RESUMO
The reduction of high levels of absenteeism among health care workers was one the objectives of the reforms undertaken to improve public hospital performance during the 1990s in Costa Rica. This paper attempts to assess the impact of changes in reimbursement methods and organizational reform on absence rates among health care personnel in Costa Rican public hospitals for the period 1995-2001. Our results show the reforms to have had a negative impact on absenteeism, which increased throughout the considered period. Results further indicate that the policy of not substituting absentee workers, which was introduced through the reforms, did not work as expected in a permissive environment in which peer pressure mechanisms were lacking. In addition, the explicit incentives for workers included in the reforms were retained and used at facility level. There is a pressing need in the future for control and disciplinary mechanisms for health care personnel and for the introduction of absence rates as an explicit goal to be monitored and evaluated.
Assuntos
Absenteísmo , Administração Hospitalar , Inovação Organizacional , Costa Rica , HumanosRESUMO
El principal propósito del presente estudio es presentar un panorama general del financiamiento, producción y prestación de los servicios de salud en Bolivia; analizar el flujo de fondos, con particular énfasis en la contribución de los impuestos, seguros, pagos de los usuarios, cooperación internacional, etc., para financiar los servicios de salud en los últimos 5 a 10; analizar la contribución de diferentes métodos de financiamiento, como impuestos generales, impuestos específicos, seguros sociales, seguros privados, pagos de los usuarios, cooperación internacional; y discutir de casos específicos: el seguro de maternidad y niñez y PROSALUD