Diseño de una red de servicios para la prevención y atención de la enfermedad renal crónica: un planteamiento y propuesta de un caso de emprendimiento medico.

Abstract

This article aims to present an analysis of the situation of chronic kidney disease in Colombia related to two points to take into account, first, the market failure that initially occurred (Chicaiza, 2005) when a few Insured patients had access to dialysis, which was paid for by a package of services that did not include comprehensive care and was not always homogeneous. Second, the competitiveness of the markets around the provision of health services for kidney patients focused on developing kidney units. In other words, the service began to be offered through the same input providers, who assumed to provide the dialysis service. Competitiveness at this point was very low, since dialysis has so far no substitute products. substitute products. Therefore, those who had control of the supply of inputs also had control of the final price of that then generated a capital gap that favored the dialysis companies. Who, in turn, influenced the medical labor market. The objective of this article is, firstly, to identify the imminent kidney health problem in Colombia, secondly, to focus on the possibility of proposing public health strategies against chronic diseases by reorienting competitiveness, thirdly, raise the need for regulation of the markets around the health system as the main strategy for creating value in health to guarantee optimal patient care. Materials and Methods: The following is an account of the experience achieved in the Colombian renal clinic, which since 2004 and with the figure of an NGO, independently and without economic muscle, managed for 14 years to carry out a clinical nephrology activity. It carried out its clinical activity registry in a medical software that also generates the database of the high cost account and allows measuring non-compliance with appointments and evaluating the determining variables for risk monitoring. This Galénica software, in client server model, can be used as a single electronic record of medical history, but it could also become a computer core around which an independent, preventive medical company is developed, which redirects the objective of nephrology towards the goals of the state and towards models of economic development of the regions and the medical union. During its clinical practice, the entity obtained a sample of 1,268 patients where each had kidney function tests (BUN, creatinine), albumin, blood pressure records and anthropometric measurements were taken to identify the stage of kidney failure in Each patient according to GFR, MDRD and CKD-EPI However, it should be noted that the results in our environment with the equations do not show exactly the same results. That is, making the decision of which equation to record impacts the results differently in the age groups. Results: The highest prevalence of CKD is found in the population between 64 and 85 years of age with a peak in the prevalence between 64 and 70 years. The GFR scale showed that the highest prevalence of CKD is in stage III-B, while the MDRD scale showed a higher prevalence of stage III-A kidney disease. Finally, the CKD-EPI scale had a higher prevalence of III-A and was who had the highest prevalence of stage V kidney disease. Discussion: There is a higher prevalence in stages III-B, IV and V when using the CKD-EPI scale, which means that depending on the scale that is in force in the protocol of each institution, it will generate more or less expenses for the health system (SGSSS). The objective of the renal clinic is to design a business plan that through medical entrepreneurship allows offering a continuous strategy to primary health care (PHC), in the consolidation and deployment of the MAITE strategy of the ministry of social protection. a medical venture that allows risk management in the territories to be related through the optimization of available resources, can improve local performance in managing chronic diseases and directing cash flow towards the actions necessary for each patient to arrive at your optimum point of risk. Conclusions: The final state of chronic kidney disease is preventable, therefore instead of having a wide offer of treatment for this condition (taking into account the costs it produces for each health provider entity according to the prevalence of CKD) , it is preferable to opt for a kidney disease prevention system which can mitigate, delay or stop the progression of kidney disease to guarantee an adequate distribution of resources.