Integration of the public health system and social security in Paraguay provider and user perceptions

Abstract

Introduction: Latin American health systems exhibit structural segmentation, which favors fragmentation, discontinuity of care, and barriers to access. In Paraguay, the public health system and social security present limited interinstitutional coordination, despite the regulatory framework for integrated and comprehensive service networks.
Objective: To describe the degree of service integration between the public health system and the Instituto de Previsión Social at the Coronel Bogado District Hospital, Paraguay, during 2022, and to characterize providers' and users' perceptions of the quality of care.
Methodology: Observational, descriptive, cross-sectional study with a quantitative approach. A total of 122 health providers were included through census-based inclusion of the accessible population, and 176 users were included through non-probabilistic convenience sampling. Checklists and Likert-type questionnaires were applied to assess dimensions of integration and perceived quality.
Results: Eighty percent of the areas showed integration in breadth (12/15), and 67% showed full integration in depth (10/15). Clinical integration through shared protocols reached 50% (3/6), and 92.3% of the integration actions among medical and nursing staff were consolidated. Full agreement on the positive impact of integration was 47.5% among providers and 51.2% among users. More than 85% rated the overall service as good or excellent.
Conclusion: Advances were observed in the integration of hospital areas and of medical and nursing staff, with positive perceptions. Gaps persisted in clinical protocols, admissions, pharmacy, and ambulance services.