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Segregación basada en el pagador en la atención ambulatoria de obstetricia y ginecología: implicaciones para la

Suzanna Larkin¹, Erika Harness, Kavita Shah Arora

¹Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Sidney Kimmel Medical College, Thomas Jefferson University, the Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, and the Department of Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; Family Planning, School of Medicine, University of Connecticut, Farmington, Connecticut; the Department of Obstetrics and Gynecology, NYU Long Island Grossman School of Medicine, Langone Health, Mineola, New York; and the Department of Obstetrics, Gynecology, and Reproductive Sciences, Larner College of Medicine, University of Vermont, Burlington, Vermont.

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La separación de los pacientes según su estado de seguro en los entornos de atención ambulatoria es una práctica consolidada en la medicina académica. Esta segregación de los pacientes basada en el pagador entre las consultas externas de los residentes y las de los profesores puede dar lugar a una calidad de atención inequitativa. Basándonos en las respuestas a una pregunta de texto de respuesta libre dirigida a residentes y directores de programas en el examen interno de obstetricia y ginecología de los EE. UU. de 2023, presentamos un comentario sobre esta inequidad estructural dentro de la obstetricia y la ginecología. El propósito de este comentario es analizar las diferencias en la población de pacientes atendida, las brechas de recursos en las clínicas de residentes, la calidad de la atención y la lesión moral, la continuidad limitada de la atención, y la formación y supervisión. Es necesario realizar más trabajos para orientar los esfuerzos de integración sistémica y explorar los efectos de la integración de los programas en los resultados de salud de los pacientes. No obstante, instamos a los centros médicos académicos a considerar cambios organizativos hacia una atención integrada por pagadores.

La separación de los pacientes según su estado de seguro en los entornos de atención ambulatoria es una práctica consolidada en la medicina académica. Esta segregación de los pacientes basada en el pagador entre las consultas externas de los residentes y las de los profesores puede dar lugar a una calidad de atención inequitativa. Basándonos en las respuestas a una pregunta de texto de respuesta libre dirigida a residentes y directores de programas en el examen interno de obstetricia y ginecología de los EE. UU. de 2023, presentamos un comentario sobre esta inequidad estructural dentro de la obstetricia y la ginecología. El propósito de este comentario es analizar las diferencias en la población de pacientes atendida, las brechas de recursos en las clínicas de residentes, la calidad de la atención y la lesión moral, la continuidad limitada de la atención, y la formación y supervisión. Es necesario realizar más trabajos para orientar los esfuerzos de integración sistémica y explorar los efectos de la integración de los programas en los resultados de salud de los pacientes. No obstante, instamos a los centros médicos académicos a considerar cambios organizativos hacia una atención integrada por pagadores.

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