Understanding SALUDVIDA the necessity of being different and to position itself, its critical that our members and rear area net know the health model and the hiring policies of the EPS, prohanging for the rational use of the resources and the benefit of services under the parameters of quality and efficiency. This situation not only benefits the user, as he receives a more personalized and opportune service; but also the network to implement a model that guarantee the attention under the criteria of opportunity, rationality, security and optimization of the resources.

1. OBJECTIVE

SALUDVIDA SA EPS has designed and implemented a model of preventive and assistant health, that has as it objective to analyze, evaluate and take part positively in the state of health of the affiliates through institutional strategies that tend to prevent diseases, to diminish and to control the risk.

 

2. COMPONENTS OF OUR MODEL

 

The components of our model are:

A. IDENTIFICATION OF THE RISK:

One of the main objectives of the model is to know, through well designed observation and research, every one of the stages or components of the health-disease process, with the purpose to take part the earlier possible and avoid that the wear away process continues.

The identification of the risks and its factors, are the input of specific preventive strategies (level I,II or III) that allow a positive impact in the health of the affiliated.

The identification of the risk is an insurance policy in witch every affiliated should have a state of health and risk card to enter the institution, the consolidation of this information will be the base of the risk intervention strategies and the assistance of the events.

The following elements are a part of this component:

 Etareo Profile: allow us to build the population pyramid.

Epidemiologist Profile: is an indirect measurement of the risk of the affiliated.

 Risk Profile: It allows us to visualize a panorama of risks of the affiliated.

B. CLASSIFICATION OF THE RISK:

Each individual has a special characteristic that attributes a certain susceptibility to suffer one or another pathology, of equal it forms that each individual is capable to improve its present state of health, being understood that the susceptibility and capacity to improve is not distributed equally in all the human beings.

Characteristics exist that are shared among the human beings and allow them to group in such form that collective interventions may be established, this is what is known as classification of the risk.

C. INTERVENTION OF THE RISK:

Once the risk has been classified, focused collective and individual actions are established that allow to avoid the occurrence of the event or the diminution of its prevalence.

One is due to prioritize which events are susceptible to be intervened by the EPS and which ones surpass its intervention capacity, meaning, that exiting factors as over population, potable water disposition, and others, require the intervention of the government through it PUBLIC HEALTH Department.

The interventions are effective as long as they are oriented and focused in the element that contributes in a space and period of time on the event of interest.

There are some characteristics that should be consider when choosing a certain intervention.

The intervention should be based upon evidence; the factor you want to affect must be totally identified and have some mayor evidence that indicates it as a cause of the event.

The intervention must not be prolonged; an intervention should not be applied in a rutinary way year by year, what is effective in a period it’s not necessarily good in other one.

The intervention must not be generalized; an intervention could be effective in a determine region but not in any other; unless the characteristics of the regions are similar.

The intervention must be cost-effective; it should demonstrate a greater yield with the existing resources.

All the intervention should be measured; in terms of management and results.

The following are elements of the intervention of the risk:

 National or zonal plans in promotion and prevention.

 Hiring of the rear area net based on the profiles (Etareo, Epidemiologist and of Risk) with the purpose of satisfying the necessities of the specific affiliated population.

 Using the edu-comunication strategies, to increase the demand of health services. (induced demand).

 Specific intervention plans in highly occurrence events.

D. IMPACT IN HEALTH

The health of the members should be a continuous measuring variable, by means of the construction and management of the health indicators that permit and evaluation of the implanted intervention at the time and in any certain period.

The indicators must have a regularity according to the events that are evaluating therefore these do not have to be conditional to evaluation routines (annual, monthly etc.) unless they agree with the possibility to demonstrate visible results of the interventions.

3. TEORIC CONCEPTS AND DEFINITIONS

Pre-patogenic period: Is the first stage of the paradigm, in this phase the interaction with the environment takes place. Here still a pathological state does not exist.

Early discernible disease: in this phase you watch the first changes in a pathological level, the first symptoms may evidence.

Advanced disease: in this phase the pathological state of the patient has consolidated, the symptoms are more evident and the damages and changes are more evident.

Convalescence: this phase is the prior time to the last result of the illness, here is were the mayor damage and complications happen.

Final Result: is the last stage of the paradigm and here you find some of the pathology possible results (death, disability, recovery, limitations etc.)

Prevention is considered any action that seeks the interruption of the interaction between the different elements that may cause the pathology, its complications or final result.
In this sense you can find 3 types of prevention:

Primary Prevention: Any action that has as objective is to avoid or interrupt the presence or interaction of the disease with the target. This type of action seeks the diminution and control of the factors of risk and development of the protective factors.

This type of actions is used in the first phase of the paradigm Natural History of the illness.

Secondary Prevention: Any action that has as objective the early detection of the disease and to assure an opportune treatment.

This type of actions is used in the second phase of the paradigm Natural History of the illness.

Tertiary Prevention: All action that has as objective to diminish and to avoid to the maximum the complications, limitations and fatal results of the pathology in course.

 

The hiring policies contemplate mechanisms that entail the rational use of the resources and allow to put in practice the philosophy of the model of SALUDVIDA attention. In such sense it tries to create conditions that guarantee the administration of the risk in health, the sufficiency of the network, the securing of minimum standards of quality, the scientific technical rationality in the benefit of the services, the technical balance of the operation and the implementation of schemes of progressive integral prevention with emphasis in the familiar health.

To evaluate the minimum essential requirements based in the SALUDVIDA manual, being the medical auditor's responsibility or medical coordinator as it is the case.

The result of the minimum requirement evaluation could not be less than 75%.

The modality of selected recruiting is capitation or event will depend on the briefcase of services that IPS, the number offers of affiliated and the conditions of the market.

The pre selection committee of the rear area net is composed by the Zonal Director, Coordinating Zonal Doctor and the Zonal Commercial Coordinator.

A differentiation should exist between the subsidized and contributing regime network.

The charges for the co payments and the moderator quotas will be handle by the IPS.

All the hired network should have a global civil responsibility policy.