scispace - formally typeset
Search or ask a question
Author

Amparo Susana Mogollón-Pérez

Other affiliations: Universidade de Pernambuco
Bio: Amparo Susana Mogollón-Pérez is an academic researcher from Del Rosario University. The author has contributed to research in topics: Health care & Health services research. The author has an hindex of 13, co-authored 28 publications receiving 670 citations. Previous affiliations of Amparo Susana Mogollón-Pérez include Universidade de Pernambuco.

Papers
More filters
Journal ArticleDOI
TL;DR: Differences can be detected in the use of services: in Colombia greater geographical and economic barriers and the need for authorization from insurers are more relevant, whereas in Brazil, it is the limited availability of health centres, doctors and drugs that leads to longer waiting times.

122 citations

Journal ArticleDOI
TL;DR: In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels, and the design of the health systems appears to determine access to the health services: two insurance schemes with different benefits packages and a segmented system in Brazil, with a significant private component.
Abstract: Introduction: Health system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia. Methods: A cross-sectional study was conducted based on a survey of a multistage probability sample of people who had had at least one health problem in the prior three months (2,163 in Colombia and 2,167 in Brazil). The outcome variables were dichotomous variables on the utilization of curative and preventive services. The main independent variables were income, being the holder of a private health plan and, in Colombia, type of insurance scheme of the General System of Social Security in Health (SGSSS). For each country, the prevalence of the outcome variables was calculated overall and stratified by levels of per capita income, SGSSS insurance schemes and private health plan. Prevalence ratios were computed by means of Poisson regression models with robust variance, controlling for health care need. Results: There are inequities in favor of individuals of a higher socioeconomic status: in Colombia, in the three different care levels (primary, outpatient secondary and emergency care) and preventive activities; and in Brazil, in the use of outpatient secondary care services and preventive activities, whilst lower-income individuals make greater use of the primary care services. In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels. Income in both countries, insurance scheme enrollment in Colombia and holding a private health plan in Brazil all contribute to the presence of inequities in utilization. Conclusions: Twenty years after the introduction of reforms implemented to improve equity in access to health care, inequities, defined in terms of unequal use for equal need, are still present in both countries. The design of the health systems appears to determine access to the health services: two insurance schemes in Colombia with different benefits packages and a segmented system in Brazil, with a significant private component.

87 citations

Journal ArticleDOI
TL;DR: The results show how in the Colombian healthcare system structural and organizational barriers to care access are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment, providing evidence to question the promotion of the managed competition model in low and middle-income countries.
Abstract: The health sector reform in Colombia, initiated by Law 100 (1993) that introduced a managed competition model, is generally presented as a successful experience of improving access to care through a health insurance regulated market. The study's objective is to improve our understanding of the factors influencing access to the continuum of care in the Colombian managed competition model, from the social actors' point of view. An exploratory, descriptive-interpretative qualitative study was carried out, based on case studies of four healthcare networks in rural and urban areas. Individual semi-structured interviews were conducted to a three stage theoretical sample: I) cases, II) providers and III) informants: insured and uninsured users (35), health professionals (51), administrative personnel (20), and providers' (18) and insurers' (10) managers. Narrative content analysis was conducted; segmented by cases, informant's groups and themes. Access, particularly to secondary care, is perceived as complex due to four groups of obstacles with synergetic effects: segmented insurance design with insufficient services covered; insurers' managed care and purchasing mechanisms; providers' networks structural and organizational limitations; and, poor living conditions. Insurers' and providers' values based on economic profit permeate all factors. Variations became apparent between the two geographical areas and insurance schemes. In the urban areas barriers related to market functioning predominate, whereas in the rural areas structural deficiencies in health services are linked to insufficient public funding. While financial obstacles are dominant in the subsidized regime, in the contributory scheme supply shortage prevails, related to insufficient private investment. The results show how in the Colombian healthcare system structural and organizational barriers to care access, that are common in developing countries, are widened by both the insurers' use of mechanisms that limit the utilization and the public healthcare providers' change of behavior in a competition environment. They provide evidence to question the promotion of the managed competition model in low and middle-income countries.

73 citations

Journal ArticleDOI
TL;DR: The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management.
Abstract: Although integrated healthcare networks (IHNs) are promoted in Latin America in response to health system fragmentation, few analyses on the coordination of care across levels in these networks have been conducted in the region. The aim is to analyse the existence of healthcare coordination across levels of care and the factors influencing it from the health personnel' perspective in healthcare networks of two countries with different health systems: Colombia, with a social security system based on managed competition and Brazil, with a decentralized national health system. A qualitative, exploratory and descriptive-interpretative study was conducted, based on a case study of healthcare networks in four municipalities. Individual semi-structured interviews were conducted with a three stage theoretical sample of (a) health (112) and administrative (66) professionals of different care levels, and (b) managers of providers (42) and insurers (14). A thematic content analysis was conducted, segmented by cases, informant groups and themes. The results reveal poor clinical information transfer between healthcare levels in all networks analysed, with added deficiencies in Brazil in the coordination of access and clinical management. The obstacles to care coordination are related to the organization of both the health system and the healthcare networks. In the health system, there is the existence of economic incentives to compete (exacerbated in Brazil by partisan political interests), the fragmentation and instability of networks in Colombia and weak planning and evaluation in Brazil. In the healthcare networks, there are inadequate working conditions (temporary and/or part-time contracts) which hinder the use of coordination mechanisms, and inadequate professional training for implementing a healthcare model in which primary care should act as coordinator in patient care. Reforms are needed in these health systems and networks in order to modify incentives, strengthen the state planning and supervision functions and improve professional working conditions and skills.

70 citations

Journal ArticleDOI
01 Jul 2015-BMJ Open
TL;DR: The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America.
Abstract: Introduction Although fragmentation in the provision of healthcare is considered an important obstacle to effective care, there is scant evidence on best practices in care coordination in Latin America. The aim is to evaluate the effectiveness of a participatory shared care strategy in improving coordination across care levels and related care quality, in health services networks in six different healthcare systems of Latin America. Methods and analysis A controlled before and after quasi-experimental study taking a participatory action research approach. In each country, two comparable healthcare networks were selected—intervention and control. The study contains four phases: (1) A baseline study to establish network performance in care coordination and continuity across care levels, using (A) qualitative methods: semi-structured interviews and focus groups with a criterion sample of health managers, professionals and users; and (B) quantitative methods: two questionnaire surveys with samples of 174 primary and secondary care physicians and 392 users with chronic conditions per network. Sample size was calculated to detect a proportion difference of 15% and 10%, before and after intervention (α=0.05; β=0.2 in a two-sided test); (2) a bottom-up participatory design and implementation of shared care strategies involving micro-level care coordination interventions to improve the adequacy of patient referral and information transfer. Strategies are selected through a participatory process by the local steering committee (local policymakers, health care network professionals, managers, users and researchers), supported by appropriate training; (3) Evaluation of the effectiveness of interventions by measuring changes in levels of care coordination and continuity 18 months after implementation, applying the same design as in the baseline study; (4) Cross-country comparative analysis. Ethics and dissemination This study complies with international and national legal stipulations on ethics. Conditions of the study procedure were approved by each country9s ethical committee. A variety of dissemination activities are implemented addressing the main stakeholders. Registration No.257 Clinical Research Register of the Santa Fe Health Department, Argentina.

64 citations


Cited by
More filters
Journal Article

1,347 citations

Journal Article
TL;DR: This book offers a vast amount of information to the beginning researcher or to professionals interested in reviewing studies with a more critical eye, and is an appropriate reference book for the clinician.
Abstract: O ne of the few research texts authored by those with occupational therapy expertise, this book offers a vast amount of information to the beginning researcher or to professionals interested in reviewing studies with a more critical eye. The book proceeus in a logical fashion beginning with the philosophy of research. The how-to's of designing a study and collecting data are presented, and the final chapters deal with analysis and interpretation of data. In Pan I, the authors define research as a form of knowledge that is \"logical, understandable, confirmable and useful\" (p. 5). DePoy and Gitlin also point out that research provides the scientific evidence necessary to generate a professional body of knowledge. The naturalistic approach to research, designed to uncover phenomena via inductive reasoning, is presented in a positive light. The reader becomes aware of the basic theoretical differences between this approach and the somewhat less controversial experimental approach and is given examples of each. The authors discuss that, although these approaches vary in theory, they may be combined to proVide an integrated approach to research. In Part II, the specifics of structuring research projects are addressed. Which framework (experimental, naturalistic, or a combination) is used depends on the question the researcher wants to answer. The authors also discuss the importance and mechanics of performing a thorough literature review and methods to categorize research designs. The remainder of Pan II is devored to further explanation of the naturalistic and experimental approaches. Examples to illustrate the continuum of designs in each of these approaches are given and several methods 1O combine these designs are proposed. In Part Ill, DePoy and Gitlin delve into selection of appropriate populations and sample sizes. They talk aboLlt nor only what population to include, but also what population to exclude to provide the most stable foundation for a research project. Data-gathering techniques are examined in depth for borh the naturalistic and experimental designs, and several methods for performing statistical analysis are presented. Analysis techniques for naturalistic methodologies are included also. Some basic tips for metamorphosing the information proVided from data analysis into a written text that is clear and concise are outlined in the remaining chapters. The authors also make the pOint that information gleaned from research, no matter how relevant, is nor of use to the profession unless it is disseminated to others. In the last chapter, the authors share their personal research experiences. The reader is left with some perceptions of performing research in a practice-oriented profession. The entry-level researcher, or the clinician wishing to upgrade his knowledge of what constitutes a strong study, will find this book of great interest. The authors have tackled a rather esoreric subject and tied it into a clinician's frame of reference. This text was also written to be included in research curriculums. The Student will find all of the necessary teaching information, as well as examples of the theories presented. Some interesting features of this text include its logical organization. Each chapter contains a summary of the information presented so that the reader can review at a glance. Several of the chapters that present the steps necessary to carry out a study have mental exercises the reader can perform to tesl his knowledge. A wonderful gJossary, bibliography, and thorough index make this an appropriate reference book for the clinician. Theories, strategies, and methodologies are presented with tables and illustrations that are clear to those nor familiar with basic research ideas. One area that could be strengthened is the authors' use of clinical examples. The examples provided in the text are sometimes vague and difficult for the reader to relate to the tenets they are used to reinforce. In addition, many examples appear to be drawn from the authors' social work experience, rather than from their occupational therapy expertise. The book does, however, contain several pertinent references to studies encompassing the occupational therapy range. Several of these studies were also done by the authors, lending further credence to their opinions. For the most part, the authors present the information in an easily understandable style. The beginning of the text, with its explanations of the theory of research and the philosophies of several approaches, may be difficult reading for some. But overall, this text does what it was written to do: give the reader interested in research a thorough background in theory and methodology. The authors seek to demystify the research process for those in the health and human services fields, and the reader is left with a sense that research is not JUSt for those with specialized training, but that direct patient care proViders also can possess the necessary skills and knowledge to make a significant contribution to their profession's body of knowledge. Joanne Merante Baird, MA. OTRIL

593 citations

Journal ArticleDOI
TL;DR: To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, 13 country case studies from various regions around the world are compiled.
Abstract: The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.

430 citations

Journal ArticleDOI
TL;DR: In this article, the authors provide an outline about the research that has been done on TPS during last 15 years as a biodegradable food packaging material, and summarize numerous studies related to interaction of plasticizers and starch for the production of biodesgradable TPS food packaging materials.
Abstract: In the past years, research has been focused on biodegradable materials to replace petroleum based plastics for food packaging application. For this purpose, biopolymers are considered the most promising material because of their biodegradable nature and long shelf life properties like resistance to chemical or enzymatic reactions. Starch is renewable, cheap, and abundantly available biopolymer. However, the intermolecular forces and hydrogen bonds in starch resist it to be processed as a thermoplastic material. To overcome this issue, different plasticizers are used to have deformable thermoplastic material called thermoplastic starches (TPSs). A plasticizer enhances the flexibility, the process stability of starch below the degradation temperature. Plasticizer lowers the glass transition temperature (Tg). TPS is very promising among the biobased materials available for the production of biodegradable plastic. TPS have some limitations; bad mechanical properties and water sensitivity. Starch absorbs water under higher relative humidity. This work will provide an outline about the research that has been done on TPS during last 15 years as biodegradable food packaging material. Practical Applications The basic role of food packaging material is to make it cost effective that satisfies industry requirements and consumer desires, and provide protection from three major classes of external influences: chemical, biological, and physical, e.g., such as exposure to gases, barrier to microorganisms, or from mechanical damage, respectively. These external influences may damage the quality of the food and shelf life. For this motive, starch has become the most preferred option among the verified classes of synthetic and natural materials. Retrogradation of starch chains in presence of water make it impossible to be use as packaging material. To overcome this issue, Starch has been plasticized with water and low molecular weight additive that can interact with its backbone by hydrogen bonding to produce thermoplastic starch (TPS). The objective of this review is to summarize numerous studies related to interaction of plasticizers and starch for the production of biodegradable TPS food packaging materials.

190 citations