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Managed competition has been one of most promoted health sector reforms in Latin American countries, among others, in. It is characterised by the insurers use of managed care tools to control healthcare provision in their providers networks. These tools act upon the demand –services authorisation- or upon the supply –clinical audits, clinical practice control and capitation payment. The objective of this study is to analyse the utilisation of managed care strategies in and their impact on access to health care from the viewpoint of main actors.
Methods
A phenomenological, qualitative study was carried out. Areas of study were four providers networks that provide services to a defined population in an urban (Ciudad Bolívar) and a rural area (La Cumbre). Data were collected by means of semi-structured individual interviews to a criterion sample of informants: network managers (29), professionals (64) and users (51). Content analyse was carried out, with mix generation of categories and segmentation by informants’ groups.
Results
In networks with insurer and providers integration, the predominant mechanism is the control of clinical practice, while non integrated networks use authorisations or capitation payment. Two opposite viewpoints emerged: a) private insurer and provider managers defend the appropriateness of these instruments for reducing costs and inadequate demand, and to improve continuity of care; b) users and public providers perceived them as a barrier for access to secondary care. Difficulties in access depends on the type of instrument: authorisations increase waiting time and transport costs; limits to care practice entail that patients do no receive adequate care -pharmaceuticals, tests, secondary care; and, capitation payment incentives imply a decrease in quality and quantity of services.
Conclusions
Despite the abundant literature that indicates increase in efficiency as the main contribution of managed care, the perceived risk to health care access and quality is very worrying, especially in contexts with important structural barriers
Learning Objectives: 1.Describe the utilisation of managed care strategies in Colombia and their impact on access to health care from the viewpoint of main actors 2.Recognize how a phenomenon such as the access to health care can be influenced by the use of managed care strategies in a developing country. 3.List the main difficulty in access cause by each managed care strategy identified by the actors
Sub-Theme: Public Health and Research: Evidence Based Policy on Health