Barriers to healthcare coordination in market-based and decentralized public health systems: a qualitative study in healthcare networks of Colombia and Brazil

摘要: Although integrated healthcare networks (IHNs) are promoted in Latin America response to health system fragmentation, few analyses on the coordination of care across levels these have been conducted region. The aim is analyse existence and factors influencing it from personnel' perspective two countries with different systems: Colombia, a social security based managed competition Brazil, decentralized national system. A qualitative, exploratory descriptive-interpretative study was conducted, case four municipalities. Individual semi-structured interviews were three stage theoretical sample (a) (112) administrative (66) professionals levels, (b) managers providers (42) insurers (14). thematic content analysis segmented by cases, informant groups themes. results reveal poor clinical information transfer between all analysed, added deficiencies Brazil access management. obstacles related organization both networks. In system, there economic incentives compete (exacerbated partisan political interests), fragmentation instability Colombia weak planning evaluation Brazil. networks, inadequate working conditions (temporary and/or part-time contracts) which hinder use mechanisms, professional training for implementing model primary should act as coordinator patient care. Reforms needed systems order modify incentives, strengthen state supervision functions improve skills.