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Seminario Internacional.
A formação e a remuneração dos
professionais responsáveis pela atenção
primária em saúde
Métodos ...
Contenido
1. Proceso Histórico y contexto
2. Formas de remuneración en su tránsito
histórico
3. Antecedentes de investigac...
Proceso Histórico
Capitalismo

a) manufactura
b) Industrial
c) Taylorismo
Fordismo

a) reconversión
Industrial
b) flexibil...
Contexto
Múltiples elementos de la emergencia del tema y su
posicionamiento
a) Racionalización financiera
b) Disminución d...
Remuneración directa

Base salarial única

Base salarial y pagos adicionales
A = Salario base
B = Antigüedad
C= Ayuda rent...
Pago segmentado
Pago por diversos componentes

D

B

A
C

A = Producto final
B = Incentivos a la productividad
C = evaluac...
Bibliografía seleccionada: Métodos de pago (1)
1. Del Bueno D. and Bridges P. (1985) Providing Incentives While Reducing C...
Bibliografía seleccionada: Métodos de pago (2)
12. Médici, A. C., & Girardi, S. N. (1996). Emprego, remuneracao de pessoal...
Métodos de pago: tema reciente

1985 - 1990

Emergencia
Presencia

1990 – 2000
Presencia
Y
diversidad

Ausencia
Reemergenc...
Ingresos y descuentos mensuales a médicos de
atención primaria. IMSS 2013
DESCUENTOS
15%

INGRESOS 85%
Componentes del ingreso a médicos de atención
primaria. IMSS 2013
Otros*
25%
Puntualidad
6%
Asistencia
19%

Salario Base
4...
Pago a personal (USD, 2010) de APS. SS y SESA.
México 2009
Categoría

Honorarios

Contrato

Diferencia %

Medicina General...
Pago a personal de APS Sector privado
México 2006
Tipo de Pago

%

Por servicio

41

Por día

59

Total

100

Fuente. Jari...
Métodos de pago a profesionales de medicina. El caso de México
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Métodos de pago a profesionales de medicina. El caso de México

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Apresentação do convidado internacional Edgar C. Jarillo Soto, no seminário OIAPSS-Colufras, realizado no dia 02/02/2014, em Brasília.

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Métodos de pago a profesionales de medicina. El caso de México

  1. 1. Seminario Internacional. A formação e a remuneração dos professionais responsáveis pela atenção primária em saúde Métodos de pago a profesionales de medicina. El caso de México SGEP/MS – Brasil, OPAS/OMS – Brasil, Observatorio Ibero-Americano de Políticas e Sistemas de Saúde (OIAPSS), Conferencia Luso-Francófona de Saúde (Colufras). Brasilia, Brasil. 2 de febrero de 2014 Edgar C. Jarillo Soto Universidad Autónoma Metropolitana-Xochimilco. México
  2. 2. Contenido 1. Proceso Histórico y contexto 2. Formas de remuneración en su tránsito histórico 3. Antecedentes de investigación 4. Experiencia en México
  3. 3. Proceso Histórico Capitalismo a) manufactura b) Industrial c) Taylorismo Fordismo a) reconversión Industrial b) flexibilización Remuneración directa Pago segmentado
  4. 4. Contexto Múltiples elementos de la emergencia del tema y su posicionamiento a) Racionalización financiera b) Disminución de costos c) Optimización de la gestión d) Calidad
  5. 5. Remuneración directa Base salarial única Base salarial y pagos adicionales A = Salario base B = Antigüedad C= Ayuda renta D = Alimentos E = Asistencia, puntualidad B C D A E
  6. 6. Pago segmentado Pago por diversos componentes D B A C A = Producto final B = Incentivos a la productividad C = evaluación de los usuarios D = otras
  7. 7. Bibliografía seleccionada: Métodos de pago (1) 1. Del Bueno D. and Bridges P. (1985) Providing Incentives While Reducing Costs: An Employee Suggestion Plan. Nursing Economics. 3:212-215. 2. Hillman A. (1987). Financial Incentives for Physicians in HMOs: Is There a Conflict of Interest? N Engl J Med, 317(27):1743-1748. 3. Chan L, Wagers S, Park W, Hernández R, and Bernstain S, (1990). “An Incentive Program to Increase Revenue in a Public Hospital.” Health Care Manage Rev. 15(2):31-41. 4. McGuire TG. and Mark PV. (1991). Physician Response to Fee Changes with Multiple Payers. Journal of Health Economics.10:385-410. 5. Rakich J. and Becker ER. (1992). United States Physician Payment Reform: Background and Comparison With the Canadian Model. Health Care Manage Rev 17(1):9-19. 6. Grumbach K. and Frey J. (1993) “Managing Primary Care in the United States and in the United Kingdom.” N Engl J Med. 328(13):940-945. 7. Lee DW. and Gillis KD. (1993). Physician Responses to Medicare Physician Payment Reform: Preliminary Results on Access to Care. Inquiry 30:417-428. 8. Teisberg E, Porter M E, and Brown GB. (1994). Making Competition in Health Care Work. Harvard Business Review. Jul/Aug:131-141. 9. Cherchiglia, M. L. (1994). Remuneracao do trabalho médico: um estudo sobre seus sistemas e formas em hospitais gerais de Belo Horizonte. Cad. Saúde Públ., Rio de Janeiro, 10 (1):67–79. 10.Seixas P. (1996). Incentivos financieros: Revisión y elementos de reflexión, en: Brito P. Campos F. y Novichk M. (Orgs) Gestión de recursos humanos en las reformas sectoriales en salud: cambios y oportunidades. Washington, D.C., OPS, pp. 53-92. 11.Seixas P. (1996). Incentivos financieros: Revisión y elementos de reflexión, en: Brito P. Campos F. y Novichk M. (Orgs) Gestión de recursos humanos en las reformas sectoriales en salud: cambios y oportunidades. Washington, D.C., OPS, pp. 53-92.
  8. 8. Bibliografía seleccionada: Métodos de pago (2) 12. Médici, A. C., & Girardi, S. N. (1996). Emprego, remuneracao de pessoal e productividade em saúde: um balanco da literatura recente. Divulgacao em Saúde para Debate, (14):38-43. 13. Cherchiglia, M. L.,Girardi, SN. & et al (1997). Remuneracao e productividade: o caso da Fundacao Hospitalar de Minas Gerais, 1992–95. Belo Horizonte: UFMG. 14. Chawla M, Windak A, Berman P, Kulis M. (1997). Paying the physicians: Review of different methods. Data for Decision Making Project. Harvard School of Public Health. Boston, pp.1-24. 15. Relman AS. (1998). Salaried Physicians and Economic Incentives. N Engl J Med:319:784-89. 16. LLovet JJ. (1999). Transformaciones en la profesión médica: un cuadro de situación al final del siglo. En: Bronfman M., Castro R. (eds) Salud Cambio social y políticas. Perspectivas desde América Latina. Mexico: EDAMEX, pp. 335-349. 17. Alvarez B, Pellisé L, Lobo F. (2000) Sistemas de pago a prestadores de servicios de salud en países de América Latina y de la OCDE. Rev Panam Salud Publica, 8(1-2):55-70. 18. Jarillo EC, Chapela MC, Mendoza JM. (2005) Repercusiones de los sistemas de pago en la profesión y la formación médica. Reencuentro. 44:63-69. 19. Jochelson K. (2007) Paying the patient. Improving health using financial incentives. Kicking bad habits. King´s Fund. London, pp 1-18.. 20. Grépin K, Savedoff W. (2009) 10 best resources on … health workers in developing countries. Health Policy an Planning, 24:479-482. 21. Nigenda G, Ruiz JA, Aguilar M, Arias R. (2012). Regularización Laboral de Trabajadores de la salud 22. pagados con recursos del Seguro Popular en México. Sal Pub México. 54(6):616-623. 23. Hernández P, Poullier J, Van Mosseveid C, Van de Maele N, Cherilova V, Indikadahena C, Lie G, TaTorres T, Evans DB. (2013). Health worker remuneration in WHO Member States. Bull World Health Organ. Nov 1:191(11):808-815. 24. Langerbrunner J, Liu X. (S/F) How to pay. Understanding and using incentives, Health, Nutrition an Population (HNP). Discussion Paper. World Bank. Washington, pp iii-24. 25. Shang J, You L, Ma Ch, Altares D, Sloane D, Aiken L. (2014). Nurse employment in Chinese hospitals: impact of inequitable benefit structure on nurse and patient satisfaction. Human Resources for Health 12;1
  9. 9. Métodos de pago: tema reciente 1985 - 1990 Emergencia Presencia 1990 – 2000 Presencia Y diversidad Ausencia Reemergencia 2001 – 2010 Reformas
  10. 10. Ingresos y descuentos mensuales a médicos de atención primaria. IMSS 2013 DESCUENTOS 15% INGRESOS 85%
  11. 11. Componentes del ingreso a médicos de atención primaria. IMSS 2013 Otros* 25% Puntualidad 6% Asistencia 19% Salario Base 43% Sobresueldo Médicos 7% * Otros: Renta Libros Despensa
  12. 12. Pago a personal (USD, 2010) de APS. SS y SESA. México 2009 Categoría Honorarios Contrato Diferencia % Medicina General 1088 1671 54 Medicina Especializada 1261 2003 59 Odontología 930 1410 52 Enfermera General 666 1038 56 Enfermera Auxiliar 573 893 56 Auxiliar de Diagnóstico y Tratamiento 540 854 58 Administrativo 542 586 8 Fuente: Nigenda G, Ruiz JA, Aguilar M, Arias R. Regularización Laboral de Trabajadores de la salud pagados con recursos del Seguro Popular en México. Sal Pub México 2012,54(6):616-623.
  13. 13. Pago a personal de APS Sector privado México 2006 Tipo de Pago % Por servicio 41 Por día 59 Total 100 Fuente. Jarillo EC, Chapela MC, Mendoza JM. Repercusiones de los sistemas de pago en la profesión y la formación médica. Reencuentro. 2005;44:63-69.

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