Article information
Resumen
La propuesta de elaboración de un “catálogo” de prestaciones del Sistema Nacional de Salud pone de relieve algunos problemas, políticos y técnicos, relacionados con su puesta en práctica. En este trabajo se examinan seis de estos elementos que se consideran relevantes para el desarrollo de esta estrategia: el instrumento para llevar a cabo esta definición, el gasto sanitario, la eficiencia del sistema, el acceso a los servicios, la calidad de los servicios y el proceso de toma de decisiones para la definición de las prestaciones. Se concluye que un sistema de ordenación simple, evitando el establecimiento de un catálogo detallado, se adapta a las necesidades del Sistema Nacional de Salud.
Palabras clave:
Prestaciones
Sistema Nacional de salud
Evaluación tecnología
Summary
The definition of a “benefit package” of services covered by the National Health System of Spain -NHSS- raises technical and political problems. This article examines six relevant issues related with the implementation of this strategy: the instrument to define the services covered by the public system; health care expenditures; access to the services; quality; and the decision making-process. The definition of a comprehensive package of -broadly defined- services covered by the NHSS seems to be the most appropriate strategy, instead of a very detailed “catalog” of medical practices.
Key words:
Benefit package
Spain's National Health System
Evaluation of technology
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Bibliografía
[1.]
E. Chelimsky.
The political debate about health care: are us losing sight of quality?.
Science, 262 (1993), pp. 525-528
[2.]
J. Califano.
America's health care revolution.
[3.]
T.R. Marmor.
Commentary on Canadian health insurance: lessons for the United States.
Int J Health Serv, 23 (1993), pp. 45-62
[4.]
A. Williams.
Cost-effectiveness analysis: is it ethical?.
J Med Ethics, 18 (1992), pp. 7-11
[5.]
C.M. Grogan.
Deciding on access and levels of care: a comparison of Canada, Britain, Germany and the United States.
J Health Pol, Pol & Law, 17 (1992), pp. 213-232
[6.]
R. Klein.
Can we restrict the health care menu?.
Health Policy, 13 (1994), pp. 84-100
[7.]
T.A. Sheldon, G.D. Smith, G. Bevan.
Weighting in the dark: resource allocation in the new NHS.
BMJ, 305 (1993), pp. 835-838
[8.]
J. Eyles, S. Birch.
A population-based approach to healthcare resource allocation and planning in Ontario: a link between policy goals and practice?.
Can J Public Health, 84 (1993), pp. 112-117
[9.]
R. Carr-Hill, T. Sheldon.
Rationality and the use of formulae in the allocation of resources to health care.
J Public Health Med, 14 (1992), pp. 117-126
[10.]
J. Nieto, J.M. Cabasés, G. Carmona.
Equidad y eficiencia en la distribución territorial de recursos financieros para la sanidad en España. Análisis teórico y empírico.
Hacienda Pública Española, Monografías, I (1993), pp. 109-125
[11.]
N. Sanfrutos.
La financiación de los servicios regionales de salud. Problemas y posibles soluciones.
Gac Sanit, 26 (1991), pp. 219-224
[12.]
G. López Casanovas, J.F. Corona, J. Figueres.
Estudio del sistema de financiación autonómico de la sanidad.
[13.]
OECD.
The reforms of health care: a comparative analysis of seven countries.
[14.]
Government Committee on Choices on Health Care.
Choices on health care.
[15.]
E. Bratton, M.M. Warner.
La contratación de la asistencia sanitaria desde una perspectiva británica.
Reformas de los sistemas sanitarios en Europa,
[16.]
Contrato-Programa Ministerio de Sanidad y Consumo-Insalud para 1993 (mimeo).
[17.]
OECD.
OECD health systems.
Facts and trends,
[18.]
J. Barea.
Cuentas satélites del gasto público en sanidad. Años 1988,1989 y 1990 Universidad Autónoma de Madrid.
Facultad de Ciencias Económicas y Empresariales, (1993),
[19.]
J. Barea, A. Gómez Círia.
Crecimiento del gasto público en sanidad en la década de los 80.
XIII Jornadas de Economía de la Salud, (1993),
[20.]
US General Accounting Office.
Canadian health insurance: lessons for the United States (GAO/HRD-91-90).
[21.]
L.D. Brown.
The national politics of Oregon's rationing plan.
Health Aff, 10 (1991), pp. 28-51
[22.]
J. Elola.
Sistema Nacional de Salud: Evaluación de su eficiencia y alternativas de reforma.
[23.]
Banco Mundial.
Informe sobre el desarrollo mundial 1993.
Invertir en salud,
[24.]
A. Donabedian.
Social responsibility for personal health services: an examination of basic values.
Inquiry, 8 (1971), pp. 3-19
[25.]
Comisión de Análisis y Evaluación del Sistema Nacional de Salud.
Informe y recomendaciones.
[26.]
J. Callahan.
Rationing medical progress. The way to affordable health care.
N Engl J Med, 322 (1990), pp. 1810-1813
[27.]
K.L. White.
Evaluation and medicare.
Economic and medical evaluation of health care technologies,
[28.]
M. Eddy, J. Billing.
The quality of medical evidence: implications for quality of care.
Health Affairs, I (1988), pp. 19-32
[29.]
K. McPherson.
International differences in medical care practices. En: OECD. Health care systems in transition.
[30.]
R.H. Brook.
Testimony before the Committee on Ways and Means.
U.S. House of Representatives Washington DC, (1991),
[32.]
D.M. Eddy.
What care is “essential”? What services are “basic”?.
JAMA, 265 (1991), pp. 786-788
[33.]
D.M. Eddy.
Clinical decision making: from theory to practice. The individual vs society. Resolving the conflict.
JAMA, 265 (1991), pp. 2399-2401
[34.]
A. Gafni, S. Birch.
Guidelines for the adoption of new technologies: a prescription for uncontrolled growth in expenditure and how to avoid the problem.
Can Med Assoc J, 148 (1993), pp. 913-917
[35.]
A. Laupacis, D. Feeny, A.S. Detsky, et al.
How attractive does a new technology have to be to warrant adoption and utilization?. Tentative guidelines for using clinical and economical evaluations.
Can Med Assoc J, 146 (1992), pp. 973-981
[36.]
E. Nord.
The relevance of health state after treatment in prioritising between different patients.
J Med Ethics, 19 (1993), pp. 37-42
[37.]
A.S. Relman.
Is rationing inevitable?.
N Engl J Med, 332 (1990), pp. 1809-1810
[38.]
R.M. Veatch, C.M. Spicer.
Medically futile care: the role of the physician in setting limits.
Am J Law & Med, 18 (1992), pp. 15-36
[39.]
F. Rodriguez Artalejo, V. Ortún.
De la efectividad clínica a la eficiencia social.
Med Clín (Barc), 95 (1990), pp. 385-388
[40.]
A. Etzioini.
Health care rationing: a critical evaluation.
Health Aff, 10 (1991), pp. 88-95
[41.]
M. Dubinsky, J.H. Ferguson.
Analysis of the National Institutes of health Medicare coverage assessment.
Int J Technol Assess Health Care, 6 (1990), pp. 480-488
[42.]
R.C. Herdman, J.L. Wagner, L. Wolfe, M.E. Gluck, T.W. Brogan.
Health technology and health reform.
Cancer Invest, 11 (1993), pp. 337-344
[43.]
Reports from the Swedish Council on Technology Assessmentin Health Care (SBU).
Critical analysis in medicine.
Int J Technol Assess Health Care, 9 (1993), pp. 450-453
[44.]
H.D. Klevit, A.C. Bates, T. Castañares, P.R. Kirk EP, Sipes-Metzler, R. Wopat.
Prioritization of health care services. A progress report by the Oregon Health Services Commission.
Archiv Int Med, 15 (1991), pp. 912-916
[45.]
Une réforme axée sur le citoyen. Quebecq: Govemement du Quebecq, Ministére de la Santé et des Services Socieaux, 1990
[46.]
J.E. Wennberg.
Outcomes research, cost containment, and the fear of health care rationing.
N Engl J Med, 323 (1990), pp. 1202-1204
[47.]
G. Dominighetti.
“L'empowerment” du consummateur dans le marché sanitaire: una Strategie indispensable.
Epistula, (1994), pp. 9-10
Este trabajo ha sido parcialmente financiado por la ayuda 94/5058 del Fondo de Investigaciones Sanitarias.
Copyright © 1995. Sociedad Española de Salud Pública y Administración Sanitaria
