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Barriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazil

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dc.creatorVargas, Ingridspa
dc.creatorMogollón Pérez, Amparo Susana
dc.creatorDe Paepe, Pierrespa
dc.creatorda Silva, Maria Rejane Ferreiraspa
dc.creatorUnger, Jean-Pierrespa
dc.creatorVázquez, María-Luisaspa
dc.date.accessioned2020-05-26T00:09:54Z
dc.date.available2020-05-26T00:09:54Z
dc.date.created2016spa
dc.description.abstractAlthough integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills. © 2015 The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.1093/heapol/czv126
dc.identifier.issn14602237
dc.identifier.issn02681080
dc.identifier.urihttps://repository.urosario.edu.co/handle/10336/24187
dc.language.isoengspa
dc.publisherOxford University Pressspa
dc.relation.citationEndPage748
dc.relation.citationIssueNo. 6
dc.relation.citationStartPage736
dc.relation.citationTitleHealth Policy and Planning
dc.relation.citationVolumeVol. 31
dc.relation.ispartofHealth Policy and Planning, ISSN:14602237, 02681080, Vol.31, No.6 (2016); pp. 736-748spa
dc.relation.urihttps://www.scopus.com/inward/record.uri?eid=2-s2.0-84977109174&doi=10.1093%2fheapol%2fczv126&partnerID=40&md5=dc2b19aa88afd2d52fcf0e1ded1b6a2cspa
dc.rights.accesRightsinfo:eu-repo/semantics/openAccess
dc.rights.accesoAbierto (Texto Completo)spa
dc.source.instnameinstname:Universidad del Rosariospa
dc.source.reponamereponame:Repositorio Institucional EdocURspa
dc.subject.keywordBrazilspa
dc.subject.keywordIntegratedeng
dc.subject.keywordContent analysisspa
dc.subject.keywordCoordinationspa
dc.subject.keywordDecentralizationspa
dc.subject.keywordDoctor patient relationspa
dc.subject.keywordExploratory researchspa
dc.subject.keywordHealth care personnelspa
dc.subject.keywordHealth insurancespa
dc.subject.keywordHumanspa
dc.subject.keywordHuman experimentspa
dc.subject.keywordManagerspa
dc.subject.keywordMarketspa
dc.subject.keywordModelspa
dc.subject.keywordPatient carespa
dc.subject.keywordPrimary medical carespa
dc.subject.keywordQualitative researchspa
dc.subject.keywordSemi structured interviewspa
dc.subject.keywordSkillspa
dc.subject.keywordSocial securityspa
dc.subject.keywordTheoretical samplespa
dc.subject.keywordWork environmentspa
dc.subject.keywordBrazilspa
dc.subject.keywordColombiaspa
dc.subject.keywordCommunity carespa
dc.subject.keywordHealth care deliveryspa
dc.subject.keywordHealth personnel attitudespa
dc.subject.keywordIntegrated health care systemspa
dc.subject.keywordInterviewspa
dc.subject.keywordOrganization and managementspa
dc.subject.keywordPoliticsspa
dc.subject.keywordPublic healthspa
dc.subject.keywordQualitative researchspa
dc.subject.keywordAttitude of Health Personnelspa
dc.subject.keywordBrazilspa
dc.subject.keywordColombiaspa
dc.subject.keywordCommunity Networksspa
dc.subject.keywordDelivery of Health Careeng
dc.subject.keywordHealth Services Accessibilityspa
dc.subject.keywordHumansspa
dc.subject.keywordInterviews as Topicspa
dc.subject.keywordPoliticsspa
dc.subject.keywordPublic Healthspa
dc.subject.keywordQualitative Researchspa
dc.subject.keywordBrazilspa
dc.subject.keywordCare coordinationspa
dc.subject.keywordCare integrationspa
dc.subject.keywordColombiaspa
dc.subject.keywordDecentralizationspa
dc.subject.keywordIntegrated delivery systemsspa
dc.subject.keywordManaged competitionspa
dc.subject.keywordQualitative researchspa
dc.titleBarriers to healthcare coordination in market-based and decentralized public health systems: A qualitative study in healthcare networks of Colombia and Brazilspa
dc.typearticleeng
dc.type.hasVersioninfo:eu-repo/semantics/publishedVersion
dc.type.spaArtículospa
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