Integrated health care networks (IHN) as a way of organising health care have been widely promoted in Latin America. Equity-LA aimed at providing evidence on the impact of different types of IHN on a) health care access and b) health care provision efficiency, in Colombia and Brazil. The analysis combined qualitative with quantitative research methods and was carried out within and cross-country.
Findings indicate that in both countries difficulties are faced in the implementation of the IHN policy, identifying a series of important weaknesses regarding the IHNs’ results regarding intermediary outcomes (access, care coordination, and continuity of care) and final outcomes (equity of access and quality of care). Equity-LA provides evidence to develop policies conducive to better quality and more efficient health care provision and contributes to reducing inequities in access to health care. It has also further developed methods and tools to assess health providers’ performance and strengthen the research capacity of the institutions involved.
Many countries in Latin America have carried out reforms to their financial and delivery structures, during the last two decades. These included calls for more efficient allocation of resources through market mechanisms, stronger institutional capacity of health systems through decentralised responsibility and management, and different ways of organising the sector. Equity-LA focuses on one type of organization of health systems that emerged as a consequence of these reforms, namely on integrated health care networks (IHN).
An IHN is defined as a network of organisations that provides or arranges to provide a coordinated continuum of services to a defined population and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population served. IHN have been and are still widely promoted by governments of Latin-American countries and international organisations despite insufficient evidence on their impact on equity, quality and efficiency.
To analyse the impact of different types of IHN to a) health care access and b) health care provision efficiency, with particular reference to women health in two Latin-American countries: Colombia and Brazil. Equity-LA combined qualitative with quantitative research methods and conducted the analysis within and cross-country.
Equity-LA provides first results on IHN policies in the two studied Latin-American countries and their results on intermediary and final outcomes. The study identified numerous failures in the IHN policy implementation, indicating a poor performance of IHN in both countries. The findings were corroborated by multiple sources of evidence (users, health services personnel, policy-makers, patient’s records and policy documents) and methods interviews, surveys, records review and documentary analysis).
Regarding access across the continuum of care, different barriers were identified related to
Care coordination across the first and secondary care level is limited in both countries. Identified obstacles are related to
The perception of continuity of care by users with diabetes and breast cancer – when considering relational continuity – are relatively better in Brazil and than in Colombia due to a fragmented purchase of services by the insurer. In both countries, users perceive low managerial care continuity because first, necessary services are excluded from the benefit packages in Colombia and second waiting times from diagnosis to treatment are too long in both countries, but exacerbated in Colombia due to long insurers’ authorization procedures and lack of geographical access, Finally, perceived informational continuity is low due to poor information transfer and collaboration between providers in all analysed IHN.
IHN performance regarding access and quality of care assessed by the calculation of indicators based on records review was limited. For diabetes care, for example, insufficient albuminuria and glycohemoglobin tests, irregular visits to nephrologists and ophthalmologists, and limited access to specialist care in Colombia for patients of the subsidised regime. For breast cancer: long waiting times for specialist consultations and the onset of treatment in Brazil or for patients belonging to the contributory regime in Colombia.
Finally, results of the population survey in the study areas highlight inequities in access and utilization of care, which depends on
Equity-LA provides evidence of the implications of introducing IHN on its intermediate and final outcomes; and for the development of policies conducive to better quality and more efficient health care provision; and contributes to reducing inequities in access to health care. In addition, the research has developed and tested appropriate methods to assess the performance of health providers.
Finally, the research contributes to
Results of Equity-LA will serve as a basis for the follow-up Equity-LA II project, which aim is to evaluate the effectiveness of different care integration strategies in IHN of six Latin-American countries with different healthcare system models; including Argentina, Brazil, Chile, Colombia, Mexico and Uruguay.
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