RESUMO
Abstract-The introduction of Seguro Popular de Salud (SPS) expanded the practice of contracting in the Mexican health system. Specifically, SPS established that formal relationships among institutional agencies should be mediated by written agreements and contracts. These contracts were supposed to ensure a technically sound interaction between financing and service provision agencies. This study aims to assess the degree to which the contracts adhere to five characteristics of cost-effective contracting proposed by Figueras et al. Information was extracted from a purposive sample of 30 institutional agreements and contracts formalizing the relationship among federal, state, and local public agencies and between public and private agencies. Contracts and management agreements were obtained from of a series of SPS evaluations carried out between 2007 and 2012 (including some agreements signed in 2006); additional contracts signed after 2012 were obtained through an Internet search. Most of the five framework characteristics were identified in the sample of contracts, but certain elements such as pay-for-performance and the explicit definition of the volume of services to be provided were clearly deficient. This analysis found that over time SPS contracts have been modified to better establish inter-institutional relationships in compliance with guidelines regarding the allocation of funds and the purchasing of services, but they still need further improvements to accomplish their role of increasing efficiency in the flow of funds through the Mexican health system.
RESUMO
El objetivo que se plantea es dar cuenta del proceso de formulación e implementación del Seguro Popular de Salud, como parte de las políticas públicas en salud en un estado de la república mexicana: el estado de México. El método que se realiza es un análisis en la normatividad en salud emitida a nivel nacional y estatal, y se sistematiza. De esta información se identifican variables, se desarrolla una guía de entrevistas a semiprofundidad, realizadas a los responsables que estuvieron en el inicio del Seguro Popular en el estado de México, conociéndose su proceso de implementación en los servicios de salud. Resultados: Considerando que dentro del ámbito de las política públicas nacionales y estatales para la ejecución de una ley existen etapas, se encontró que sí existió el proceso a nivel nacional, procedimiento que no se cumplió en el caso del estado de México...
The objective that considers is to report formulation process and implementation of the Popular Insurance of Health like part of the public policies in health in a state of the Mexican Republic: the State of Mexico. The method that is made is an analysis in the frame normative in healthemitted at national level and state and it is systematized; of this information, variables are identified, is developed a guide of interviews to semidepth made to the people in charge who were in the beginning of the Popular Insurance in the State of Mexico knowing itself theirprocess implementation in the services of health. The main obtained results are that within the scope of the national and state public policies for the execution of a Law stages exist, being in the present that yes the process at national level existed, procedure that was not fulfilled in the case of the State of Mexico...
O objetivo que considera é relatar o processo da formulação e a execução do Seguro Popular de Saúde como parte das políticas públicas na saúde em um estado da república mexicana: oEstado de México. O método que é feito é uma análise na normatividade na saúde emissora no nível e no estado nacionais e sistematizado; desta informação, as variáveis são identificadas, são tornadas uma guia das entrevistas ao semiprofundidade feito aos responsáveis do posto que estavam no começo do Seguro Popular no Estado de México e que conheceram sue processo de execução nos serviços da saúde. Os resultados obtidos principais estão aquele dentro do espaço do nacional e as políticas públicas do estado para a execução de estágios de uma lei existem, sendo no presente que sim o processo no nível nacional existiu, o procedimento que não foi cumprido no exemplo do estado de México...