Implementing the Unique and Claim Clinical File in the Insure System in Mexico, can Decrease Medical Demands or Lawsuits | Chapter 9 | Current Topics in Medicine and Medical Research Vol. 6

 

Aim: We have had a rise in medical requirements in all health subsystems in the last decade in Mexico, we have researched twelve years (2004-2016) on the disturbing increase in demands at the Mexican Institute of Health due to the disorganisation of the clinical records, the absence of an interconnected electronic database, in addition to the absence of an original record of claims in the insurance.

Objective: to eliminate injuries at the Institute for Allegations of Medical Negligence, to prevent duplication of insurance reserve fees reflected at the expense of the Mexican health system with the existence of a single clinical record.

Materials and Methods: The Integrated Clinical Record and Quality Model (MECIC) developed in 2013 was implemented in the observational, descriptive , cross-sectional and retrospective analysis carried out on claims made by the Mexican Institute of Social Security (MISS), which revealed that no records could be developed due to the absence of a record. Copy or Original. The ECUS-generated instrument was Applied to files with a claim by which 0 was evaluated if it did not meet the criteria stated, 1 if it had content in each sense, and NA or Not Applicable if the words did not apply to the correspondent of the service. This reported duplicate cases, open and closed patients,  Simultaneous reserves and lack of record incorporation with a lack of conformity with NOM 004.

Results: 172 claims files were reviewed for patients of various ages enrolled under insurance from 2004 to October 2016 in compliance with the Medical Professional Civil Liability Policy; to determine the causes of the claims, the facilities involved and to make recommendations for the claims;  Minimization of these.

Conclusion: As part of the Universal Health Record for Mexico, the Single Clinical Claim File (ECUS),  When implemented, it will allow automatic assessment of physical , digital or claims medical records,  Issuing reports, giving the organisation an appropriate recommendation, preventing harm to patients, in addition to  Reduction of health system costs as a result of multiple incidents or abuse in the insurance system.

Author (s) Details

Marxlenin Rodríguez-Martínez
Department of Gynecology and Obstetrics, FUNIBER, Marx & Associates, Mexico.

Nicolás Padilla-Raygoza
School of Medicine, University of Celaya, Celaya, Mexico.

Georgina Olvera-Villanueva
Department of Nursing and Obstetrics, Division of Health Sciences and Engineering, Campus Celaya, Salvatierra, University of Guanajuato, Celaya, Mexico.

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