Abstract
ABSTRACTThis present study is carried out with the general objective of Proposing a New Health System Model based on the Praxeology of the actors that participate in the Health System Model of Peru, and as specific objectives (i) Analyze the Peruvian health system model from the subjectivities of its actors; (ii) Contrast jointly with the actors the models of Latin American health systems with the Peruvian health system model; (iii) Design the health system model for Peru from the perspective of the actors; (iv) Validate the proposed health system model for Peru; with reference to the bases of pragmatic paradigms, of complementarity, systemic, humanist and complexity. A mixed Derivative Sequential Exploratory study was conducted, contemplating the scope of transdisciplinary, projective research and multiple triangulation was applied. The study was presented in two successive phases, in the first, the theory based on the research method was chosen, 40 key participants were interviewed using the semi-structured in-depth interview; in the second, the exploratory research method, applying a questionnaire to 1308 participants nationwide. The results on the analysis, a negative rating was determined: degree of user satisfaction of 10.7%, and it was determined that 89.3% agree with what a reform to the current model. Regarding the comparison with other models, it is was found that 89.3% believe that reforms applied in other countries must be implemented in our country. About the design of the model, it was found that 89.3% of the participants prefer a combination between public and private; the 91.6% that should be emphasized the implementation of health determinants; the 37.2%, of the models presented, prefer the Bismarck Model. Accordingly, a praxeological model for the Peruvian health system is proposed, that relegates the dilemma of preferences between public and private, that considers a comprehensive approach to health determinants; and progressively towards a Bismarck model.
Highlights
Health systems were, for centuries, institutions that operated at a very small scale, largely of charitable or, in some cases, of private origin, but almost all ineffective
It is evident that the actors of the health system in Peru firmly express the need for a reform
It is the thirteenth policy of the National Agreement to 2021, universal access to health services, and included in the fifth strategic axis of the Vision of Peru to 2050, efficient, transparent and decentralized state, approved in the National Agreement of April 29, 2019
Summary
For centuries, institutions that operated at a very small scale, largely of charitable or, in some cases, of private origin, but almost all ineffective. Just over 100 years ago, health systems underwent a radical change, growing exponentially on account of the new knowledge acquired and applied, and of the needs and demands of the population. This explosive growth brought about an enormous benefit to improve health. It always had, and still does, a weak point, that is how to reach the general population especially the poorest sector. These inequities are not the result of technical limitations, but rather of systemic failures. It is essential to assess its current functioning, perform a comprehensive analysis and propose new models to achieve its full potential (1)
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