Resumen

CARRENO ESCOBEDO, Ricardo y LLANOS ZAVALAGA, Luis Fernando. Costo del proceso administrativo de reembolso por atenciones del Seguro Integral de Salud en la Dirección de Salud IV Lima Este, en el año 2002.. Rev Med Hered, ene./mar. 2008, vol.19, no.1, p.10-17. ISSN 1018-130X.

Costs for reimbursement of the Integral Health Insurance (SIS) have not been studied in Peru. Objectives: To estimate the economic costs for administrative procedures for SIS reimbursement in DISA IV Lima Este during year 2002.Material and Methods: A cost study of SIS reimbursement involving a description of each activity required for reimbursement on the suppliers including time measurement, human resources required, administrative costs of reimbursement and the frequent of rejection of cases. Based on a pilot study, considering Level of Confidence: 95%, Standard error: 0.03, a sample of 60 outpatient consultations was calculated. An ad-hoc form was designed for a process analysis of SIS reimbursement for primary health care facilities (Health centers and posts).Results: Administrative costs of billing of the health consultation of SIS patient was in average 5,49 (CI 95%: 2,75 - 8,23) nuevos soles (n.s.). 100% of reimbursements lasts more than 30 days, with an average of 168 days (range: 123 - 220 days). The administrative-year costs estimated for SIS consultations at year 2002 was 1 448 251.02 n.s., amount not recognized as reimbursable at SIS. Conclusions: Costs non recognized as reimbursable are quite high and equivalent to 3 621 hospitalizations in Intensive Care Units, to 14 483 deliveries and to 10 345 cesarean sections based on SIS rates. (Rev Med Hered 2008;19:10-17).

Palabras llave: Costs; Health insurance; administrative costs.