International Forum SECTOR REFORM HEALTH
Developing information systems, as the minimum basic set of hospital discharge data, which know the product enable the attention of health systems is an indispensable basis. At the same time is required development of accounting systems that will allow an approach to efficiency. Currently available tools, even with its limitations are useful for systematizing medical practice, measurement of the results of care processes and to share the risk of decisions between managers and clinicians. We identified three areas of clinical management:
The determination of effective clinical practices, developed based on based medicine evidence and used as instruments development of clinical protocols. Process management, which rearranges the attention focused on the internal customers (staff) and external and the continuum of care. The organization and management services that facilitate definition of responsibility centers are involving to clinical management of their services through the clinical budgeting. Since the beginning of the process which must lead to autonomous management of an establishment health is introduces training of managers and professionals principles and techniques of clinical management and whether furthermore, the organization is plotted targets for improvements in clinical practice and customer service, the possibilities success and consolidation of reform will increase considerably.
Recommendations for improved management should combined measures to improve system management the establishments and the process of care that are consistent and mutually reinforcing. Management measures should be accompanied by the appropriate changes in regulation of the system, deregulating of strengthening operational and monitoring results.
In a well developed regulatory framework, the actions of a pilot or experiences limited in the macro and micro are most useful for universal measures because latter block initiatives the suppliers, new experiences and adapting to environment. It is not possible to accurately predict the success of a management innovation, and consequently will be needed experiences and go out rectified in accordance with results will be obtained. This requires a high capacity for evaluation and a culture of transparency and communication of the results only possible in an environment of consensus and negotiation.
Conclusions
System Reforms health develop in a given environment that conditions and, generally, as part of the reform. This is a first-order condition must be known and analyzed by those who prepare proposals and decision makers. Reforms often focus exclusively the care services to individuals and, therefore, only can produce results that can be achieved with changes in themselves. The integration of public financing is a policy that promotes equity and efficiency. If the integration into a single fund to provide universal coverage is not feasible, should be sought integration formulas that get double coverage and avoid cross-subsidization between public funds or between public funds and private. Charged directly for services should be regulated and must be applied cautiously because of its implications on equity and the difficulty of their control. Reform policies should include determination of benefits that the State guarantees the population and how to access them. The processes decentralization may be useful to bring services to the population, share risks and democratize decision whether they are carried out through an orderly process of distribution functions, taking into account ability of management receiving powers and protecting equity and integrated care for people.
Measures strengthening management capacity must reach everyone levels system, from the regulator to the care professionals and must be consistent with objectives system and serve to promote them.
The management establishments and clinical management will develop best in a decentralized, respecting and supporting initiatives the providers as well as professional groups, and evaluating experiments carried out. Gradual negotiation and consensus must be present in everyone times of reform.