Abstract
BackgroundThe high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. In 2004 the district government of Bogota decided to implement a Primary Health Care (PHC) strategy through the Home Health program. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. This study aims to evaluate the performance of the essential dimensions of the PHC strategy in six localities geographically distributed throughout Bogotá city.MethodsThe rapid assessment tool to measure PHC performance, validated in Brazil, was applied. The perception of participants (users, professionals, health managers) in public health facilities where the Home Health program was implemented was compared with the perception of participants in private health facilities not implementing the program. A global performance index and specific indices for each primary care dimension were calculated. A multivariate logistic regression analysis was conducted to determine possible associations between the performance of the PHC dimensions and the self-perceived health status of users.ResultsThe global performance index was rated as good for all participants interviewed. In general, with the exception of professionals, the differences in most of the essential dimensions seemed to favor public health care facilities where the Home Health program was implemented. The weakest dimensions were the family focus and community orientation—rated as critical by users; the distribution of financial resources—rated as critical by health managers; and, accessibility—rated as intermediate by users.ConclusionsThe overall findings suggest that the Home Health program could be improving the performance of the network of the first-level public health care facilities in some PHC essential dimensions, but significant efforts to achieve its objectives and raise its visibility in the community are required.
Highlights
The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system
The rapid assessment method validated by Almeida, Macinko et al in Brazil was applied [10,11,12]. This methodology and its instruments are applicable to the evaluation of the Home Health program in Bogota since this strategy is based on the same essential dimensions assessed in the Brazilian experience
Association between self-perceived health status and global performance index The analysis showed that self-perceived health status was positively and significantly associated with the GPI of the Primary Health Care (PHC)
Summary
The high segmentation and fragmentation in the provision of services are some of the main problems of the Colombian health system. PHC was conceived as a model for transforming health care delivery within the network of the first-level public health care facilities. The Colombian General System of Social Security in Health (GSSSH) is based on an insurance market with different public-private provider combinations. Insurance companies from the contributory regime collect funds from the enrollees and outsource the provision of care through contracts mainly with private health care providers. Insurance companies from the subsidized regime receive funds from national transfers made by local health authorities and outsource the provision of care through contracts mostly with public health care providers. Individuals in both, the contributory and subsidized regimes, choose their insurer and the health care providers from within the insurer’s network, and they receive a health benefits package. The contributory regime package covers all levels of care, while the subsidized covers primary care, as well as some inpatient and emergency care (40% less coverage than the contributory regime) [2]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
