Protección financiera en salud: evolución y comparación del gasto de bolsillo de los hogares chilenos / Financial protection for health care expenses provided by public and private systems in Chile

Background: People need a financial protection system to face the high costs of health care. Aim: To compare the financial protection between households affiliated to the Chilean public health financing system (FONASA) or to a private health financing system (ISAPRE). To describe the evolution of protection at the national level between 2007 and 2012. Material and Methods: As proposed by the World Bank, impact indicators to measure the equity and efficiency of the insurance systems were generated. Namely, average out-of-pocket expenses by insurance and average out-of-pocket spending as a percentage of expenditure. Also, the evolution of out-of-pocket spending by quintiles and Gini Coefficient were measured as measure of equity. To determine these, Family Budget Surveys for 2007 and 2012 were used. Results: Household out-of-pocket spending increased by 14.12%. When expressed as a percentage of total expenditure, it grew from 5.6% to 6.2%. Household Gini coefficient and per capita out-of-pocket spending decreased and the ratio between the highest and lowest quintile out-of-pocket increased at both analysis levels. Pocket expense in absolute values or expressed as a percentage of total expenses was higher among persons insured in private systems than those affiliated to the public financing service. Conclusions: Out-of-pocket spending increased for all income groups and people insured in the public system had a lower absolute and relative spending than those insured in private systems.

Carcinoma de células en anillo del sello de colón en adolescentes / Signet ring cell carcinoma of sigmod colon in an adolescent patient, report of a case

Reportamos el caso de una paciente de dieciséis años, quién fue diagnosticada de adenocarcinoma de células en anillos de sello del colón sigmoides. Se discute la historia clínica haciendo especial énfasis en la temprana edad de presentación de esta poco frecuente variedad histológica de cáncer de colón.

Apendicitis amebiana complicada: reporte de un caso en el Hospital Antonio Skrabonja. EsSalud de Pisco / Apendicitis amebiana complicada: reporte de un caso

Reportamos el caso de una paciente atendida por abdomen agudo que es intervenida quirúrgicamente con el diagnóstico presuntivo de apendicitis aguda complicada. Al examen anatomopatológico se hace el diagnóstico de apendicitis amebiana complicada. Se discuten la presentación clínica y los hallazgos histopatológicos de esta infrecuente presentación de infección amebiana.