síndrome da Imunodeficiência Adquirida/terapia , Custos de Cuidados de Saúde , Seguradoras , Síndrome da Imunodeficiência Adquirida/economia , Colômbia , Análise Custo-Benefício , Pessoal de Saúde , Humanos
8.
Rev. bras. med. trab ; 14(2): 153-161, maio.-ago. 2016.
Artigo em Espanhol | LILACS | ID: biblio-1831

RESUMO

Introducción: Las contingencias laborales constituyen un importante problema de salud pública en el mundo. Para reducir los daños, los países han introducido leyes y normas técnicas para la prevención de las mismas y reparación de las víctimas a través de seguros de compensación laboral y atención médica integral. Objetivo: Conocer el nivel de evidencia existente sobre los accidentes de trabajo y enfermedades profesionales compensados y las características de los trabajadores que los presentaron e industrias más afectadas. Métodos: Se realizó una revisión sistemática bajo la metodología "Prisma". La búsqueda bibliográfica se llevó a cabo en bases de datos y revistas científicas a través de palabras claves que fueron combinadas y restringidas a artículos publicados entre los años 2003 y 2013. Resultados: Se incluyeron 11 artículos de investigaciones que fueron realizadas en cuatro continentes: Europa, Asia, Oceanía y América. Los tipos de estudios fueron, principalmente, retrospectivos con fuentes secundarias. Las muestras variaron entre 307 hasta 1.320.792 registros en diferentes grupos poblacionales, que tuvieron una o múltiples reclamaciones de compensación por accidentes de trabajo y/o enfermedades laborales. El género masculino tuvo el porcentaje más alto de reclamaciones; las industrias más afectadas fueron la manufactura y la construcción; predominaron como primera causa los esguinces o torceduras, seguidos por los trastornos musculoesqueléticos. Conclusiones: Las investigaciones revisadas proporcionan informaciones para caracterizar las contingencias ocupacionales y orientar las estrategias de prevención en las industrias y en las poblaciones trabajadoras más afectadas. Sin embargo, tienen limitaciones para establecer la gravedad de las lesiones y los tipos de compensación otorgados.


Introduction: Occupational injuries constitute an important problem of public health in the world. In order to reduce damage, countries have introduced laws and technical standards for their prevention, and to provide the victims support by means of worker's compensation insurance and comprehensive health care. Objective: To know the existing evidence level of work accidents and compensated occupational diseases and the characteristics of workers who presented them, and the most affected branches of industries. Methods: A systematic review following the "Prisma" methodology was conducted. The bibliographic research was carried out in databases and scientific journals through keywords that were combined and restricted to articles published between 2003 and 2013. Results: Eleven articles about researches conducted in four continents (Europe, Asia, Oceania and America) were included. The studies were mainly retrospective with secondary sources, and the samples ranged from 307 to 1,320,792 records in different population groups, who had one or multiple claims of compensation for work-related accidents or illnesses. The male gender had the highest percentage of claims; the most affected industries were manufacture and construction; the first causes were sprains and strains followed by musculoskeletal disorders. Conclusions: The reviewed investigations provide information to characterize the occupational contingencies and to orient the strategies of prevention in the industries and in the most affected working population. However, there are limitations to establish the seriousness of the injuries and the types of compensation awarded.


Assuntos
Pensões , Acidentes de Trabalho/prevenção & controle , Indenização aos Trabalhadores/normas , Seguradoras/normas , Doenças Profissionais/prevenção & controle
9.
Salud Publica Mex ; 57(5): 426-32, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26545004

RESUMO

OBJECTIVE: Econometric analysis that seeks to measure the cost impact of a private insurer's own network upon outpatient care for its policyholders, own network refers to vertical integrated providers. The purpose is to assess whether greater use of its own network reduces the costs that the insurer incurred, according to what specialized literature suggests. MATERIALS AND METHODS: Study based on a multiple linear regression on data from a private insurer. The dependent variable is per capita cost of outpatient services. The explanatory variables are adherence to the own network and a number of variables to specify better the model. RESULTS: With all other factors constant, in relation to covering the costs of outpatient care, it is noted that policyholders with high adhesion to their own network are less expensive than whose with low adhesion. CONCLUSIONS: The decision-making process about what services and what grade should be applied to each person by special conditions of the offer as the aggregation of human resources in own offices under formal rules has an impact on health care costs. Particular supply conditions cause variations in how resources are used.


Assuntos
Assistência Ambulatorial/economia , Seguradoras/economia , Assistência Ambulatorial/estatística & dados numéricos , Colômbia , Análise Custo-Benefício , Custos de Cuidados de Saúde , Humanos , Modelos Lineares , Modelos Econométricos
10.
Salud pública Méx ; 57(5): 426-432, sep.-oct. 2015. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-764724

RESUMO

Objetivo. Medir el impacto de la red propia (proveedores verticalmente integrados) de una aseguradora privada sobre los costos médicos ambulatorios de sus asegurados, a través de un análisis econométrico. Se busca verificar si un mayor uso de la red propia reduce los costos en los que la aseguradora incurre, de acuerdo con lo que sugiere la literatura especializada. Material y métodos. Estudio basado en una regresión lineal múltiple sobre los datos de una aseguradora privada. La variable dependiente es el costo per cápita de los servicios ambulatorios. Las variables explicativas son la adherencia a la red propia y una serie de variables para especificar mejor el modelo. Resultados. En relación con la cobertura de los costos de atención ambulatoria, si los demás factores se mantienen constantes, se observa que los asegurados con alta adherencia a la red propia presentan menores costos de atención que aquéllos con baja adherencia. Conclusión. El proceso decisorio sobre qué servicios y en qué grado debe ser aplicado a cada persona, por condiciones particulares de la oferta como el hecho de reunir recurso humano en sedes propias bajo reglas formales, presenta un impacto en los costos de atención en salud. Condiciones particulares de la oferta producen variaciones en la forma como son empleados los recursos.


Objective. Econometric analysis that seeks to measure the cost impact of a private insurer's own network upon outpatient care for its policyholders, own network refers to vertical integrated providers. The purpose is to assess whether greater use of its own network reduces the costs that the insurer incurred, according to what specialized literature suggests. Materials and methods. Study based on a multiple linear regression on data from a private insurer. The dependent variable is per capita cost of outpatient services. The explanatory variables are adherence to the own network and a number of variables to specify better the model. Results. With all other factors constant, in relation to covering the costs of outpatient care, it is noted that policyholders with high adhesion to their own network are less expensive than whose with low adhesion. Conclusions. The decision-making process about what services and what grade should be applied to each person by special conditions of the offer as the aggregation of human resources in own offices under formal rules has an impact on health care costs. Particular supply conditions cause variations in how resources are used.


Assuntos
Humanos , Assistência Ambulatorial/economia , Seguradoras/economia , Modelos Lineares , Modelos Econométricos , Custos de Cuidados de Saúde , Análise Custo-Benefício , Colômbia , Assistência Ambulatorial/estatística & dados numéricos
11.
Bogotá; Alcaldía Mayor de Bogotá;Secretaría Distrital de Salud; 2015. 17 p. tab, graf.
Não convencional em Espanhol | COLNAL | ID: biblio-1414893

RESUMO

El boletín informativo 2 interactuemos y su equipo buscan orientar el que hacer de las EAPB para el cumplimiento del actual Plan Decenal de Salud Pública 2.012-2.021 que define en sus lineamientos la orientación a fortalecer el desarrollo de la Salud Pública con la toma de decisiones oportunas y mejoramiento de capacidades de acción. Por esta razón en Bogotá se ha considerado de importancia el generar espacios de interacción con las EAPB para llevar a cabo la asistencia técnica y la asesoría. Dentro del documento se mencionan los avances en el trabajo realizado con las aseguradoras, la asistencia de las AEPB en las mesas de trabajo de las aseguradoras, los resultados de la evaluación de los Plan Operativo Anual 2014 presentados por la EAPB, los desafíos para la asistencia técnica y se finaliza con las conclusiones y recomendaciones.


Assuntos
Humanos , Orientação , Saúde Pública , Índice de Desenvolvimento em Saúde , Tomada de Decisões , Seguradoras
12.
Salud(i)ciencia (Impresa) ; 20(8): 852-858, oct. 2014.
Artigo em Espanhol | LILACS | ID: lil-797130

RESUMO

Desde la mitad del siglo XIX comenzó a propagarse una idea confusa que consistía en llamar servicios de salud a la atención de pacientes, organizada predominantemente por compañías de seguros y por el Estado. Algo parecido ocurrió con los ministerios de higiene y salud pública que nacieron a principios del siglo XX, a los cuales en los años 40 les cambiaron de nombre, llamándolos Ministerios de Salud, aparentemente para proveer servicios destinados a proteger y mantener la salud de los habitantes de la nación. Lamentablemente, esto no fue lo que ocurrió, pues se convirtieron en ministerios para atender principalmente la enfermedad y sus consecuencias, relegando a su mínima expresión la promoción, la protección y el mantenimiento de la salud. Este ensayo analiza cómo ocurrió dicho cambio sin que la población se percatara de la falacia que esto representaba y las nefastas secuelas que ha ocasionado, como la iatrogénesis. Es necesario llamar las cosas por su nombre para no engañar a la sociedad y corregir el grave desequilibrio entre los servicios de salud y los servicios médicos. Se hace referencia a los verdaderos servicios de salud y se mencionan algunas repercusiones en la práctica médica y la educación médica.


In the mid-19th century a mystifying idea began to circulate that consisted in giving the name of health services to the medical care of patients organized predominantly by insurance agencies and the State. Something similar happened with the ministries of hygiene and public health that were created at the beginning of the 20th century; in the 1940’s their names were changed to health ministries, apparently to provide health services to protect and maintain the health of the population. Regrettably, this was not what happened, because they became ministries to take care mainly of disease and its consequences, relegating the promotion, protection and maintenance of health to their minimum expression. This paper analyzes how this change happened unnoticed by a deceived population, with ominous sequels, such as a rise in iatrogenesis. It is necessary to call things by their name in order not to deceive socie-ty and to correct the serious imbalance between medical services and health services. A summarized reference is made to true health services and certain implications for medicine and medical education are mentioned.


Assuntos
Serviços de Saúde , Seguradoras , Educação Médica , Medicina Preventiva , Promoção da Saúde
13.
In. Giovanella, Lígia; Escorel, Sarah; Lobato, Lenaura de Vasconcelos Costa; Noronha, José Carvalho de; Carvalho, Antonio Ivo de. Políticas e sistema de saúde no Brasil. Rio de Janeiro, Editora Fiocruz, 2 ed., rev., amp; 2014. p.427-456, tab, graf.
Monografia em Português | LILACS, Sec. Est. Saúde SP | ID: lil-745039
15.
PLoS One ; 7(6): e38281, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22737210

RESUMO

Agriculture is inherently risky. Drought is a particularly troublesome hazard that has a documented adverse impact on agricultural development. A long history of decision-support tools have been developed to try and help farmers or policy makers manage risk. We offer site-specific drought insurance methodology as a significant addition to this process. Drought insurance works by encapsulating the best available scientific estimate of drought probability and severity at a site within a single number- the insurance premium, which is offered by insurers to insurable parties in a transparent risk-sharing agreement. The proposed method is demonstrated in a case study for dry beans in Nicaragua.


Assuntos
Agricultura/economia , Tempo (Meteorologia) , Países em Desenvolvimento , Secas , Fabaceae , Geografia , Humanos , Seguro/economia , Seguradoras/economia , Modelos Teóricos , Nicarágua , Probabilidade , Risco , Medição de Risco , Clima Tropical
17.
In. Giovanella, Lígia; Escorel, Sarah; Lobato, Lenaura de Vasconcelos Costa; Noronha, José Carvalho de; Carvalho, Antonio Ivo de. Políticas e sistema de saúde no Brasil. Rio de Janeiro, Fiocruz, 2 ed., rev., amp; 2012. p.427-456, tab, graf.
Monografia em Português | LILACS | ID: lil-670022
18.
Subj. procesos cogn ; 16(2): 44-69, 2012.
Artigo em Espanhol | BINACIS | ID: bin-128903

RESUMO

A partir de la declaración de los Derechos Humanos se han ido produciendo, progresivamente, cambios sociales y legislativos en pos de la defensa de las garantías de los derechos de las personas. Los Estados se han visto obligados a dar respuesta y a velar por tales valores. Salud mental no fue la excepción. Dada la complejidad de su especialidad, esta requiere de un esfuerzo de revisión minucioso a la hora de articular los correctos procedimientos asistenciales. Los juicios de responsabilidad profesional crecen en forma sostenida en la República Argentina en la última década y han modificado en forma sustancial el modo en el cual se ejerce la actividad asistencial en el país. De tal manera, los profesionales médicos han contratado en forma universal la prestación de seguros para el eventual juicio, Tales compañías, han implementado cursos de capacitación continua para mejorar las condiciones médico legales en los que se desarrolla la asistencia. Los médicos conocen los derechos de los pacientes, se enfatiza el mejor modo de redactar los registros escritos y se han extendido los comités de bioética. A su vez, han ido incorporando la previsión ante la eventualidad de un procesamiento judicial y adquieren los conceptos jurídicos que les permiten enfrentar situaciones de gran complejidad. En contraste, los profesionales psicólogos sostenemos una actitud que podría denominarse de ônegaciónö ante la realidad de los tribunales de justicia actuales. Esta hipótesis encuentra sostén en la escasa bibliografía vinculada al tema escrita por psicólogos, lo cual no resulta consecuente con la responsabilidad que nos cabe como especialistas en trastornos mentales, orientación universitaria que nos impone un ôsaberö específico e intransferible y, gracias al cual, podemos obtener un sustento económico (lo cual desde luego conforma un contrato tácito con derechos y obligaciones como en cualquier otro contrato). Inmersos en este marco, es propósito de esta breve exposición, abordar dos temas centrales y críticos que atañen a la práctica cotidiana de la asistencia en psicopatología. Estos son: historia clínica y consentimiento informado (AU)


Assuntos
Saúde Mental , Bioética , Responsabilidade Legal , Consentimento Livre e Esclarecido , Seguradoras
19.
Subj. procesos cogn ; 16(2): 44-69, 2012.
Artigo em Espanhol | LILACS | ID: lil-668928

RESUMO

A partir de la declaración de los Derechos Humanos se han ido produciendo, progresivamente, cambios sociales y legislativos en pos de la defensa de las garantías de los derechos de las personas. Los Estados se han visto obligados a dar respuesta y a velar por tales valores. Salud mental no fue la excepción. Dada la complejidad de su especialidad, esta requiere de un esfuerzo de revisión minucioso a la hora de articular los correctos procedimientos asistenciales. Los juicios de responsabilidad profesional crecen en forma sostenida en la República Argentina en la última década y han modificado en forma sustancial el modo en el cual se ejerce la actividad asistencial en el país. De tal manera, los profesionales médicos han contratado en forma universal la prestación de seguros para el eventual juicio, Tales compañías, han implementado cursos de capacitación continua para mejorar las condiciones médico legales en los que se desarrolla la asistencia. Los médicos conocen los derechos de los pacientes, se enfatiza el mejor modo de redactar los registros escritos y se han extendido los comités de bioética. A su vez, han ido incorporando la previsión ante la eventualidad de un procesamiento judicial y adquieren los conceptos jurídicos que les permiten enfrentar situaciones de gran complejidad. En contraste, los profesionales psicólogos sostenemos una actitud que podría denominarse de “negación” ante la realidad de los tribunales de justicia actuales. Esta hipótesis encuentra sostén en la escasa bibliografía vinculada al tema escrita por psicólogos, lo cual no resulta consecuente con la responsabilidad que nos cabe como especialistas en trastornos mentales, orientación universitaria que nos impone un “saber” específico e intransferible y, gracias al cual, podemos obtener un sustento económico (lo cual desde luego conforma un contrato tácito con derechos y obligaciones como en cualquier otro contrato). Inmersos en este marco, es propósito de esta breve exposición, abordar dos temas centrales y críticos que atañen a la práctica cotidiana de la asistencia en psicopatología. Estos son: historia clínica y consentimiento informado


Assuntos
Seguradoras , Bioética , Consentimento Livre e Esclarecido , Responsabilidade Legal , Saúde Mental
20.
Gac Sanit ; 25(6): 450-3, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21917362

RESUMO

OBJECTIVE: To evaluate the ability of transaction costs theory to explain incentives in the health care chain. METHODS: We performed a case study of CPS, a health insurance company in Bogota (Colombia), which preferred not to publish its name. RESULTS: CPS moves in the environment of high transaction costs and uses the hybrid form of governance at the outpatient level. Incentive intensity, administrative control and the contract all agree with the theory. At the hospital level, the market is used, despite greater uncertainty. Because of the discrete form (1.0) of the incentives and the absence of administrative control, it is difficult for CPS to relate payment to hospital performance. CONCLUSIONS: Transaction costs theory explains the configuration of incentives. Another contribution made by this theory to the literature is the criterion to differentiate between the market and the hybrid. We propose that the market uses discrete-type (1.0) incentives, while the hybrid uses continuous, commission-like incentives.


Assuntos
Custos e Análise de Custo , Seguradoras/economia , Seguro Saúde/economia , Modelos Econômicos , Reembolso de Incentivo/economia , Assistência Ambulatorial/economia , Colômbia , Hospitalização/economia
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