Peñaloza Blanca, Leisewitz Thomas, Bastías Gabriel, Zárate Víctor, Depaux Ruth, Villarroel Luis, Montero Joaquín
Departamento de Medicina Familiar, Pontificia Universidad Católica de Chile, Santiago, Chile.
Rev Panam Salud Publica. 2010 Nov;28(5):376-87.
Present a methodology for evaluating cost-effectiveness in primary health care centers (PHCs) in Chile based on the family health care model promoted in Chile and evaluate the results of the first two years of operation of the first pilot center to work under this new primary-care model.
A cost-effectiveness study with a social perspective and a one-year time frame was conducted. In order to compare the university health center in question with the control (a municipal health center), a Family Health Center Composite Quality Index (FHCCQI) was devised. It combines technical indicators and user perceptions of the health centers in six areas: access, continuity of medical care, a preventive and promotional clinical approach, problem-solving capability, participation, and a biopsychosocial and family approach. In order to calculate the costs, the centers' expenses, the savings realized in the rest of the health system, and patients' out-of-pocket expenditures were considered. The incremental cost-effectiveness ratio (ICR) was estimated and a sensitivity analysis was performed.
The university health center was 13.4% more expensive (an additional US$8.93 per annum per enrollee) and was more effective (FHCCQI 13.3% greater) than the municipal one. Accordingly, the ICR is US$0.67 for each additional percentage point of FHCCQI increase.
According to the PHC evaluation model that was implemented, the centers that follow the Chilean family health care model are more effective than traditional PHC centers, as measured by both technical indicators and user ratings.
基于智利推广的家庭医疗模式，提出一种评估智利初级卫生保健中心成本效益的方法，并评估首个按照这种新的初级保健模式运营的试点中心头两年的运营结果。
开展了一项具有社会视角且为期一年的成本效益研究。为了将相关大学健康中心与对照中心（一个市立健康中心）进行比较，设计了家庭健康中心综合质量指数（FHCCQI）。该指数结合了六个领域的技术指标以及用户对健康中心的看法：可及性、医疗连续性、预防和促进性临床方法、解决问题能力、参与度以及生物心理社会和家庭方法。为了计算成本，考虑了各中心的支出、卫生系统其他部分实现的节省以及患者的自付费用。估计了增量成本效益比（ICR）并进行了敏感性分析。
该大学健康中心比市立健康中心贵13.4%（每位参保人每年额外8.93美元），且更具成效（FHCCQI高13.3%）。因此，FHCCQI每增加一个百分点，ICR为0.67美元。
根据所实施的初级卫生保健评估模型，按照智利家庭医疗模式运营的中心，无论是通过技术指标还是用户评级衡量，都比传统初级卫生保健中心更具成效。
