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Beca estatal, condonación de préstamos y programas relacionados: la red de seguridad no anunciada
D E Pathman1, D H Taylor, T R Konrad
1Cecil G. Sheps Center for Health Services Research, University of North Carolina, CB7590, Chapel Hill, NC 27599, USA. don_pathman@unc.edu
JAMA
|October 24, 2000
Resumen
Los programas estatales que ofrecen incentivos financieros a los profesionales de la atención primaria en áreas desatendidas se duplicaron entre 1990 y 1996, generando una fuerza laboral comparable a las iniciativas federales.
Área de la Ciencia:
- Distribución de la fuerza laboral en salud Distribución de la fuerza laboral en salud
- Política de salud pública Política de salud pública.
- Iniciativas de acceso al cuidado de la salud Iniciativas de acceso al cuidado de la salud.
Sus antecedentes:
- Los estados expandieron los incentivos financieros como becas y programas de reembolso de préstamos a mediados de la década de 1980 para abordar la escasez de atención primaria en áreas desatendidas.
- La falta de coordinación nacional ha limitado la comprensión de estos programas a nivel estatal y su crecimiento.
Objetivo del estudio:
- Identificar y describir programas financiados por el estado que ofrecen apoyo financiero a los proveedores de atención médica a cambio de servicios en regiones desatendidas.
- Evaluar la contribución de estos programas estatales a la red de seguridad sanitaria de los Estados Unidos.
Principales métodos:
- Un estudio transversal y descriptivo que utiliza datos de encuestas telefónicas, cuestionarios de correo y documentación del programa disponible.
- Incluidos los programas estatales que operaban en 1996 que ofrecían ayuda financiera para el servicio en áreas desatendidas designadas a médicos, enfermeras practicantes, asistentes médicos y enfermeras parteras.
- Se excluyen los programas federales e iniciativas de la comunidad local.
Principales resultados:
- En 1996, 82 programas estatales (29 de reembolso de préstamos, 29 de becas, 11 de préstamos, 8 de incentivos directos, 5 de apoyo a los residentes) operaron en 41 estados, más del doble de los 39 de 1990.
- Se estima que 1306 médicos y 370 profesionales de nivel medio cumplían con sus obligaciones a través de estos programas estatales en 1996, un número comparable al de los programas federales.
- Las características clave incluyeron un enfoque en la atención primaria, los objetivos de distribución de la fuerza laboral estatal y la dependencia de la financiación pública.
Conclusiones:
- Los programas patrocinados por el estado proporcionaron una fuerza laboral de atención primaria en 1996 comparable en tamaño a las iniciativas federales.
- Estos programas estatales son un componente importante de la red de seguridad de la atención médica de los Estados Unidos y requieren un monitoreo y evaluación continuos.
- Las iniciativas estatales deben integrarse en discusiones y planificación más amplias para mejorar el acceso a la atención médica.
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