Una revisión de las formas de pago de los servicios de salud en el distrito capital.

This article presents an evaluation of the forms of pay that recognize services
ren<lercd to the poor population not housed in the capital district. TI1e results
of the present work are concentrated principally in an analysis of one form
of pay: Global fixed prospective pay for finished activities, and only in t\vo
of the finished activities as defined by the Secretary. Such work is: general
elective medica! consultations and specialize<l elective medica! consultations.
These two activities represent, between the two, sorne 81.15% of the finished
activites done by the network of hospitals, and of these the general medica!
attention represents 79.70%.
This methodological process for a full evaluation creates six large
subprocesses: a) bibliographic review, b) a conceptual framework an<l the
design of a plan for analysis, e) review of the technical specifications for the
identification of the registries for health services rendered, d) evaluation of the
current system, e) construction of adjustment scenarios, and f) formulation
of indicators for the continuation of the forms of pay.
From these results it was found that the current paymenl systems of the
District Financia) Fund requirc adjustmcnts that permit better managcmcnt
of financia! risk. Toe search must continue for the conciliation of political
objectives betwcen the District Hcalth Secretary and the hospitals that serve the
poor population nol covered by necessary subsidies. Before thinking of moving
to another system, it is necessary to understand that each one of the mechanisms
generates different incentives which can be controled through lhe monitoring
and evaluation systems.