Eficiencia en los Sistemas de Salud: Lactancia Materna y Financiación Capitativa

  • Autor: Juan Antonio Quesada Torres
  • Director/es: Jorge Eduardo Martínez Pérez e Ildefonso Méndez Martínez
  • Defensa: 18/7/2023 - Universidad de Murcia
  • Tribunal: David Cantarero Prieto, José Mª Abellán Perpiñán, Luz Mª Peña Longobardo
  • Calificación: Sobresaliente cum laude
  • Ver publicaciones relacionadas

Resumen

La tendencia observada durante las últimas décadas del gasto sanitario a registrar incrementos anuales como consecuencia de la evolución de sus principales determinantes, así como los significativos incrementos del mismo en los años más recientes, han hecho resurgir con fuerza el interés por la gestión sanitaria. En el contexto actual, caracterizado por la necesidad de un reforzamiento de los sistemas sanitarios, de restricciones presupuestarias derivadas de las elevadas tasas de déficit y deuda pública de los Estados, y por el carácter disruptivo de la tecnología en el ámbito biosanitario, se hace imprescindible el uso de herramientas de evaluación de prestaciones en términos de coste-efectividad, así como su complementario análisis de impacto presupuestario.

En el estudio llevado a cabo en el capítulo I hemos seguido la metodología utilizada por otros autores para estimaciones similares realizadas en otros países, considerando únicamente cuatro patologías en las que la evidencia científica muestra una menor prevalencia para los bebés alimentados con leche materna (otitis media, gastroenteritis, infección respiratoria y enterocolitis necrotizante), y fijando las tasas objetivo de lactancia materna exclusiva en el 95% al alta hospitalaria y el 50% de LME a los 6 meses. Según los resultados de nuestro trabajo, el ahorro para el sistema sanitario español por niño nacido derivado del incremento de las actuales tasas de LME a las es de 460 euros al año.

A la vista de la situación actual en nuestro país, y de la evidencia sobre la efectividad y rentabilidad de las acciones y políticas públicas para la protección, promoción y apoyo a la lactancia materna obtenidas de la revisión sistemática de la literatura, concluimos en el capítulo II que se debe continuar con el impulso de políticas de conciliación de la vida familiar y laboral en España; unificar la monitorización de los datos relativos a LM; formación específica en lactancia materna de nuestros profesionales sanitarios, obligatoria y continuada; coordinación de todos los profesionales de niveles de asistencia sanitaria primaria y hospitalaria; y fomentar la información y educación en lactancia materna en general, y especialmente en los momentos pre, peri y postnatal a las madres. Asimismo, es imprescindible corregir y eliminar las prácticas llevadas a cabo por la industria de la leche artificial con efectos negativos para la lactancia materna.

Además de actuaciones en el ámbito asistencial, la búsqueda de la eficiencia de los sistemas sanitarios debe abordarse también desde la perspectiva financiera y presupuestaria. El objetivo del análisis llevado a cabo en el capítulo III ha sido simular un modelo de presupuestación de base capitativa por áreas de salud para el SMS utilizando: la estratificación de la población por GMA, por edad y sexo; y la información de costes a paciente; obteniendo los coeficientes modulares de la cápita que han permitido calcular las cifras de población ajustada, para a continuación realizar la simulación de la presupuestación por áreas de salud y un análisis de viabilidad. Metodológicamente, hemos elegido, por su mejor desempeño, una estimación por GLM que emplea como familia una distribución gamma y como función de enlace la transformación logarítmica.

La implantación de un sistema de financiación basado en GMA en la Región de Murcia dejaría de considerar situaciones tales como el grado de dispersión de la población, condiciones socioculturales, zona vacacional o zona limítrofe. La aplicación del modelo de financiación capitativa basado en GMA debe utilizarse como complemento del existente, facilitando mejorar la equidad de la presupuestación en el SMS. Sería necesaria la implementación de un sistema ágil, transparente y efectivo de compensación entre áreas de salud.

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Indeed, some authors found that a 10% increase in exclusive breastfeeding rates in the first two years of life led to a reduction in treatment costs of US$312 million in the US, US$7.8 million in the UK, US$30 million in China, and US$1.8 million in Brazil. Among high-income countries, Spain stands out for its low breastfeeding rate. Methods: We calculated the savings that the Spanish National Health System would have benefited from had breastfeeding rates been higher in Spain, both from the time of hospital discharge and at 6 months postpartum. We followed the methods used in similar studies carried out in the US, Italy, Australia, the Netherlands, and the UK, to conservatively estimate these potential savings by considering only the lower thresholds in all our estimates. Here we approximated the benefits of having increased exclusive breastfeeding rates based on the lower incidence of infantile pathologies among exclusively breastfed infants. Robust evidence indicates that among breastfed infants there is a lower prevalence of otitis media, gastroenteritis, respiratory infections, and necrotising enterocolitis. We obtained the estimated monetary cost of these diseases by combining their prevalences with data about their economic costs for diagnosis-related groups. Results: The estimated effects we calculated imply that the Spanish National Health System could have saved more than €5.6 million for every percentage point increase in exclusive breastfeeding rates in Spain during 2014. Conclusions: Breastfeeding is essential both for the health of mothers and the health and development of newborns but is rarely considered as an economic issue and remains economically invisible. In addition to the improved wellbeing of mothers and their infants, breastfeeding can positively impact society as a whole and should therefore be better defined in public policies. Thus, strategies aimed at increasing exclusive breastfeeding rates would likely contribute to lowering the fiscal burden of the Spanish National Health System. Moreover, the magnitude of these potential benefits suggests that such policies would likely be socially cost–effective. 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Indeed, some authors found that a 10% increase in exclusive breastfeeding rates in the first two years of life led to a reduction in treatment costs of US$312 million in the US, US$7.8 million in the UK, US$30 million in China, and US$1.8 million in Brazil. Among high-income countries, Spain stands out for its low breastfeeding rate. Methods: We calculated the savings that the Spanish National Health System would have benefited from had breastfeeding rates been higher in Spain, both from the time of hospital discharge and at 6 months postpartum. We followed the methods used in similar studies carried out in the US, Italy, Australia, the Netherlands, and the UK, to conservatively estimate these potential savings by considering only the lower thresholds in all our estimates. Here we approximated the benefits of having increased exclusive breastfeeding rates based on the lower incidence of infantile pathologies among exclusively breastfed infants. Robust evidence indicates that among breastfed infants there is a lower prevalence of otitis media, gastroenteritis, respiratory infections, and necrotising enterocolitis. We obtained the estimated monetary cost of these diseases by combining their prevalences with data about their economic costs for diagnosis-related groups. Results: The estimated effects we calculated imply that the Spanish National Health System could have saved more than €5.6 million for every percentage point increase in exclusive breastfeeding rates in Spain during 2014. Conclusions: Breastfeeding is essential both for the health of mothers and the health and development of newborns but is rarely considered as an economic issue and remains economically invisible. In addition to the improved wellbeing of mothers and their infants, breastfeeding can positively impact society as a whole and should therefore be better defined in public policies. Thus, strategies aimed at increasing exclusive breastfeeding rates would likely contribute to lowering the fiscal burden of the Spanish National Health System. Moreover, the magnitude of these potential benefits suggests that such policies would likely be socially cost–effective. 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