Bibliographic citations
Llave, Y., (2021). Caracterización del tiempo de atención en el proceso de reembolso económico de la Institución Administradora de Fondos de Aseguramiento en Salud SALUDPOL durante los años 2017 y 2018 [Universidad Peruana Cayetano Heredia]. https://hdl.handle.net/20.500.12866/9558
Llave, Y., Caracterización del tiempo de atención en el proceso de reembolso económico de la Institución Administradora de Fondos de Aseguramiento en Salud SALUDPOL durante los años 2017 y 2018 []. PE: Universidad Peruana Cayetano Heredia; 2021. https://hdl.handle.net/20.500.12866/9558
@misc{renati/1280113,
title = "Caracterización del tiempo de atención en el proceso de reembolso económico de la Institución Administradora de Fondos de Aseguramiento en Salud SALUDPOL durante los años 2017 y 2018",
author = "Llave Benito, Yeber Michel",
publisher = "Universidad Peruana Cayetano Heredia",
year = "2021"
}
During 2017 and 2018, the reimbursement process, one of the most relevant for IAFAS SALUDPOL, was among the most problematic ones and executed most financial resources in both years. This was expressed on the percentage of claims and complaints (35.9% in 2018). This study seeks to describe the reimbursement process during the years 2017 and 2018; and analyze the process time. This mix-study is qualitative-quantitative. The qualitative sub-study characterized the reimbursement process based on the SALUDPOL regulations; the quantitative, analyzed the time for reimbursement; for this, we estimated measures of central tendency and dispersion, and bivariate statistical tests (U Mann-Whitney and Chi2). Two different guidelines regulate the reimbursement process (2017 and 2018), with requirements, actors and flowcharts. To reduce biases, process-time were measured in the second semester of each year. During that period, in 2017, 21,969 requests were registered and 46,619 in 2018. In 2017, 91% of requests for a lower amount were attended within the established period; while, in 2018, 78% (p <0.05). Requests for a larger amount were attended in less time during 2018 than 2017. It was concluded that between the two years the reimbursement process differs in its flowcharts, times and deadlines; the requests for a lower amount were attended to a greater percentage within the deadline in 2017. SALUDPOL must standardize and adapt its intra and inter-institutional conditions to control the flow of reimbursement requests.
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