Costos directos del reembolso o indemnización por prestadores de servicios en quejas médicas

espanolLa atencion de quejas medicas en la Conamed incluye un analisis de la atencion medica, que se realiza en forma detallada considera principios ci entificos, e ticos y legales regulan, fin de valorar si existe o no evidencia de ma la practica (EMP). Cuando se demuestra mala practica la reparacion del dano puede ser economica, dependiendo de la g ravedad e impacto en los usuarios de servicios de salud. Material y metodos. El objetivo fue determinar los costos directos que ocasiona el rembolso o indemnizacion por los prestadores de servicios de salud, producto de las quejas medicas calificadas en conciliacion o arbitraje medico; se trata de un estudio descriptivo, retrospectivo y polietapico, sobre quejas medicas atendidas en la Conamed entre 2002 y 2008. Resultados. Las quejas medicas se conciliaron a traves de diversas modalidades de compromiso, agrupadas en tres categorias: con compromiso economico, sin compromiso economico y con otro tipo de compromiso; solo una tercera parte de las quejas conciliadas representaron un costo economico directo para el prestador de servicios. El costo global de 1,465 quejas conciliadas fue de $60.06 mdp, en donde 64% se pago por indemnizaciones, 35% se pago por reembolsos y 1.0% correspondio a condonaciones. El costo economico varia de acuerdo a la especialidad, es mayor en urgencias medicas y quirurgicas, asi como en la cirugia general, en tanto que el menor costo se observa en odontologia y oftalmologia. Discusion. Solo en la tercera parte de las quejas atendidas el prestador termina pagando un monto al paciente o su familia. Se encontro que en los promoventes de la queja medica no existe dolo y si reclama la devoluciond elg asto efectuado en su atencion; en la tercera parte de las quejas conciliadas solo requirio de aclaracion o explicacion del prestador de servicios. Conclusiones. Quienes presentan una queja medica, no parecen estar motivados por el beneficio economico ya que solo en la tercera parte (33.7%) de las quejas atendidas mediante conciliacion se llego a un arreglo mediante algun compromiso economico. La importancia de la explicacion y la disculpa al paciente por parte del prestador del servicio, quedo manifiesta en la tercera parte de las quejas que fueron conciliadas sin ningun compromiso economico EnglishThe attention of medical complaints in the Conamed includes an analysis of health care that it is realized in detailed form considering scientific, ethical and legal issues regulate that it in order to assess whether there is evidence or not of malpractice (EMP). When it is demonstrated malpractice, the damage repair could be economical, depending on the severity and impact on health service users. Material and methods. The objective was to determine the direct cost incurred for reimbursement or compensation of health service providers, product of medical complaints in conciliation or medical arbitration qualified; it is about a study multi-stage, retrospective and descriptive on medical complaints taken care in Conamed between 2002 and 2008. Results. The medical complaints were reconciled through different forms of commitment, grouped into three categories: with economic engagement, without economic engagement, and with other kind of commitment, only a third of the conciliated complaints represented a direct economic cost to the provider services. The overall cost of 1,465 conciliated complaints was of 60.06 million of mexican pesos, where 64% was paid for compensation, 35% was paid by reimbursements and 1.0% was condoned. The economic cost varies according to speciality, is higher in surgical and medical emergencies as well as general surgery, while the lowest cost was seen in dentistry and ophthalmology. Discussion. Only a third of the complaints dealt with the provide services ends up paying an amount patient or his family. It was found that who promote the medical complaint if there is fraud and is seeking to recover the expenditure incurred in their care, the third part of conciliated complaints only required for clarification or explanation of the service provider. Conclusions. The people who promote a medical complaint does not seem to be motivated by profit and only in one third (33.7%) of complaints dealt with by conciliation settlement was reached through a financial commitment. The importance of explanation and apology to the patient of the provider of service is evident from the third part of the complaints were settled without any economic commitment.