Evolución de la accesibilidad a los centros sanitarios en España. Seguimiento de los últimos setenta años / Evolution of the accessibility of health centers in spain. monitoring of the last seventy years

Introducción. La accesibilidad de la población a los centros sanitarios españoles ha ido evolucionando en las últimas décadas, ligada al estado de bienestar y a los cambios en las competencias en materia de salud. El objetivo de esta revisión es describir la evolución de la accesibilidad y su impacto en la población. Metodología. Se han utilizado bases bibliográficas para buscar los artículos relacionados con el objetivo de la revisión y comprendidos entre 1940 y 2013. Se han seleccionado aquellos artículos con mayor calidad y que ayudaban a construir la revisión del tema propuesto. Resultados. La accesibilidad a los centros sanitarios españoles está ligada a la evolución de la atención pública en los últimos setenta años. Por un lado, la aparición del Seguro Obligatorio de Enfermedad (SOE) y la creación de la Seguridad Social hicieron que casi el total de la población española tuviera cobertura sanitaria. Por otro lado, la aplicación de principios como los de justicia y equidad hicieron aflorar numerosos centros hospitalarios con la finalidad de acercar al máximo la asistencia a la población. En los inicios del siglo xxi, con un crecimiento desmesurado de centros hospitalarios y una crisis económica mundial, se constata la necesidad de ubicar los centros asistenciales de acuerdo con el principio de eficiencia económico-espacial o de racionalidad económica. Conclusiones. En un entorno actual de crisis se analizan las consecuencias de la hiperaccesibilidad (sistema sanitario insostenible, polimedicación de la población, etc.) y se busca un sistema sanitario más eficiente. También es necesario plantearse la relación existente entre la hiperaccesibilidad y la hiperfrecuentación de la población a los servicios sanitarios, así como la relación entre la hiperaccesibilidad y la polimedicación (AU)

Introduction: the accessibility of the population to health centers in Spain has evolved to over the past decades, linked to the welfare state and changes in the health skills. The aim of this review is to describe the evolution of accessibility and its impact on the population. Methodology: we used bibliographic databases to search for articles related to the purpose of reviewing and between 1940 and 2013. We have selected those items with higher quality and that helped to build the review of the proposed topic. Results: the accessibility to health centers in Spain is linked to the performance of public attention in the last seventy years. On the one hand, the appearance of Compulsory Health Insurance (SOE) and the creation of Social Security made almost all of the Spanish population had health coverage. On the other hand, the application of principles such as justice and equity brought to the surface many hospitals with the aim of bringing the most assistance to the population. In the early twenty-first century, with an enormous growth of hospitals and a global economic crisis, we see the need to locate health facilities under the principle of spatial economic efficiency or economic rationality. Conclusions: in a current environment of crisis, the consequences of hyperaccessibility are analyzed (unsustainable health system, population polypharmacy, etc. ) and a more efficient healthcare system is searched. It is also necessary to consider the relationship between the hyperaccessibility and the frequent attendance of population to the health services, and the relationship between hyperaccessibility and polypharmacy

Private sector unlikely to follow Medicare lead in providing health plan disenrollment comparisons.

BACKGROUND: There have been substantial efforts to improve the measurement and reporting of comparative quality information. A three-stage effort to develop comparative voluntary disenrollment measures for private health insurance plans is described. The literature on disenrollment and how key groups might use disenrollment information is reviewed; the development of a comparative survey of disenrollment is described; reasons employers, purchasing coalitions, and plans were ultimately unwilling or unable to sponsor the survey are delineated; and implications of these findings are discussed. DATA AND METHODS: Methods used to develop the survey included review of existing literature on disenrollment, review of extant disenrollee surveys, cognitive testing, and expert review of the survey. Informal and formal interviews were conducted to assess the feasibility of different sponsors. RESULTS: A disenrollment survey instrument that covered areas of common interest to consumers, purchasers, and plans could be developed, but sponsors to test the collection and reporting of these data could not be recruited. This was due to four interrelated factors: technical challenges in developing appropriate samples, wide variation in resources and capabilities of purchasers and plans, the perception that the costs of the survey outweighed the benefits of comparative information on disenrollment to the different sponsors, and the absence of strong demand from purchasers, regulators, or consumers to motivate plans to collect or report comparative information on disenrollment. IMPLICATIONS: Several major barriers must be overcome before disenrollment information can become a component of comparative health care quality measures for the privately insured.

A community quality initiative for health care reform.

In 1989, the Madison Area Employers Health Care Coalition conducted a feasibility study for the purpose of finding solutions to common health care concerns. The study revealed three conclusions: (1) there was little or no price competition among providers; (2) employers lacked useful data and information regarding health care costs and outcomes; and (3) employers and employees lacked basic health care consumerism. These conclusions led to the development of a health care purchasing group in the spring of 1990 with the formation of the Employers Health Care Alliance Cooperative (The Alliance). The conclusions outlined above became the cornerstone of the services offered by The Alliance, which include provider contracting, data collection, and consumer education and advocacy. The Alliance also developed the community quality initiative, a partnership of employers, health care consumers, and providers committed to using continuous quality improvement methods.

Is CALPERS (California Public Employees Retirement System) a HIPC (health insurance purchasing cooperative)?

California's big Public Employees' Retirement System has been touted as the nation's best example of managed competition. But evidence suggests that it has plenty room for improvement.

Insurer competition and protection from risk redefinition in the individual and small group health insurance market.

Analyses of problems in the health insurance market usually focus on the individual and small group market. Consumers in this market who experience an illness or diagnosis of illness in one time period are likely to have their future risk redefined by insurers. Despite the fact that risk-averse consumers should desire protection against redefinition of risk, policies featuring that protection currently are not common in the individual and small group market. Contracts offering that protection must either be offered by pools that can guarantee replenishment of good risks over time, or be multiperiod contracts. Risk replenishment is impossible for individuals and may be technically difficult for many small groups. Also, the terms of multiperiod contracts with a single insurer may be unattractive to individuals and small groups, given the current structure of the market. Multiperiod contracts with a pool, rather than an individual insurer, may make it possible for individuals and small groups to enjoy the same advantages as consumers who obtain employment-based health insurance through large firms.