Asignación presupuestaria orientada a la gestión de riesgos en hospitales públicos: una revisión conceptual
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Vive Rev. Salud
Abstract
La asignación presupuestaria en hospitales públicos constituye uno de los pilares fundamentales para garantizar la operatividad, calidad y sostenibilidad de los servicios de salud en América Latina. El objetivo del estudio es examinar la asignación presupuestaria orientada a la gestión de riesgos en hospitales públicos latinoamericanos, identificando la transición desde enfoques burocráticos hacia instrumentos estratégicos de gestión sanitaria. El enfoque es cualitativo, orientado mediante una revisión teórica de la literatura (2003-2025). Las bases de datos académicas y repositorios incluyen Scopus, PubMed, Redalyc, SciELO, y repositorios institucionales como la OPS/OMS. En total fueron seleccionados 45 estudios para la revisión. Los resultados evidencian una integración incipiente entre presupuestación y gestión de riesgos (epidemiológicos, económico-financieros, socio-políticos y operativos), principalmente reactiva ante crisis como la pandemia COVID-19, que expuso vulnerabilidades estructurales particularmente en economías dependientes de recursos extractivos. Se identificaron mecanismos innovadores como presupuestos participativos, costeo ABC y gestión adaptativa de recursos, cuya implementación efectiva requiere marcos normativos habilitantes, capacidades técnicas, sistemas de información robustos y compromiso político sostenido. Se propone un marco conceptual integrador con cinco componentes interrelacionados: gestión estratégica del riesgo, metodologías técnicas adaptativas, mecanismos de flexibilidad operativa, gobernanza participativa multinivel e integración sistémica resiliente, que operan como un sistema adaptativo complejo con tres ciclos principales: adaptación estratégica, legitimación participativa y resiliencia transformativa. La investigación concluye que avanzar hacia modelos presupuestarios más robustos requiere transformaciones multidimensionales, graduales y contextualizadas, que reconozcan particularidades socioculturales y económicas de cada contexto.
Budget allocation in public hospitals constitutes one of the fundamental pillars for ensuring the operation, quality, and sustainability of health services in Latin America. The objective of this study is to examine budget allocation for risk management in Latin American public hospitals, identifying the transition from bureaucratic approaches to strategic health management instruments. The approach is qualitative, guided by a theoretical review of the literature (2003-2025). Academic databases and repositories include Scopus, PubMed, Redalyc, SciELO, and institutional repositories such as PAHO/WHO. A total of 45 studies were selected for the review. The results show an incipient integration between budgeting and risk management (epidemiological, economic-financial, socio-political, and operational), primarily reactive to crises such as the COVID-19 pandemic, which exposed structural vulnerabilities, particularly in economies dependent on extractive resources. Innovative mechanisms such as participatory budgeting, ABC costing, and adaptive resource management were identified, whose effective implementation requires enabling regulatory frameworks, technical capacities, robust information systems, and sustained political commitment. An integrative conceptual framework is proposed with five interrelated components: strategic risk management, adaptive technical methodologies, operational flexibility mechanisms, multilevel participatory governance, and resilient systemic integration, which operate as a complex adaptive system with three main cycles: strategic adaptation, participatory legitimation, and transformative resilience. The research concludes that moving toward more robust budgetary models requires multidimensional, gradual, and contextualized transformations that recognize the sociocultural and economic specificities of each context.
Budget allocation in public hospitals constitutes one of the fundamental pillars for ensuring the operation, quality, and sustainability of health services in Latin America. The objective of this study is to examine budget allocation for risk management in Latin American public hospitals, identifying the transition from bureaucratic approaches to strategic health management instruments. The approach is qualitative, guided by a theoretical review of the literature (2003-2025). Academic databases and repositories include Scopus, PubMed, Redalyc, SciELO, and institutional repositories such as PAHO/WHO. A total of 45 studies were selected for the review. The results show an incipient integration between budgeting and risk management (epidemiological, economic-financial, socio-political, and operational), primarily reactive to crises such as the COVID-19 pandemic, which exposed structural vulnerabilities, particularly in economies dependent on extractive resources. Innovative mechanisms such as participatory budgeting, ABC costing, and adaptive resource management were identified, whose effective implementation requires enabling regulatory frameworks, technical capacities, robust information systems, and sustained political commitment. An integrative conceptual framework is proposed with five interrelated components: strategic risk management, adaptive technical methodologies, operational flexibility mechanisms, multilevel participatory governance, and resilient systemic integration, which operate as a complex adaptive system with three main cycles: strategic adaptation, participatory legitimation, and transformative resilience. The research concludes that moving toward more robust budgetary models requires multidimensional, gradual, and contextualized transformations that recognize the sociocultural and economic specificities of each context.
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Vol. 8, No. 23