metodología para la evaluación de la relación costo-efectividad en centros de atención primaria de chile methodology for evaluating cost-effectiveness in primary health care centers in chile

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ID: 133340
2010
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Abstract
OBJETIVO: Presentar una metodología para la evaluación de la relación costo-efectividad en centros de atención primaria de salud (APS) a partir del modelo de atención familiar promovido en Chile y evaluar los resultados de los dos primeros años de funcionamiento del primer centro piloto que funciona bajo este nuevo modelo de atención primaria. MÉTODOS. Se realizó un estudio de costo-efectividad, con una perspectiva social y un horizonte temporal de un año. Para comparar el centro intervenido (universitario) con el centro de control (municipal) se construyó el índice compuesto de calidad de los centros de salud familiar (ICCESFAM), que combina indicadores técnicos y la percepción de los usuarios de los centros en seis dimensiones: accesibilidad, continuidad de la atención médica, enfoque clínico preventivo y promocional, resolutividad, participación, y enfoque biopsicosocial y familiar. Para calcular los costos se tomó en cuenta el gasto en los centros, el ahorro producido al resto del sistema sanitario y el gasto de bolsillo de los pacientes. Se estimó la razón costo-efectividad incremental (RCEI) y se realizó un análisis de sensibilidad. RESULTADOS: El centro de salud universitario resultó 13,4% más caro (US$ 8,93 anuales adicionales por inscrito) y más efectivo (ICCESFAM 13,3% mayor) que el municipal. Estos resultados hacen que la RCEI sea de US$ 0,67 por cada punto porcentual adicional que aumenta el ICCESFAM. CONCLUSIONES: Según el modelo elaborado de evaluación de centros de APS, los centros que siguen el modelo de salud familiar chileno son más efectivos, tanto por sus indicadores técnicos como por la valoración de sus usuarios, que los centros de APS tradicionales.
OBJECTIVE: Present a methodology for evaluating cost-effectiveness in primary health care centers (PHCs) in Chile based on the family health care model promoted in Chile and evaluate the results of the first two years of operation of the first pilot center to work under this new primary-care model. METHODS: A cost-effectiveness study with a social perspective and a one-year time frame was conducted. In order to compare the university health center in question with the control (a municipal health center), a Family Health Center Composite Quality Index (FHCCQI) was devised. It combines technical indicators and user perceptions of the health centers in six areas: access, continuity of medical care, a preventive and promotional clinical approach, problem-solving capability, participation, and a biopsychosocial and family approach. In order to calculate the costs, the centers' expenses, the savings realized in the rest of the health system, and patients' out-of-pocket expenditures were considered. The incremental cost-effectiveness ratio (ICR) was estimated and a sensitivity analysis was performed. RESULTS: The university health center was 13.4% more expensive (an additional US$ 8.93 per annum per enrollee) and was more effective (FHCCQI 13.3% greater) than the municipal one. Accordingly, the ICR is US$ 0.67 for each additional percentage point of FHCCQI increase. CONCLUSIONS: According to the PHC evaluation model that was implemented, the centers that follow the Chilean family health care model are more effective than traditional PHC centers, as measured by both technical indicators and user ratings.
Reference Key
pealoza2010revistametodologa Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Blanca Peñaloza;Thomas Leisewitz;Gabriel Bastías;Víctor Zárate;Ruth Depaux;Luis Villarroel;Joaquín Montero
Journal communications on pure and applied analysis
Year 2010
DOI
DOI not found
URL
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892010001100008
Keywords
primary health care atención primaria de salud chile cost-benefit analysis tropical medicinepublic aspects of medicine

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