Improving health care in Latin America
The study EQUITY-LA examined the performance of different types of integrated health care networks, in relation to intermediate outcomes (access to, care coordination and continuity of care) and final outcomes (equity of access and quality of care), in Colombia and Brazil. The project was two-pronged: a country case study, based on a qualitative study and a cross-sectional quantitative study to analyse the actual performance of IHN, with particular reference to two tracer conditions- diabetes and breast cancer. A cross-country comparative analysis determined factors and actors affecting the performance of IHN in each particular context. The results reveal significant barriers of access - greater in terms of seeking and use of healthcare and in the resolution of the health problem in the Colombian study areas and of entry to the health services in those of Brazil. There is also poor clinical information transfer and clinical management between care levels, with added deficiencies in Brazil in the coordination of access across levels of care. Problems of coordination exist that suppose, according to the informants, interruptions of care, inadequate follow-up of patients by the first level of care and duplication of tests. Lastly, there is poor quality of care for the two tracer conditions – late detection of breast cancer with long diagnosis-treatment delays and poor results for diabetes control. Influencing factors are related to health system characteristics: economic incentives to competition instead of collaboration, (between insurers and providers in Colombia; levels of government in Brazil) which are exacerbated in Brazil by partisan political interests; limited coverage of the insurance benefit package in Colombia; and financing problems in Brazil. Other factors include IHN organisers and coordinators: in Colombia, introduction of managed care mechanisms by insurers that restrict access to care, and in Brazil, weak planning and control by regional and local governments. There are also structural and organisational factors of the network's health services: limitedly available secondary care services in Colombia, and in Brazil also of primary care that result in long waiting times; and working conditions that increase the rotation of personnel leading to insufficient use of coordination mechanisms and lack of interest in providing high-quality care. Users have limited economic resources and difficulties in getting work permissions and family support to access care. The results are important because they are among the first documenting the results of IHN in Latin America. They have been shared with the Brazilian and Colombian Ministries of Health to guide policy decisions. Dissemination of the results to five different peer-reviewed journals will further expand the scope of these findings to improve health care policies throughout Latin America.
Keywords
Health care, integrated health care network, breast cancer, diabetes, coordination of care, wait time, health care policies
