RESUMO
Objetivos: evaluar la calidad del Programa de Salud Administrada (PSA) de "Todo Corazón", el cual ofrece la Asociación Mutual SER ESS en Colombia, uno de los primeros en su género, a fin de manejar riesgos cardiovasculares con eficiencia y calidad. La evaluación se enfocó sobre el grado de satisfacción de los usuarios (en términos de accesibilidad, oportunidad, aceptación y adherencia, trato e información recibida, y percepción de beneficios) frente a los siguientes componentes del programa: suministro de medicamentos; talleres de información educación y comunicación (IEC); visitas domiciliarias por parte los agentes educativos; y consulta a enfermería, medico general y especialistas. Métodos: siguiendo un diseño de corte transversal, se diseñó, validó y aplicó un cuestionario, para entrevista estructurada, a una muestra de 260 personas, seleccionada aleatoriamente a partir del universo de usuarios del PSA conformado por 17,466 personas distribuidas en ocho departamentos. Resultados: en todos los componentes del PSA y aspectos del servicio evaluados, se observaron niveles de satisfacción superiores al 80 por ciento, con excepción de dos: (1) visitas domiciliarias, y (2) talleres de información, educación y comunicación. Conclusiones: los usuarios del PSA están altamente satisfechos con la mayoría de sus servicios. No obstante, hay oportunidades importantes para el mejoramiento de cada uno de los componentes específicos evaluados.
Objectives: To evaluate the quality of services provided by the Managed Health Program (MHP) ¨De Todo Corazón, one of the first of its kind, offered in Colombia by AsociaciónMutual SER ESS, in order to manage cardiovascular risks with efficiency and quality. The focus was on patient satisfaction (regarding accessibility, opportunity, acceptance and adherence,information provided, and perception of benefits) with the following components of the MHP: medicines supply; information education and communication (IEC) workshops; homevisits by educational agents; and health care provided by nurses, primary care doctors, and specialists. Methods: Following a crossectional design, a questionnaire for structured interviewwas designed, validated, and then applied to a random sample of 260 people, selected from a universe comprising 17,466 subjects registered in the MHP, and distributed over eight states. Results: Satisfaction levels above 80% were found in all of the components and aspects evaluated,except two: (1) home visits by educational agents, and (2) IEC workshops. Conclusions: The clientele served by the MHP is highly satisfied with most of its services, although thereare opportunities for improvement.
Assuntos
Humanos , Riscos Ocupacionais , Doenças Profissionais , Satisfação do Paciente , Medição de RiscoRESUMO
To evaluate the impact on access to, and use of, health services in Colombia's new national health insurance system, the authors compared two cross sections of the population: before (1993) and after (1997), with the approval of Act 100, creating the General System for Social Security in Health (SGSSS). Two equity indicators were assessed: concentration curves (CC) and concentration indices (CI), summarizing the distribution of access to health care and utilization of health care services provided by the SGSSS according to income deciles. Between 1993 and 1997, the CI for access to insurance halved from 0.34 to 0.17; simultaneously, coverage increased from 23 to 57, especially among the poorest segments of the population, where it increased from 3.7 to 43.7 as a result of subsidies provided by local governments. The CI for utilization of health care services did not vary significantly. Increased disease prevalence and utilization of services among the insured, due to biased selection of risks and moral hazards, were also documented. These findings suggest a positive impact by the Reform on inequalities in access to health care insurance; however, a similar effect on inequities in utilization of health services is not clear.