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5 razones por las cuales los gobiernos deben integrar los sistemas de salud y los servicios sociales

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Los servicios socio-sanitarios, es decir la integración de los servicios de salud y los servicios sociales, son cada vez más comunes en áreas como el desarrollo infantil, la atención de jóvenes en riesgo y de población en riesgo de exclusión o vulnerables. Sin embargo, aspectos como el envejecimiento de la población, el cambio del perfil epidemiológico entre otros aspectos, ponen de manifiesto la necesidad de avanzar en esta área que no solo debe responder a factores sociales sino también a diagnósticos clínicos. Aquí van 5 razones por las que se hace cada vez más imperativa esta integración:

1. Envejecimiento acelerado de la población: Según datos de la OMS la población mayor de 60 años entre el 2000 y 2050 pasará del 11% a representar casi el 22% a nivel mundial, así para el 2050 existirán más de 2000 millones de adultos mayores. Es decir, a futuro habrá menos niños y más adultos mayores que si bien reflejan un aumento en la esperanza de vida, implican nuevos retos como la seguridad económica en la vejez, la organización de los sistemas de atención a la salud y los sistemas de protección social, en especial aquellos de apoyo familiar.

2. Incremento de enfermedades crónicas: Si bien la carga generada por enfermedades transmisibles aún es considerable, hoy las enfermedades crónicas son responsables de un mayor número de muertes y de más discapacidad, en especial en la población adulta y mayor. En América Latina y el Caribe las enfermedades crónicas no transmisibles causan casi el 68% de la mortalidad Pero este no es un fenómeno regional, según el reporte World Population Ageing 2013 de las Naciones Unidas, en el 2008 el 85% de las muertes de personas mayores de 60 años a nivel mundial estaban asociadas a enfermedades no transmisibles.

3. Mayores casos de enfermedades mentales: Asociado a las enfermedades crónicas está el incremento de los casos de demencia o enfermedades mentales a nivel mundial, en el 2013 existían 44.4 millones de personas con demencia, para el 2030 se espera que sean 75.6 millones y para el 2050, 135.5 millones, con un mayor incremento en América Latina donde se espera un aumento del 100% de los casos. Esto sin pasar por alto que el riesgo de padecer demencia aumenta con la edad, por lo que la situación empeora si tenemos en cuenta el envejecimiento acelerado de la población. Las condiciones crónicas son enfermedades de larga duración que demandan atención permanente y por lo general cuidados y tratamientos diferentes a los curativos.

4. Aumento del número de personas dependientes: Ante el aumento significativo en la población mayor de 60 años para el 2050, también se prevé un aumento de la población mayor dependiente, que se estima se multiplicará por cuatro. Esta situación estará acompañada de más población mayor que demandará una rápida capacidad de respuesta así como mayor atención y cuidado permanente dadas sus limitaciones físicas y mentales. Según estimaciones de la CEPAL para el año 2000 la relación de dependencia de adultos mayores ([Población de 60 años y más/ población de 15-59]*100) en América latina era de 13.00 y para el 2050 se estima que llegue al 39.3.

5. Presiones importantes en el gasto en salud: El envejecimiento de la población está directamente asociado a una mayor prevalencia de enfermedades y demanda de los servicios de salud, lo cual se traduce en más gastos sanitarios, en muchos casos, por tiempos prolongados que se extienden desde el inicio de la enfermedad, pasando por la discapacidad y hasta la muerte. Muchas veces, estos gastos no son absorbidos por el sistema sino que se trasladan a la familia contribuyendo a la persistencia de un gasto de bolsillo elevado y a su empobrecimiento. Por ejemplo, se estima que enfermedades como la demencia tendrán un costo de US$604 millones a nivel mundial, equivalente al 1% de producto interno bruto del mundo, siendo esta una sola de las múltiples enfermedades que afectan con mayor prevalencia al adulto mayor.

Estos aspectos nos invitan a pensar en una nueva configuración de los servicios sanitarios y sociales en los que se redefinan aspectos como la atención de la salud y el bienestar de la población. No cabe duda que con el envejecimiento de la población y con un mayor número de enfermos crónicos nos enfrentamos a retos que van más allá de su sostenibilidad financiera, por lo que es importante avanzar en acciones integradas que permitan atender las dolencias y enfermedades de esta población pero a su vez garantizar los cuidados requeridos en su condición de discapacidad y dependencia, así como un mayor acompañamiento de sus familias en este proceso.

Países como España, Francia, Canadá, Australia, y Estados Unidos, a través de diferentes modelos y enfoques se han embarcado en el camino hacia la integración socio-sanitaria a través de la cual se han logrado flexibilizar ambos sistemas para hacer frente de manera coordinada a una realidad apremiante y de necesidades coincidentes desde el punto de vista social y sanitario, que solo la integración de los dos sistemas puede proveer, garantizar y mejorar.

¿Cómo funciona esta integración en tu país? ¿Puedes encontrar otras razones por las cuales se deban integrar ambos servicios? Comparte tus comentarios en la sección de abajo o mencionando a @BIDgente en Twitter.

Carolina González es especialista en salud en la División de Protección Social y Salud del Banco Interamericano de Desarrollo (BID).


 

Por Carolina González Acero.

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