ABSTRACT
El Mapa Sanitario, Sociosanitario y de Salud Pública de Cataluña es un instrumento que da criterios para la operativización de las políticas y estrategias que vienen definidas por el Plà de Salut y los Plans Directors y Plans Estratègics del Departament de Salut. La efectividad del Mapa viene determinada por la capacidad de servir a la toma de decisiones en los distintos niveles organizativos y de gestión. Los principales ámbitos de operativización son la planificación operativa, los gobiernos territoriales de salud y las relaciones intersectoriales. Los instrumentos de que nos valemos en el momento de la concreción de las ideas y propuestas estratégicas son: el plan de inversiones en infraestructuras sanitarias, la asignación de recursos y la compra de servicios sanitarios y sociosanitarios orientado fundamentalmente a la compra integrada, así como un enfoque de la evaluación orientado a este objetivo, el sistema de información y la investigación aplicada
The Health, Social Health and Public Healthcare Map of Catalonia is an instrument that provides criteria for putting into operation the policies and strategies defined by the Health Plan and the Master Plansand Strategic Plans of the Department of Health. The effectiveness of the Map is determined by its capacity to help in decision making at the different organisational and management levels. The principaloperational fields are, operations planning, territorial healthcare governments and cross-sector relationships. The tools used when setting ideas and strategic proposals included the healthcare infrastructureinvestment plan, the assignation of resources and the purchasing of health and social-health services aimed fundamentally at integrated purchasing, as well as an evaluation approach geared towards this objective,the information system and the applied research
Subject(s)
Humans , Health Policy, Planning and Management/organization & administration , Health Planning Guidelines , 32477 , Spain , MapABSTRACT
OBJECTIVE: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective. METHODS: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones. RESULTS: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers. CONCLUSIONS: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.
Subject(s)
Capitation Fee , Delivery of Health Care/organization & administration , Reimbursement Mechanisms , SpainABSTRACT
Objetivo: Evaluar desde una perspectiva cualitativa el impacto sobre la coordinación asistencial de la prueba piloto del sistema de compra capitativo en Cataluña.Métodos: Estudio cualitativo, exploratorio y descriptivo, mediante análisis de documentos y entrevista individual, con muestreo teórico de documentos e informantes: directivos del comprador(9), directivos de los proveedores (26), profesionales(16). Análisis de contenido, con generación mixta de categorías y segmentación por grupos de informantes, temas y áreas. El área de estudio la constituyeron las 5 zonas piloto.Resultados: La prueba facilitó, según los informantes, una visión conjunta del territorio y mejoró la comunicación. No obstante, los cambios introducidos a partir de la prueba para mejorar la coordinación asistencial fueron escasos. Se estableció una única alianza virtual entre proveedores de un territorio,con objetivos compartidos y cambios estructurales. En general, se intercambiaron los mecanismos de coordinación asistencial existentes, con un uso variable. La incertidumbre de la prueba, el temor a perder la identidad, el limitado interés ylos límites de gestión de algunos proveedores se percibían como barreras al cambio.Conclusiones: El sistema de compra capitativo, diseñado yejecutado, no generó incentivos suficientes para desencadenar cambios en la coordinación asistencial. Sería necesario corregir las debilidades identificadas en la evaluación antes de extender la prueba al resto de Cataluña
Objective: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective.Methods: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants groups, themes, and areas. The study area consisted of the 5 pilot zones.Results: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty,providers fears of losing their identity, lack of interest, and the management limits of some providers.Conclusions: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia
Subject(s)
Direct Service Costs , Health Planning Councils/trends , Purchasing, Hospital/methods , Organizational Innovation/economicsABSTRACT
The Health, Social Health and Public Healthcare Map of Catalonia is an instrument that provides criteria for putting into operation the policies and strategies defined by the Health Plan and the Master Plans and Strategic Plans of the Department of Health. The effectiveness of the Map is determined by its capacity to help in decision making at the different organisational and management levels. The principal operational fields are, operations planning, territorial healthcare governments and cross-sector relationships. The tools used when setting ideas and strategic proposals included the healthcare infrastructure investment plan, the assignation of resources and the purchasing of health and social-health services aimed fundamentally at integrated purchasing, as well as an evaluation approach geared towards this objective, the information system and the applied research.
