Atenção Primária à Saúde: elementos de continuidade e mudanças na saúde do Distrito Federal / Primary Health Care: continuity and change in public health at the Federal District

RESUMO A Atenção Primária à Saúde (APS) ocupa lugar de destaque na agenda governamental. Os objetos do estudo são o sistema de saúde do Distrito Federal e as iniciativas para reorganização da APS, com objetivo de analisar o comportamento dos gastos em busca de elementos de continuidade e mudanças nessa política, no período de 2005 a 2014. Adotou-se a pesquisa documental com foco em dados do Sistema de Informações sobre Orçamentos Públicos. Partindo do neoinstitucionalismo histórico, os resultados apontam contradição entre o discurso em defesa da APS e a manutenção das elevadas despesas com assistência hospitalar, testemunhando a característica de path dependence.

ABSTRACT Primary Health Care (PHC) has a prominent position in the Brazilian governmental agenda. This study focuses on the health system in the Federal District and the initiatives to reorganize PHC, with the analysis of expenditure behavior in order to identify aspects of continuity and change during the period from 2005 to 2014. To achieve this purpose, documental research was carried out focusing on data from the Public Budget Information System. Drawing on historical neo-institutionalism, the results reveal contradiction between the discourse in defense of PHC and the maintenance of high level of expenditure with hospital services, thus confirming path dependence characteristic.

The Impact of Health Care Coverage on Changes in Self-Rated Health: Comparison between the Near Poor and the Upper Middle Class / 보건행정학회지

BACKGROUND: This study aims to analyze the impact of levels of health care coverage on the trajectory of self-rated health, comparing the near-poor which tends to be excluded in traditional health care systems with the upper middle class. METHODS: The study participants were 3,687 people who sincerely responded questions regarding health care expenditures, unmet medical needs, and self-rated health in the Korea Health Panel data in 2009-2012. RESULTS: The higher health care expenditures and the presence of unmet medical needs were significantly associated with the lower level of self-rated health. However, both factors did not significantly predict the steeper decline in the self-rated health. The results from multiple group analyses showed that health care expenditures and unmet medical needs had greater impact on the near-poor compared to their higher income counterparts. CONCLUSION: Public health care coverages need to be enhanced as well as reducing health care expenditures and unmet medical needs.

A Panel Study on the Effect of Obesity and the Chronic Diseases on the Health Care Expenditures / 보건행정학회지

We analyze the determinants of obesity and the chronic diseases using the Korea Health Panel data. Also we analyze the effect of obesity and the chronic diseases on the health care expenditures. Through this study, to reduce the health care expenditures, we suggest the policy implication that might curb the obesity and the chronic diseases. We estimate the determinants of obesity, the chronic diseases, and the health care expenditures using 2SLS (two stage least squares) estimation method under the simultaneous equations framework. Result says that obesity and chronic diseases significantly have positive effects on the health care expenditures. Also the determinants of the health care expenditures that have positive effects are age, income and health care utilization variables.

Demographic Structure, Environmental Quality and Resident Expenditureson Health / 中国卫生经济

Objective: To explore the impacts of demographic structure, environmental quality on household health care expenditures. Methods: Based on 2000-2010 inter-provincial panel data, the method of dynamic panel SYS GMM is used. Results:(1) The rise of elederly dependency ratio promotes residents’ health care expenditures; (2) the decline in juvenile dependency ratio is also the acceleration factor of health care expenditures; (3) the seriousness of environmental quality pollution expands the health care demand. Conclusion: To improve the health status residents, it is needed to implement the medical insurance system for the eldly, construct the health care insurance system for the children, besides, environment protection should be people oriented.

Measurement and analysis of government health expenditures and health efficiency / 中国卫生政策研究

Objective:To calculate the health efficiency of government health expenditures in 1990 , 2000 and 2010 and analyze its determinants. Methods:To calculate the health efficiency of government health expenditures and analyze its determinants by using the DEA-Tobit model. Results:Health efficiency of government health expenditures has been increasing gradually;the same provinces are found to be on the productive frontier, but the provinces off the frontier are different;eastern provinces have a higher efficiency than those in the middle and western regions. Fiscal decentralization has a significant negative impact on health efficiency. Conclusion:The current Chinese fiscal decen-tralization system reform is important to improve the health efficiency of government health expenditures.

Trend and Prediction of Urban Family Expenditure for Health Care / 예방의학회지

The increase of health care expenditures is an important problem in the almost countries. Also, suppression of the health care expenditures is an important problem in the health field of Korea since the national health insurance for total people in 1989. Thus, it is very important to grasp the change of the health care expenditures of family and proportions of the health care expenditures to total expenditures of family, because they are the basis of national health care expenditures in Korea. While the health care expenditures of urban family were increased during 1980-1993 by 12.8% annually, the total expenditures of urban family were increased by 14.8% annually. consequently, the proportions of health care expenditures to total expenditures were decreased from 5.98% to 4.76%. The proportions of health care expenditure for 3 years to come were predicted to 4.75% in 1994, 4.67% in 1995, and 4.63% in 1996 by the time-series ana]ysis. That is, it was predicted that they would be decreasing slowly. The product elasticity of health care expenditure was less than 1 in the multiple regression analysis, so the health care is normal good rather than superior good. Therefore, it seems that the household economy is able to bear the expense pursuing the improvement of quality of health care by actualizing the medical insurance fee.

Physician payment reform in the United States

The United States recently adopted an entirely new system of paying physicians for the services they provide to elderly and disabled patients. The new system is based on a fee schedule in which the relative values among different services are derived on the basis of the cost of providing such services. To control expenditure growth, a system of Volume Performance Standards (VPSs) was adopted, which explicitly links physician fee levels to the success the physician community has in controlling the total volume of services provided. This article presents and analyzes the new payment system and examines its applicability to other countries. It concludes that the methodology used to develop the fee schedule may be useful to other countries, particularly if they are unable to reach a consensus on appropriate physician fee levels, but that the VPS system needs to be refined in a number of ways before it can be successfully exported.