Desigualdad en recursos financierosde la Atención Primaria de SaludMunicipal en Chile, 2001-2013

Junio 2017

ARTÍCULO DE INVESTIGACIÓN 723 Rev Med Chile 2017; 145: 723-733 Desigualdad en recursos financieros de la Atención Primaria de Salud Municipal en Chile, 2001-2013 Camilo Riquelme Briceño1, Juan Haase Delgado2,a, Sebastián Lavanderos Bunout3, Andrea Morales Martínez4,5,a,b Inequality of financial resources for primary health care Background: The availability of health care resources is one of the main factors influencing health care inequalities. Aim: To evaluate communal inequality in financial resources for municipal primary care in Chile. Material and Methods: The evolution of income, expenditure and investment per subject enrolled was assessed for the period 2001-2013 in the 320 municipalities that administer municipal health. Inequality was evaluated using Lorenz curves and annual indicators (Gini, Theil, Coefficient of Variation and Reason 90/10). For a panel analysis with fixed effects, the association of these resources with socioeconomic variables and municipal health was evaluated. Results: The Gini of per capita spending increased 1.75 times, while the Gini investment grew by 30%. Per capita spending was significantly and inversely associated with poverty, dependency on the Municipal Common Fund, resources coming from the City Hall, spending per capita, expenses in personnel, performance and investment, rate of years of potential life lost and infant mortality. A direct and significant association was observed with global, less than two years and greater than 64 years urban population, destination of municipal revenue to health, per capita investment in health, rate of healthcare professionals, number of attentions and health care centers and availability of primary emergency facilities. Per capita investment was inversely associated with the number of health care centers and directly to the Fund dependency, municipal health coverage and personnel expenses. Conclusions: Inequality in municipal health funds increased substantially and were associated with social vulnerability, access to municipal health and community health outcomes. (Rev Med Chile 2017; 145: 723-733) Key words: Health Disparities; Health Resources; Primary Health Care; Socioeconomic Factors. 1Hospital Adriana Cousiño. Quintero, Chile. 2Departamento de Medicina Interna, Hospital Clínico Universidad de Chile. Santiago, Chile. 3Hospital de Loncoche, Loncoche, Chile. 4Departamento de Consultas y Procedimientos. Hospital Clínico Universidad de Chile. Santiago, Chile. 5Departamento de Neurología y Neurocirugía, Hospital Clínico Universidad de Chile. Santiago, Chile. aMédico becario. bMSc. en Bioestadística, MBA, MSc. en Políticas Públicas. Recibido el 2 de agosto de 2016, aceptado el 18 de junio de 2017. Correspondencia a: Dr. Camilo Riquelme camiloriquelme.b@gmail.com Para abordar las desigualdades en salud, la declaración de Alma-Ata de 1978 consideró prioritario potenciar la atención primaria de salud (APS), como pilar fundamental de los sistemas sanitarios1. Existe evidencia de que una APS robusta genera mejores resultados sanitarios, mayor equidad y un uso más eficiente de recursos2,3. Se ha observado que el impacto de la inversión en APS sobre la equidad, sería incluso mayor que el de la inversión en el sistema de salud general4. Si bien Chile destaca por sus indicadores sanitarios, comparables con países desarrollados, posee la mayor desigualdad de ingresos de la Organización para la Cooperación Económica y el Desarrollo (OECD) y una baja redistribución por beneficios sociales e impuestos5; lo que, teó


Junio 2017
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