Impacto de un sistema de compra capitativo en la coordinación asistencial

Abstract

Objective: To evaluate the impact of the catalan pilot project of capitation payment on healthcare coordination from a qualitative perspective. Methods: An exploratory, descriptive, qualitative study was carried out by means of document analysis and individual interviews. A criterion sample of documents and of informants was selected: purchasers (9) and providers (26) managers, and health professionals (16). A content analysis was conducted, with mixed generation of categories and data segmentation by informants' groups, themes, and areas. The study area consisted of the 5 pilot zones. Results: According to the informants, the pilot test facilitated a shared vision of the area and improved communication among providers. Nevertheless, changes introduced as a consequence of the project to improve healthcare coordination were scarce. A virtual alliance among providers with shared objectives and structural changes was found in just one area. Healthcare coordination mechanisms were exchanged, with variable use. Perceived barriers to change were uncertainty, providers' fears of losing their identity, lack of interest, and the management limits of some providers. Conclusions: The designed and implemented capitation payment system failed to generate enough incentives to stimulate changes in healthcare coordination. The weaknesses identified by this evaluation should be resolved before extending the pilot project to the rest of Catalonia.