Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil

Ingrid Vargas, Amparo Susana Mogollón-Pérez, Pierre De Paepe, Maria Rejane Ferreira Da Silva, Jean Pierre Unger, María Luisa Vázquez

    Resultado de la investigación: Contribución a RevistaArtículo

    14 Citas (Scopus)

    Resumen

    © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.
    Idioma originalEnglish (US)
    Páginas (desde-hasta)736-748
    Número de páginas13
    PublicaciónHealth Policy and Planning
    Volumen126
    DOI
    EstadoPublished - 2016

    Huella dactilar

    Colombia
    Brazil
    Public Health
    Delivery of Health Care
    Health
    Motivation
    Managed Competition
    Tropical Medicine
    Insurance Carriers
    Latin America
    Social Security
    Contracts
    Hygiene
    Health Personnel
    Primary Health Care
    Patient Care
    Economics
    Organizations
    Interviews

    Citar esto

    Vargas, Ingrid ; Mogollón-Pérez, Amparo Susana ; De Paepe, Pierre ; Ferreira Da Silva, Maria Rejane ; Unger, Jean Pierre ; Vázquez, María Luisa. / Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil. En: Health Policy and Planning. 2016 ; Vol. 126. pp. 736-748.
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    abstract = "{\circledC} 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.",
    author = "Ingrid Vargas and Mogoll{\'o}n-P{\'e}rez, {Amparo Susana} and {De Paepe}, Pierre and {Ferreira Da Silva}, {Maria Rejane} and Unger, {Jean Pierre} and V{\'a}zquez, {Mar{\'i}a Luisa}",
    year = "2016",
    doi = "10.1093/heapol/czv126",
    language = "English (US)",
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    Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil. / Vargas, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; Ferreira Da Silva, Maria Rejane; Unger, Jean Pierre; Vázquez, María Luisa.

    En: Health Policy and Planning, Vol. 126, 2016, p. 736-748.

    Resultado de la investigación: Contribución a RevistaArtículo

    TY - JOUR

    T1 - Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil

    AU - Vargas, Ingrid

    AU - Mogollón-Pérez, Amparo Susana

    AU - De Paepe, Pierre

    AU - Ferreira Da Silva, Maria Rejane

    AU - Unger, Jean Pierre

    AU - Vázquez, María Luisa

    PY - 2016

    Y1 - 2016

    N2 - © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

    AB - © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

    U2 - 10.1093/heapol/czv126

    DO - 10.1093/heapol/czv126

    M3 - Article

    C2 - 26874327

    VL - 126

    SP - 736

    EP - 748

    JO - Health Policy and Planning

    JF - Health Policy and Planning

    SN - 0268-1080

    ER -