Revisión sistemática realista sobre las opciones de incentivos en Colombia para la gestión en salud
DOI:
https://doi.org/10.17533/udea.le.n98a348472Palabras clave:
Revisión sistemática, Servicios de salud, Mecanismos, Calidad, EficienciaResumen
Los sistemas y los mercados de los servicios de salud tienen como prioridad en sus agendas de política el tema de la mejora del desempeño y la calidad de los servicios de salud a través de la incorporación de incentivos a los agentes de interés. Este artículo responde a la pregunta de investigación sobre cómo transferir incentivos a diferentes agentes del sistema de salud en Colombia, con especial énfasis en los proveedores de servicios de salud, para mejorar su eficiencia, en términos de la calidad de los servicios de salud, minimizando las externalidades negativas. Para responder a esta inquietud se realiza una revisión sistemática realista con la extracción de información de 42 estudios. Se utiliza un modelo lógico iterativo y basado en procesos. Como resultado se identifican seis grandes mecanismos de intervención con distintos niveles de intensidad que tratan sobre la transferencia de incentivos, específicamente a proveedores de servicios de salud, teniendo en cuenta las externalidades y sus efectos en calidad y eficiencia.
Descargas
Citas
Administradora de los Recursos del Sistema General de Seguridad Social en Salud (ADRES). (s.f.). Misión y visión. Consultado el 15 de octubre de 2021. https://www.adres.gov.co/nuestra-entidad/acerca-de-adres/mision-y-vision#:~:text=fortalecer%20la%20gesti%c3%b3n%20del%20riesgo,financiera%20del%20sistema%20de%20salud.
Andoh-Adjei, F., Spaan, E., Asante, F., Mensah, S., & Van Der Velden, K. (2016). A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries. Ghana Medical Journal, 50(4), 207–219. https://doi.org/10.4314/gmj.v50i4.3
Arellano, B. (2016). Gobierno conductual: nudges, cambio de comportamiento inconsciente y opacidad. Foro Internacional, 56 (4), 904-940. https://www.scielo.org.mx/pdf/fi/v56n4/0185-013X-fi-56-04-00903.pdf
Báscolo, E. (2002). Economía de la salud y neoinstitucionalismo. Cuadernos Médico Sociales de Rosario, 82(1), 5–28.
Berthiaume, J., Chung, R., Ryskina, K., Walsh, J., & Legorreta, A. (2006). Aligning financial incentives with quality of care in the hospital setting. Journal for Healthcare Quality, 28(2), 36-51. https://doi.org/10.1111/j.1945-1474.2006.tb00601.x
Berwick, D. (2005). 'A deficiency of will and ambition': a conversation with Donald Berwick. [Interview by Robert Galvin]. Health Affairs (Project Hope), Suppl Web, w5-1-w5-19.
https://doi.org/10.1377/hlthaff.w5.1
Bichescu, B., Bradley, R., Smith, A., & Wei, W. (2018). Benefits and implications of competing on process excellence: evidence from California hospitals. International Journal of Production Economics, 202, 59–68. https://doi.org/10.1016/j.ijpe.2018.05.013
Blustein, J., Borden, W., & Valentine, M. (2010). Hospital performance, the local economy, and the local workforce: findings from a US national longitudinal study. Plos Medicine, 7(6), e1000297. https://doi.org/10.1371/journal.pmed.1000297
Bradley, K., Shachmut, K., Viswanathan, S., Griffin, B., & Vielehr, D. (2018). The role of incentives in health – closing the gap. Military Medicine, 183(Suppl. 3), 208–212. https://doi.org/10.1093/milmed/usy216
Butala, N. (2010). Perspectives on efficiency and quality in an ever changing system: Healthcare 2010. Yale Journal of Biology And Medicine, 83(2), 93–95. https://pubmed.ncbi.nlm.nih.gov/20589190/
Castaño, R. (2014). Mecanismos de pago en salud: anatomía, fisiología y fisiopatología. ECOE.
Chen, G., & Feldman, S. (2000). Economic aspect of health care systems: advantage and disadvantage incentives in different systems. Dermatologic Clinics, 18(2), 211–214. https://doi.org/10.1016/S0733-8635(05)70165-0
Cohen, I. & Lynch, H. (2016). Nudging health: health law and behavioral economics. JHU Press.
Conrad, D. (2015). The theory of value-based payment incentives and their application to health care. Health Services Research, 50, 2057–2089. https://doi.org/10.1111/1475-6773.12408
Davies, H., Mannion, R., Jacobs, R., Powell, A., & Marshall, M. (2007). Exploring the relationship between senior management team culture and hospital performance. Medical Care Research and Review, 64(1), 46–65. https://doi.org/10.1177/1077558706296240
Davis, C., & Rhodes, D. (1988). The impact of DRGs on the cost and quality of health care in the United States. Health Policy, 9(2), 117–131. https://doi.org/10.1016/0168-8510(88)90029-2
Dormont, B., & Milcent, C. (2005). How to regulate heterogeneous hospitals? Journal of Economics and Management Strategy, 14(3), 591–621. https://doi.org/10.1111/j.1530-9134.2005.00075.x
Duckett, S. (2008). Design of price incentives for adjunct policy goals in formula funding for hospitals and health services. BMC Health Services Research, 8, 72. https://doi.org/10.1186/1472-6963-8-72
Eggleston, K., Ellis, R., & Lu, M. (2012). Risk adjustment and prevention. The Canadian Journal of Economics, 45(4), 1586–1607. https://doi.org/10.1111/j.1540-5982.2012.01747.x
Eijkenaar, F. (2013). Key issues in the design of pay for performance programs. European Journal of Health Economics, 14(1), 117–131. https://doi.org/10.1007/s10198-011-0347-6
El Congreso de la República de Colombia. (1993, 23 de Diciembre). Ley 100. Por la cual se crea el Sistema de Seguridad Social Integral y se dictan otras disposiciones. http://www.secretariasenado.gov.co/senado/basedoc/ley_0100_1993.html
Fässler, M., Wild, V., Clarinval, C., Tschopp, A., Faehnrich, J., & Biller-Andorno, N. (2015). Impact of the DRG-based reimbursement system on patient care and professional practise: perspectives of Swiss hospital physicians. Swiss Medical Weekly, 145. https://doi.org/10.4414/smw.2015.14080
Forsberg, E., Axelsson, R., & Arnetz, B. (2000). Effects of performance-based reimbursement in healthcare. Scandinavian Journal of Public Health, 28(2), 102–110. https://doi.org/10.1177/140349480002800205
Fu, H., Li, L., Li, M., Yang, C., & Hsiao, W. (2017). An evaluation of systemic reforms of public hospitals: the sanming model in China. Health Policy and Planning, 32(8), 1135–1145. https://doi.org/10.1093/heapol/czx058
Fusheini, A., Eyles, J., & Goudge, J. (2017). The state of public hospital governance and management in a South African hospital: a case study. International Journal of Healthcare, 3, 68. https://doi.org/10.5430/ijh.v3n2p68
Glazier, R., Green, M., Frymire, E., Kopp, A., Hogg, W., Premji, K., & Kiran, T. (2019). Do incentive payments reward the wrong providers? A study of primary care reform in Ontario, Canada. Health Affairs, 38(4), 624–632. https://doi.org/10.1377/hlthaff.2018.05272
Gobierno de Colombia (2019). Plan Nacional De Desarrollo 2019 - 2022: Pacto Por Colombia, pacto por la equidad. https://www.dnp.gov.co/DNPN/Paginas/Plan-Nacional-de-Desarrollo.aspx
Grossbart, S. (2006). What’s the return? Assessing the effect of “pay-for-performance” initiatives on the quality of care delivery. Medical Care Research and Review, 63(1 Suppl.), 29S-48S. https://doi.org/10.1177/1077558705283643
Guirao-Goris, S. (2015). Utilidad y tipos de revisión de literatura. ENE, 9(2). https://dx.doi.org/10.4321/s1988-348x2015000200002
Habermas, J. (1999). Problemas de legitimación en el capitalismo tardío. Catedra.
Herwartz, H., & Strumann, C. (2014). Hospital efficiency under prospective reimbursement schemes: an empirical assessment for the case of Germany. European Journal of Health Economics, 15(2), 175–186. https://doi.org/10.1007/s10198-013-0464-5
Hsiao, B., Shu, L., Chen, P., & Hsieh, S. (2015). Trial plan with capitation payment of the national healthcare insurance in Taiwan: establishing a loyal patient selection model [conferencia]. Pacific Asia Conference on Information Systems, PACIS 2015, 245. https://aisel.aisnet.org/pacis2015/245/
Jeong, H. (2012). Designing an effective pay-for-performance system in the Korean National Health Insurance. Journal of Preventive Medicine and Public Health, 45(3), 127–136. https://doi.org/10.3961/jpmph.2012.45.3.127
Kassak, K., Abdallah, A., & Saleh, S. (2014). Physician practice patterns in primary care: do ownership and payment mechanism matter? Journal of Health Care Finance, 41(2). http://healthfinancejournal.com/index.php/johcf/article/view/2
Kazungu, J., Barasa, E., Obadha, M., & Chuma, J. (2018). What characteristics of provider payment mechanisms influence health care providers’ behaviour? A literature review. International Journal of Health Planning and Management, 33(4), e892–e905. https://doi.org/https://doi.org/10.1002/hpm.2565
Korlén, S., Essén, A., Amer-Wåhlin, I., Lindgren, P., & Von Thiele Schwarz, U. (2018). Leaders as intermediates between economic incentive models and professional motivation. Lakartidningen, 115(22–23). https://pubmed.ncbi.nlm.nih.gov/29809273/
Kroneman, M., & Nagy, J. (2001). Introducing DRG-based financing in Hungary: a study into the relationship between supply of hospital beds and use of these beds under changing institutional circumstances. Health Policy, 55(1), 19–36. https://doi.org/10.1016/S0168-8510(00)00118-4
Lagarde, M., & Blaauw, D. (2017). Physicians’ responses to financial and social incentives: a medically framed real effort experiment. Social Science and Medicine, 179, 147–159. https://doi.org/10.1016/j.socscimed.2017.03.002
Langer A, Schröder-Back P, & Brink, A. (2009). The agency problem and medical acting: an example of applying economic theory to medical ethics. Medical Health Care and Philosophy, 12, 99–108. https://doi.org/10.1007/s11019-008-9138-y
Langlois, E., & Daniels, K. (2018). Strengthening health policy and systems: the role of evidence synthesis. In E. Langlois, K. Daniels & E. Akl (eds.), Evidence synthesis for health policy and systems: a methods guide (pp. 1-10). World Health Organization.
Lannes, L. (2015). Improving health worker performance: the patient-perspective from a PBF program in Rwanda. Social Science and Medicine, 138, 1–11. https://doi.org/10.1016/j.socscimed.2015.05.033
Laugesen, M., & France, G. (2014). Integration: the firm and the health care sector. Health Economics, Policy and Law, 9(3), 295–312. https://doi.org/10.1017/S1744133114000139
Laurell, A. (2014). Contradicciones en salud: sobre acumulación y legitimidad en los gobiernos neoliberales y sociales de derecho en América Latina. Saúde Debate, 38(103), 853–871. https://doi.org/10.5935/0103-1104.20140088
Levin, L., & Gustave, L. (2013). Aligning incentives in health care: physician practice and health system partnership. Clinical Orthopaedics and Related Research, 471(6), 1824–1831. https://doi.org/10.1007/s11999-012-2775-8
Liu, P., & Wu, S. (2016). An agent-based simulation model to study accountable care organizations. Health Care Management Science, 19(1), 89–101. https://doi.org/10.1007/s10729-014-9279-x
Ma, C., & Mak, H. (2015). Information disclosure and the equivalence of prospective payment and cost reimbursement. Journal of Economic Behavior & Organization, 117, 439–452. https://doi.org/10.1016/j.jebo.2015.07.002
Mannion, R., & Davies, H.. (2008). Incentives in health systems: developing theory, investigating practice. Journal Of Health Organization And Management, 22(1), 5–10. https://Pubmed.Ncbi.Nlm.Nih.Gov/18488515/
Ministerio de Salud y Protección Social (2014, 2 de diciembre). Decreto 2478 de 2014. Por el cual se crea y determinan las funciones de una Instancia de coordinación y asesoría dentro del Sistema General de Seguridad Social en Salud. https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%202478%20de%202014.pdf
Obadha, M., Chuma, J., Kazungu, J., & Barasa, E. (2019). Health care purchasing in Kenya: experiences of health care providers with capitation and fee-for-service provider payment mechanisms. International Journal Of Health Planning And Management, 34(1), e917–e933. https://doi.org/10.1002/hpm.2707
Organización Mundial de la Salud (OMS). (2000). Informe sobre la salud en el mundo: 2000. Mejorar el desempeño de los sistemas de salud. Organización Mundial de la Salud. https://apps.who.int/iris/handle/10665/42357
Ouzzani, M., Hammady, H., Fedorowicz, Z., & Elmagarmid, A. (2016). Rayyan — A web and mobile app for systematic reviews. Systematic Reviews, 5 (210). https://doi.org/10.1186/s13643-016-0384-4
Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005). Realist review - A new method of systematic review designed for complex policy interventions. Journal of Health Services Research and Policy, 10(1 suppl.) 21–34. https://doi.org/10.1258/1355819054308530
Presidencia de la República de Colombia. (2016, 6 de Mayo). Decreto 780 de 2016. Por medio del cual se expide el Decreto Único Reglamentario del Sector Salud y Protección Social. https://www.minsalud.gov.co/normatividad_nuevo/decreto%200780%20de%202016.pdf
Rączka, A., Hermanowski, T., & Cegłowska, U. (2017). Influence of peer pressure mechanism on quality and costs of healthcare, on examples of Israel, France and USA. Value in Health, 20(9), A664. https://doi.org/10.1016/j.jval.2017.08.1606
Rohwer, A., Pfadenhauer, L., Burns, J., Brereton, L., Gerhardus, A., Booth, A., Oortwijn, W., & Rehfuess, E. (2016). Series: Clinical Epidemiology in South Africa. Paper 3: Logic models help make sense of complexity in systematic reviews and health technology assessments. Journal of Clinical Epidemiology. http://doi.org/10.1016/j.jclinepi.2016.06.012
Ruiz, F., & Uprimmy, M. (2012). La salud: entre la reforma estructural y el ajuste regulatorio. ECOE.
Ryan, A. (2013). Will value-based purchasing increase disparities in care? New England Journal of Medicine, 369(26), 2472–2474. https://doi.org/10.1056/NEJMp1312654
Salmon, R., Sanderson, M., Walters, B., Kennedy, K., Flores, R., & Muney, A. (2012). A collaborative accountable care model in three practices showed promising early results on costs and quality of care. Health Affairs, 31(11), 2379–87. https://doi.org/10.1377/hlthaff.2012.0354
Scott, A. (1999). Patient, doctors and contracts: an application of principal-agent theory to the doctor-patient relationship. Journal of Political Economy, 46(2), 111–134. https://doi.org/10.1111/1467-9485.00124
Sheingold, S. (1986). Unintended results of medicare’s national prospective payment rates. Health Affairs, 5(4), 5–21. https://doi.org/10.1377/hlthaff.5.4.5
Small, N., & Mannion, R. (2005). A hermeneutic science: health economics and Habermas. Journal of Health Organization and Management, 19(3), 219–234. https://doi.org/10.1108/14777260510608952
Suarez-Rozo, L., Puerto-García, S., & Rodríguez-Moreno, L. (2017). La crisis del sistema de salud colombiano: una aproximación desde la legitimidad y la regulación. Revista Gerencia y Políticas de Salud, 16(32), 34–50. https://doi.org/10.11144/javeriana.rgps16-32.cssc
Sunstein, C., Thaler, R., & Balz. P. (2012). Arquitectura de decisiones. IUS ET VERITAS, 22(44), 386–401. https://revistas.pucp.edu.pe/index.php/iusetveritas/article/view/12042
Sutherland, J., Hellsten, E., & Yu, K. (2012). Bundles: an opportunity to align incentives for continuing care in Canada? Health Policy, 107(2–3), 209–217. https://doi.org/10.1016/j.healthpol.2012.02.007
Sutherland, J., Liu, G., Crump, R., & Law, M. (2016). Paying for volume: British Columbia’s experiment with funding hospitals based on activity. Health Policy, 120(11), 1322–1328. https://doi.org/10.1016/j.healthpol.2016.09.010
Thaler, R., & Sunstein, C. (2009). Nudge: improving decisions about health, wealth, and happiness. Penguin Books.
Trude, S., Au, M., & Christianson, J. (2006). Health plan pay-for-performance strategies. American Journal of Managed Care, 12(9), 537–542. https://pubmed.ncbi.nlm.nih.gov/16961442/
Tummers, J., Schrijvers, A., & Visser-Meily, J.. (2013). A qualitative study of stakeholder views on the effects of provider payment on cooperation, quality of care and cost-containment in integrated stroke care. BMC Health Services Research, 13(1). https://doi.org/10.1186/1472-6963-13-127
Yip, W. C.-M., Hsiao, W., Meng, Q., Chen, W., & Sun, X. (2010). Realignment of incentives for health-care providers in China. The Lancet, 375(9720), 1120–1130. https://doi.org/10.1016/S0140-6736(10)60063-3
Yip, W., Powell-Jackson, T., Chen, W., Hu, M., Fe, E., Hu, M., Jian, W, Lu, M., Han, W., & Hsiao, W. C. (2014). Capitation combined with pay-for-performance improves antibiotic prescribing practices in rural China. Health Affairs, 33(3), 502–510. https://doi.org/10.1377/hlthaff.2013.0702
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Cindy Chamorro, Laura Cañon, Oscar Andrés Espinosa, Jaime Ramírez, Leonardo Arregocés
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-CompartirIgual 4.0.
Este sitio web, por Universidad de Antioquia, está licenciado bajo una Creative Commons Attribution License.
Los autores que publiquen en esta revista aceptan que conservan los derechos de autor y ceden a la revista el derecho de la primera publicación, con el trabajo registrado con una Licencia de Atribución-NoComercial-CompartirIgual de Creative Commons, que permite a terceros utilizar lo publicado siempre que mencionen su autoría y a la publicación original en esta revista.
Los autores pueden realizar acuerdos contractuales independientes y adicionales para la distribución no exclusiva de la versión del trabajo publicada en la revista (por ejemplo, incluirla en un repositorio institucional o publicarla en un libro) siempre que sea con fines no comerciales y se reconozca de manera clara y explícita que el artículo ha sido originalmente publicado en esta revista.
Se permite y recomienda a los autores publicar sus artículos en Internet (por ejemplo, en páginas institucionales o personales), ya que puede conducir a intercambios provechosos y a una mayor difusión y citación de los trabajos publicados.
