redes integradas, programas de gestão clínica e generalista coordenador: análise das reformas recentes do setor ambulatorial na alemanha networks, disease management programs, gp coordinator: analysis of recent ambulatory reforms in germany

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ID: 247297
2011
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Abstract
O fortalecimento do papel do generalista na condução e coordenação de cuidados especializados, hospitalares e sociais para garantir a continuidade é tendência observada em reformas de saúde recentes em países europeus. Na Alemanha, a partir da segunda metade da década de noventa, impulsionadas por pressões econômicas, legislação específica e iniciativas dos próprios prestadores, foram desenvolvidas novas estruturas organizacionais e modelos assistenciais com o propósito de integração do sistema de saúde e a coordenação da atenção, na forma de redes de consultórios médicos, modelo generalista coordenador, programas de gestão clínica para agravos específicos e assistência integrada. A partir de revisão bibliográfica, análise documental, visitas a serviços e entrevistas com informantes-chave, o artigo analisa a dinâmica destas mudanças organizacionais no setor ambulatorial alemão. Examinam-se os mecanismos de integração e coordenação propostos, discutem-se os impactos potenciais das novas modalidades organizacionais sobre a eficiência e a qualidade e analisam-se motivos e interesses envolvidos, apontando obstáculos para a implementação. Observa-se processo de reforma incremental com tendência à diversificação do panorama assistencial na Alemanha, com presença de modelos integrados de atenção e fortalecimento do papel do médico generalista na função de coordenação dos cuidados aos pacientes.
Strengthening the role of the general practitioner in the conduction and coordination of specialized, inpatient and social care to ensure the continuity is a trend observed in recent health reforms in European countries. In Germany, from the second half of the 1990s, driven by economic pressures, a specific legislation and initiatives of the providers themselves have developed new organizational structures and care models for the purpose of the integration of the health care system and the coordination of health care in the form of: physicians networks, practitioner coordinator model, diseases management programs and integrated care. From a literature review, document analysis, visits to services and interviews with key informants, this paper analyzes the dynamics of these organizational changes in the German outpatient sector. The mechanisms of integration and coordination proposed are examined, and the potential impacts on the efficiency and quality of new organizational arrangements are discussed. Also it is analyzed the reasons and interests involved that point out the obstacles to the implementation. It was observed the process of an incremental reform with a tendency of diversification of the healthcare panorama in Germany with the presence of integrated models of care and strengthening the role of general practitioners in the coordination of patient care.
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giovanella2011cinciaredes Use this key to autocite in the manuscript while using SciMatic Manuscript Manager or Thesis Manager
Authors ;Ligia Giovanella
Journal journal of physical activity & health
Year 2011
DOI
10.1590/S1413-81232011000700040
URL
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1413-81232011000700040
Keywords
primary health care health reforms coordinationpublic aspects of medicine

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