Realización del derecho a la protección de la salud en la medicina de seguros: la primera experiencia de Covid-19
Palabras clave:
Derecho a la Salud, Coronavirus, Sistema de salud, Medicina pública, Medicina prepagada
Resumen
Este artículo analiza la efectividad de la medicina aseguradora y las consecuencias negativas de su trabajo, que pudimos observar en el primer período de la pandemia. La metodología de investigación se basa en métodos científicos generales y especiales, en particular: formal-legal, histórico-legal, análisis comparativo y modelización. El procedimiento y los temas a considerar son los siguientes: en la introducción se considerará el concepto de “derecho a la atención de la salud” y la razón de su importancia; en la primera sección, veremos el estado general de la situación, las cifras de diferentes países y los primeros resultados de la lucha contra la pandemia; en la segunda sección, abordaremos algunos de los problemas de acceso a la atención médica en el sistema de seguros y su agravamiento en relación con la pandemia; en el tercero, consideraremos el impacto de la pandemia en el sistema de seguro de salud y cómo podrían haberse evitado problemas. Los resultados de este estudio destacan cómo el sistema de seguro médico ha enfrentado de manera extremadamente insatisfactoria la pandemia y sus consecuencias, y por lo tanto es necesario al menos llevar a cabo un funcionario de pleno derecho, y en el mejor de los casos desarrollar un programa de modernización integral urgente, teniendo en cuenta la experiencia positiva anterior de otros países desarrollados.
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FAIR Health, Inc. (2020). The Projected Economic Impact of the Covid-19 Pandemic on the US Healthcare System. In https://s3.amazonaws.com/media2.fairhealth.org/brief/asset/Covid-19%20-%20The%20Projected%20Economic%20Impact%20of%20the%20Covid-19%20Pandemic%20on%20the%20US%20Healthcare%20System.pdf.
Freeman, J. D., Kadiyala, S., Bell, J. B. & Martin, D. P. (2008). The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies. Medical Care, 46(10), 1023-1032. DOI: 10.1097/MLR.0b013e318185c913.
Fullman, N., Yearwood, J., Abay, S.A. & Abbafati C. (2018). Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. GBD 2016 Healthcare Access and Quality Collaborators. DOI: 10.1016/S0140-6736(18)30994-2.
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Institute of Medicine (US). (2009). America’s Uninsured Crisis: Consequences for Health and Health Care. Washington (DC): National Academies Press. DOI: 10.17226/12511.
Kaiser Family Foundation. (2019). Health Insurance Coverage of the Total Population. In https://www.kff.org/other/state-indicator/total-population/?dataView=1¤tTimeframe=0&selectedDistributions=employer&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
Kliff, S. (June 16, 2020). Most Coronavirus Tests Cost About $100. Why Did One Cost $2,315? The New York Times. In https://www.nytimes.com/2020/06/16/upshot/coronavirus-test-cost-varies-widely.html.
Kurani, N., Pollitz, K., Cotliar, D., Shanosky, N. & Cox, C. (July 15, 2020). Covid-19 Test Prices and Payment Policy. Health System Tracker. In https://www.healthsystemtracker.org/brief/covid-19-test-prices-and-payment-policy/.
Lee, S. Y., Kim, C. W., Seo, N. K. & Lee, S. E. (2017). Analyzing the Historical Development and Transition of the Korean Health Care System. Osong public health and research perspectives, 8(4), 247–254. https://doi.org/10.24171/j.phrp.2017.8.4.03.
Majerol, M., Newkirk, V. & Garfield, R. (2015). The Uninsured: A Primer: key facts about health insurance and the uninsured in the era of health reform. Kaiser Family Foundation. In http://files.kff.org/attachment/primer-the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform.
Matsuda, S. (2019). Health Policy in Japan—Current Situation and Future Challenges. JMA Journal, 2(1), 1-10. DOI: 10.31662/jmaj.2018-0016.
McWilliams, J. M., Zaslavsky, A. M. & Meara, E. (2013). Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults. JAMA, 290(6), 757-764. DOI:10.1001/jama.290.6.757.
Mehrotra, A., Chernew, M., Linetsky, D., Hatch, H. & Cutler, D. (2020). The Impact of the Covid-19 Pandemic on Outpatient Visits: A Rebound Emerges. In https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits.
National Association of Community Health Centers and the Robert Graham Center. (2007). Access denied: a look at America’s medically disenfranchised. In https://www.graham-center.org/content/dam/rgc/documents/publications-reports/monographs-books/Access%20Denied.pdf.
U.S. Department of Labor (2020). News release: the employment situation—September 2020. Washington, DC: Bureau of Labor Statistics. In In https://www.bls.gov/news.release/pdf/empsit.pdf.
Nomura, H. & Nakayama, T. (2005). The Japanese healthcare system. BMJ (Clinical research ed.), 331(7518), 648–649. DOI:10.1136/bmj.331.7518.648.
Pimpertz, J. (May 30, 2017). Kein Spielraum für Wahlgeschenke: Wie die Demografie die privaten Haushalte belastet. In https://www.insm-oekonomenblog.de/16590-kein-spielraum-fuer-wahlgeschenke-wie-die-demografie-die-privaten-haushalte-belastet/.
Saad, L. (December 9, 2019). More Americans Delaying Medical Treatment Due to Cost. Gallup. In https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx.
Sawyer, B. & Cox, C. (December 7, 2018). How does health spending in the U.S. compare to other countries? Health System Tracker. In https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries.
Skinner, A. C. & Mayer, M. L. (2007). Effects of insurance status on children’s access to specialty care: a systematic review of the literature. BMC Health Services Research, 7, Article number: 194. DOI: 10.1186/1472-6963-7-194.
Starfield, B., Shi, L. & Macinko, J. (2005). Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly, 83(3), 457-502. DOI: 10.1111/j.1468-0009.2005.00409.x.
Sung, S. & Park, H.A. (2019). Perceived cultural differences in healthcare for foreign patients visiting South Korea: tool development and measurement. BMC Health Serv Res 19, 197. DOI: 10.1186/s12913-019-3965-9.
Tolbert, J., Orgera, K. & Damico, A. (November 6, 2019). Key Facts about the Uninsured Population. KFF. In https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.
U.S. Department of Health and Human Services Office of Inspector General. (2020). Hospital Experiences Responding to the Covid-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020. In https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp.
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Worldometers. (2020). Coronavirus Cases. In https://www.worldometers.info/coronavirus/.
Zuvekas, S.H. & Taliaferro, G.S. (2003). Pathways to Access: Health Insurance, the Health Care Delivery System, and Racial/Ethnic Disparities, 1996–1999. Health Affairs, 22(2), 139-153. DOI: 10.1377/hlthaff.22.2.139.
American Hospital Association. (2020). New AHA Report: Losses Deepen For Hospitals & Health Systems. In https://www.aha.org/press-releases/2020-06-30-new-aha-report-losses-deepen-hospitals-health-systems.
Ayanian, J. Z., Weissman, J. S., Schneider, E. C., Ginsburg, J. A. & Zaslavsky, A. M. (2009). Unmet health needs of uninsured adults in the United States. DOI: 10.1001/jama.284.16.2061.
Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., Schneider, E.C., Wright, B.J., Zaslavsky, A.M. & Finkelstein. (2013). The Oregon Experiment–Effects of Medicaid on Clinical Outcomes. The New England Journal of Medicine, 368(18), 1713-1722. DOI: 10.1056/NEJMsa1212321.
Banthin, J., Simpson, M., Buettgens, M., Blumberg, L. J. & Wang, R. (July 13, 2020). Changes in Health Insurance Coverage Due to the Covid-19 Recession. Urban Institute. In https://www.urban.org/research/publication/changes-health-insurance-coverage-due-covid-19-recession.
Becton, J. L. J., Cheng, L. & Nieman, L. Z. (2008). The effect of lack of insurance, poverty and pediatrician supply on immunization rates among children 19–35 months of age in the United States. The Journal of Evaluation in Clinical Practice, 14(2), 248-253. DOI: 10.1111/j.1365-2753.2007.00841.x.
Bodenheimer, T. & Pham, H. H. (2010). Primary Care: Current Problems and Proposed Solutions. Health Affairs, 29(5), 799–805. DOI: 10.1377/hlthaff.2010.0026.
Brown, E. R., Ojeda, V. D., Wyn, R. & Levan, R. (2000). Racial and ethnic disparities in access to health insurance and health care. UCLA Center for Health Policy Research and the Henry J. Kaiser Family Foundation. In http://healthpolicy.ucla.edu/publications/Documents/PDF/Racial%20and%20Ethnic%20Disparities%20in%20Access%20to%20Health%20Insurance%20and%20Health%20Care.pdf.
Buchmueller, T. C., Grumbach, K., Kronick, R. & Kahn, J. G. (2005). The Effect of Health Insurance on Medical Care Utilization and Implications for Insurance Expansion: A Review of the Literature. Medical Care Research and Review, 62(1), 3-30. DOI: 10.1177/1077558704271718.
Campbell, D. (July 8, 2019). NHS operations cancelled as consultants work to rule in pensions standoff. The Guardian. In https://www.theguardian.com/society/2019/jul/08/nhs-faces-existential-threat-as-senior-doctors-work-to-rule.
CBS Los Angeles. (2020). Lancaster Teen Who Died Of Possible Covid-19 Complications Lacked Insurance, Delaying Treatment. In https://losangeles.cbslocal.com/2020/03/27/coronavirus-lancaster-teen-insurance/.
Cho, Y., Chung, H., Joo, H., Park, H.J., Joh, H.-K. & Kim, J.W. (2020). Comparison of patient perceptions of primary care quality across healthcare facilities in Korea, A cross-sectional study. PLoS ONE, 15(3), e0230034. https://doi.org/10.1371/journal.pone.0230034.
Cohen, R.A., Terlizzi, E.P., Martinez, M.M. & Cha, A.E. (2020). Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, January–June 2019. National Health Interview Survey Early Release Program. In https://www.cdc.gov/nchs/data/nhis/earlyrelease/insur202005-508.pdf.
Collins, S. R., Bhupal, H. K. & Doty, M.M. (2019). Health Insurance Coverage Eight Years after the ACA. Common wealth fund. In https://www.commonwealthfund.org/publications/issue-briefs/2019/feb/health-insurance-coverage-eight-years-after-aca.
Collins, S. R., Gunja, M. Z., Aboulafia, G. N., Czyzewicz, E., Kline, C. H., Rapoport, R. & Glancey, S. (June 23, 2020). An Early Look at the Potential Implications of the Covid-19 Pandemic for Health Insurance Coverage. Rama on healthcare. In https://ramaonhealthcare.com/an-early-look-at-the-potential-implications-of-the-covid-19-pandemic-for-health-insurance-coverage/.
Dorn, S. (July 13, 2020). The Covid-19 pandemic and resulting economic crash have caused the greatest health insurance losses in American history. Families USA. In https://familiesusa.org/resources/the-covid-19-pandemic-and-resulting-economic-crash-have-caused-the-greatest-health-insurance-losses-in-american-history/.
Douthit, N., Kiv, S., Dwolatzky, T. & Biswas, S. (2015). Exposing some important barriers to health care access in the rural USA. Public Health, 129(6), 611-20. DOI: 10.1016/j.puhe.2015.04.001.
FAIR Health, Inc. (2020). The Projected Economic Impact of the Covid-19 Pandemic on the US Healthcare System. In https://s3.amazonaws.com/media2.fairhealth.org/brief/asset/Covid-19%20-%20The%20Projected%20Economic%20Impact%20of%20the%20Covid-19%20Pandemic%20on%20the%20US%20Healthcare%20System.pdf.
Freeman, J. D., Kadiyala, S., Bell, J. B. & Martin, D. P. (2008). The Causal Effect of Health Insurance on Utilization and Outcomes in Adults: A Systematic Review of US Studies. Medical Care, 46(10), 1023-1032. DOI: 10.1097/MLR.0b013e318185c913.
Fullman, N., Yearwood, J., Abay, S.A. & Abbafati C. (2018). Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. GBD 2016 Healthcare Access and Quality Collaborators. DOI: 10.1016/S0140-6736(18)30994-2.
Giordano, C. (August 8, 2019). Treat NHS patients in private hospitals to cut waiting lists, government urged. Independent. In https://www.independent.co.uk/news/health/nhs-operation-waiting-list-private-hospitals-a9047661.html.
Goncharona, O. (June 24, 2019). The Right Korea: How Direct Government Financing Of Health Care Combines With Hard Competition in the Medical Services Market. Vademecum. In https://vademec.ru/article/nuzhnaya_koreya-_vademecum_podglyadel_u_dalnevostochnogo_soseda-_kak_pryamoe_gosfinansirovanie_zdrav/?fbclid=IwAR0zbOIqK3Lq9dp63TlX_Ibu-toaVUFppCWSqwWwC8ZpyipUk8qVb2ZtK94.
Harris, S., Sondel, J. & Schneider, G. S. (April 10, 2020). Cash-starved hospitals and doctor groups cut staff amid pandemic. The Washington Post. In https://www.washingtonpost.com/health/starved-for-cash-hospitals-and-doctor-groups-cut-staff-amid-pandemic/2020/04/09/d3593f54-79a7-11ea-a130-df573469f094_story.html.
Institute of Medicine (US). (2009). America’s Uninsured Crisis: Consequences for Health and Health Care. Washington (DC): National Academies Press. DOI: 10.17226/12511.
Kaiser Family Foundation. (2019). Health Insurance Coverage of the Total Population. In https://www.kff.org/other/state-indicator/total-population/?dataView=1¤tTimeframe=0&selectedDistributions=employer&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D.
Kliff, S. (June 16, 2020). Most Coronavirus Tests Cost About $100. Why Did One Cost $2,315? The New York Times. In https://www.nytimes.com/2020/06/16/upshot/coronavirus-test-cost-varies-widely.html.
Kurani, N., Pollitz, K., Cotliar, D., Shanosky, N. & Cox, C. (July 15, 2020). Covid-19 Test Prices and Payment Policy. Health System Tracker. In https://www.healthsystemtracker.org/brief/covid-19-test-prices-and-payment-policy/.
Lee, S. Y., Kim, C. W., Seo, N. K. & Lee, S. E. (2017). Analyzing the Historical Development and Transition of the Korean Health Care System. Osong public health and research perspectives, 8(4), 247–254. https://doi.org/10.24171/j.phrp.2017.8.4.03.
Majerol, M., Newkirk, V. & Garfield, R. (2015). The Uninsured: A Primer: key facts about health insurance and the uninsured in the era of health reform. Kaiser Family Foundation. In http://files.kff.org/attachment/primer-the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-the-era-of-health-reform.
Matsuda, S. (2019). Health Policy in Japan—Current Situation and Future Challenges. JMA Journal, 2(1), 1-10. DOI: 10.31662/jmaj.2018-0016.
McWilliams, J. M., Zaslavsky, A. M. & Meara, E. (2013). Impact of Medicare Coverage on Basic Clinical Services for Previously Uninsured Adults. JAMA, 290(6), 757-764. DOI:10.1001/jama.290.6.757.
Mehrotra, A., Chernew, M., Linetsky, D., Hatch, H. & Cutler, D. (2020). The Impact of the Covid-19 Pandemic on Outpatient Visits: A Rebound Emerges. In https://www.commonwealthfund.org/publications/2020/apr/impact-covid-19-outpatient-visits.
National Association of Community Health Centers and the Robert Graham Center. (2007). Access denied: a look at America’s medically disenfranchised. In https://www.graham-center.org/content/dam/rgc/documents/publications-reports/monographs-books/Access%20Denied.pdf.
U.S. Department of Labor (2020). News release: the employment situation—September 2020. Washington, DC: Bureau of Labor Statistics. In In https://www.bls.gov/news.release/pdf/empsit.pdf.
Nomura, H. & Nakayama, T. (2005). The Japanese healthcare system. BMJ (Clinical research ed.), 331(7518), 648–649. DOI:10.1136/bmj.331.7518.648.
Pimpertz, J. (May 30, 2017). Kein Spielraum für Wahlgeschenke: Wie die Demografie die privaten Haushalte belastet. In https://www.insm-oekonomenblog.de/16590-kein-spielraum-fuer-wahlgeschenke-wie-die-demografie-die-privaten-haushalte-belastet/.
Saad, L. (December 9, 2019). More Americans Delaying Medical Treatment Due to Cost. Gallup. In https://news.gallup.com/poll/269138/americans-delaying-medical-treatment-due-cost.aspx.
Sawyer, B. & Cox, C. (December 7, 2018). How does health spending in the U.S. compare to other countries? Health System Tracker. In https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries.
Skinner, A. C. & Mayer, M. L. (2007). Effects of insurance status on children’s access to specialty care: a systematic review of the literature. BMC Health Services Research, 7, Article number: 194. DOI: 10.1186/1472-6963-7-194.
Starfield, B., Shi, L. & Macinko, J. (2005). Contribution of Primary Care to Health Systems and Health. The Milbank Quarterly, 83(3), 457-502. DOI: 10.1111/j.1468-0009.2005.00409.x.
Sung, S. & Park, H.A. (2019). Perceived cultural differences in healthcare for foreign patients visiting South Korea: tool development and measurement. BMC Health Serv Res 19, 197. DOI: 10.1186/s12913-019-3965-9.
Tolbert, J., Orgera, K. & Damico, A. (November 6, 2019). Key Facts about the Uninsured Population. KFF. In https://www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population/.
U.S. Department of Health and Human Services Office of Inspector General. (2020). Hospital Experiences Responding to the Covid-19 Pandemic: Results of a National Pulse Survey March 23–27, 2020. In https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp.
United Nations. (1966). International Covenant on Economic, Social and Cultural Rights. In https://www.ohchr.org/en/professionalinterest/pages/cescr.aspx.
Watkins, J., Wulaningsih, W., Zhou, C.D., Marshall, D.C., Sylianteng, G.D.C., Rosa, P.G.D., Miguel, V.A., Raine, R., King, L.P. & Maruthappu, M. (2017). Effects of health and social care spending constraints on mortality in England: a time trend analysis. BMJ Open, 7(11). In https://bmjopen.bmj.com/content/7/11/e017722.
Worldometers. (2020). Coronavirus Cases. In https://www.worldometers.info/coronavirus/.
Zuvekas, S.H. & Taliaferro, G.S. (2003). Pathways to Access: Health Insurance, the Health Care Delivery System, and Racial/Ethnic Disparities, 1996–1999. Health Affairs, 22(2), 139-153. DOI: 10.1377/hlthaff.22.2.139.
Publicado
2020-11-19
Cómo citar
Lutsyuk, P., Bolokan, I., Davydova, I., Chanysheva, A., & Yakymchuk, S. (2020). Realización del derecho a la protección de la salud en la medicina de seguros: la primera experiencia de Covid-19. Ius Humani. Revista De Derecho, 9(2), 341-364. https://doi.org/10.31207/ih.v9i2.259
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Derechos de autor 2020 Pavlo Lutsyk, Inna Bolakan, Iryna Davydova, Alina Chanysheva, Svitlana Yakymchuk
Esta obra está bajo licencia internacional Creative Commons Reconocimiento 4.0.
Los autores que publican en esta revista están de acuerdo con los siguientes términos:
1. Los autores conservan siempre los derechos de autor. A la vez, garantizan a la revista el derecho de ser la primera en publicar su trabajo bajo una licencia Creative Commons Attribution 4.0 que permite a otros compartir el trabajo con un reconocimiento de la autoría del trabajo y del hecho que se ha publicado en esta revista.
2. Los autores saben y aceptan que el equipo de Ius Humani procurará darle a sus contribuciones la mayor difusión posible. Ello implica distribuir sus contenidos en la versión periódica impresa, en el sitio electrónico de la Revista, en diversas bases de datos y en índices científicos.
3. Los autores pueden establecer por separado acuerdos adicionales para la distribución no exclusiva de la versión de la obra publicada en la revista (por ejemplo, situarla en un repositorio institucional o publicarla en un libro), con un reconocimiento de su publicación inicial en esta revista.
4. Se permite y se anima a los autores a difundir sus trabajos electrónicamente (por ejemplo, en repositorios institucionales o en su propio sitio web) antes y durante el proceso de envío, ya que puede dar lugar a intercambios productivos, así como a una citación más temprana y mayor de los trabajos publicados (Véase The Effect of Open Access) (en inglés).
