sábado, 17 de marzo de 2012

¿Mejora la salud disponer de más medicos de familia?




James Macinko, Barbara Starfield y Leiyu Shi tratan de responder esta pregunta y aportan evidencia científica que responde de forma afirmativa.


Señores políticos y gestores sanitarios. La atención primaria es más barata y  mejora la salud de la población. ¿Se han planteado alguna vez invertir en ella en lugar de hacer lo contrario?

En España se dedica un 15% del presupuesto sanitario a Atención Primaria cuando lo aconsejado es el 25%. No parece que estas cifras hablen de buena gestión.


 This analysis addresses the question, Would increasing the number of primary
care physicians improve health outcomes in the United States?
A search of the
PubMed database for articles containing “primary care physician supply” or
“primary care supply” in the title, published between 1985 and 2005, identified 17
studies, and 10 met all inclusion criteria. Results were reanalyzed to assess
primary care effect size and the predicted effect on health outcomes of a one-unit
increase in primary care physicians per 10,000 population. Primary care
physician supply was associated with improved health outcomes, including
all-cause, cancer, heart disease, stroke, and infant mortality; low birth weight; life
expectancy; and self-rated health. This relationship held regardless of the year
(1980–1995) or level of analysis (state, county, metropolitan statistical area
(MSA), and non-MSA levels). Pooled results for all-cause mortality suggest that
an increase of one primary care physician per 10,000 population was associated
with an average mortality reduction of 5.3 percent, or 49 per 100,000 per year.



CONCLUSIONS

Our analysis found consistent evidence that at the ecological level, the supply of
primary care physicians is positively associated with better population health in
the United States
. The relationship holds at different units of analysis (state, county,
and MSA levels) for various health outcomes (all-cause mortality; cancer, heart
disease, stroke, and infant mortality; low birth weight; life expectancy; and
self-rated health) and for various approaches to categorizing the primary care
physician supply.
Previous studies have shown that countries with well-developed primary
care systems have lower overall health system costs, better health outcomes, and
higher levels of satisfaction than countries without
(26, 27). These systems
have better results not only because the relative roles of primary care physicians
and specialists may be more clearly defined than in the United States, but
also because the health system as a whole is more directed at the supply side than at
the demand side. Greater use of evidence on the roles of primary care physicians
and specialists, and on ways to most effectively deploy them, offers promise of
more informed health policy.





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Foto: Barbara Starfield

Vía Javier Padilla