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La atención administrada y la provisión de atención de caridad por parte de los médicos
P J Cunningham1, J M Grossman, R F St Peter
1Center for Studying Health System Change, Washington, DC 20024, USA. PJC@hschange.com
JAMA
|April 3, 1999
Resumen
Los médicos en planes de atención administrada proporcionan menos atención de caridad. La alta penetración de la atención administrada en un área también reduce las horas de atención de caridad de los médicos, lo que afecta el acceso de los pacientes sin seguro.
Área de la Ciencia:
- Servicios de salud Servicios de salud Investigación Investigación.
- Los patrones de práctica de los médicos.
- Política de la atención de la salud Política de salud.
Sus antecedentes:
- Los cambios en el sistema de salud pueden limitar la capacidad del médico para ofrecer atención no compensada.
- Esto puede disminuir el acceso al médico para las poblaciones sin seguro y con seguro insuficiente.
Objetivo del estudio:
- Investigar la relación entre la participación en el cuidado administrado y la prestación de atención de caridad por parte de los médicos.
- Comprender cómo la atención administrada afecta la disponibilidad de médicos para grupos de pacientes vulnerables.
Principales métodos:
- Se utilizaron datos de la encuesta de médicos del Estudio de Seguimiento Comunitario 1996-1997.
- Analizó una muestra nacionalmente representativa de 10.881 médicos en 60 comunidades.
- Cuidado de caridad medido por el número de horas que los médicos brindaron atención gratuita o de tarifa reducida debido a la necesidad financiera del paciente.
Principales resultados:
- El 77,3% de los médicos proporcionó un promedio de 10,3 horas de atención de caridad al mes.
- Los médicos con altos ingresos por atención administrada (≥85%) eran significativamente menos propensos a proporcionar atención de caridad.
- La alta penetración de la atención administrada en un área geográfica se correlacionó con menos horas de atención de caridad, independientemente de la participación individual del médico (P<.01).
- Las consultas individuales y de dos médicos proporcionaron más atención de caridad que otros arreglos (P<.01).
Conclusiones:
- La participación del médico en la atención administrada está asociada con una reducción en la provisión de atención de caridad.
- La alta penetración de la atención administrada regional disminuye aún más la disponibilidad de atención médica de caridad.
- Estos hallazgos sugieren que la atención administrada puede exacerbar los problemas de acceso para los pacientes sin seguro.
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