ABSTRACT
Japón está compuesto por 126 millones de habitantes y corresponde a la tercera potencia económica mundial. El sistema de salud se basa en un único seguro obligatorio universal, con cobertura médica y odontológica. En las últimas décadas, el envejecimiento poblacional ha sido un punto importante a considerar en la planificación de políticas públicas sanitarias. La eficiencia de este sistema ha sido punto de comparación con distintos países, no así con Chile. Por ello, el objetivo de esta revisión narrativa es comparar el sistema de salud oral chileno y japonés. Se realizó una revisión narrativa utilizando los repositorios de revistas científicas Science Direct, y PubMed, así como publicaciones disponibles en páginas gubernamentales de Japón y Chile.El seguro japonés prioriza la promoción de salud y prevención de enfermedades, enfatizando en la población más vulnerable. Al contrario, en Chile el sistema de salud tiene énfasis en la curación y rehabilitación. Japón ha adoptado un seguro debido a la transición demográfica y epidemiológica, para garantizar la sustentabilidad del sistema en el tiempo, modelo que podría ser aplicado en Chile; considerando el envejecimiento poblacional y la carga de enfermedades crónicas no transmisibles. Ambos países tienen ventajas y limitaciones en los atributos de sus sistemas de salud. Chile tiene una Red integrada de servicios de salud y ha implementado políticas como GES. Japón tiene un sistema universal, más eficiente y equitativo. Las fortalezas del sistema japonés podrían implementarse en Chile, a través de nuevas políticas públicas que fortalezcan la salud del país, incluyendo la odontología.
Japan has a population of 126 million, and it is the third national economy in the world. The health system is on a single universal mandatory insurance, with medical and dental coverage. In the last decades, Japan has faced the ageing of its population, and this has been a relevant matter in the planning of public health policies. The efficiency of the health system has been a point of comparison in different countries, but not in Chile. Thus, the objective of this narrative review is to compare the Chilean oral-health system with the Japanese.A non-systematic review was made using Science Direct, PubMed repositories of journals and official Japanese and Chilean government pages. The Japanese healthcare insurance prioritizes health promotion and disease prevention, emphasizing the most vulnerable population. Conversely, Chile has a health system that focalizes on healing and rehabilitation. Japan has adopted insurance because of the demographic transition to guarantee the system's sustainability. Considering the increased ageing population and the non-communicable disease load, this insurance model could be applied in Chile.Both Chile and Japan have advantages and limitations regarding the attributes of their health systems. Japan has a universal, more efficient, and equitable system. Chile should study the strengths of the Japanese system for its implementation of new public policies that strengthen the country's health, including dentistry.
ABSTRACT
O câncer de colo de útero é a segunda doença mais comum entre mulheres em todo o mundo. O esfregaço de Papanicolaou é um teste simples que pode detectar a doença em um estágio precoce e curável. Embora indicado para todas as mulheres adultas, a cobertura do teste é inferior a 70 por cento das mulheres brasileiras. Este estudo teve como objetivo avaliar se a posse de plano de saúde privado está associada à realização do exame de Papanicolaou. Foram analisados dados de 6.299 mulheres com 35 anos ou mais de idade, residentes no Rio de Janeiro, entrevistadas na Pesquisa Nacional por Amostra de Domicílios (PNAD) em 2003. A fim de minimizar a ocorrência de vieses, utilizamos o escore de propensão com a técnica de pareamento, levando em consideração todas as informações do desenho amostral na estimação dos escores (pesos amostrais, estratos e unidades primárias de amostragem). Uma subamostra de 2.348 mulheres foi então obtida, com covariáveis socioeconômicas e biológicas distribuídas igualmente entre os grupos com e sem cobertura de plano de saúde privado (1.174 pares). Os resultados com utilização de modelo de regressão logística mostraram que a chance de realizar o exame Papanicolaou é 26,1 por cento maior (OR=1,261; p=0,096; IC 95 por cento=[0,96; 1,66]) para mulheres com plano de saúde quando comparadas às mulheres sem cobertura de plano de saúde, no nível de significância de 10 por cento. Os resultados indicam a necessidade da extensão do rastreio periódico do câncer de colo de útero para todas as mulheres, reduzindo as desigualdades ainda presentes nos dias atuais.
Cervical uterine cancer is the second most common malignancy affecting women worldwide. Papanicolaou smear is a simple screening test that can detect the disease at an early and curable stage. Although indicated to every adult woman, Pap smear screening covers less than 70 percent of Brazilian women. This study aimed to evaluate if private health care insurance coverage was associated with Papanicolaou smear screening. We analyzed data from 6,299 women aged 35 years or older, resident in Rio de Janeiro state, who had been interviewed in the National Household Sample Survey (PNAD) in 2003. In order to minimize the occurrence of biases, we utilized the propensity score matching method, considering all information from sample design in the scores estimation (sample weights, strata and primary sampling units). A sub-sample of 2,348 women was then obtained, with socioeconomic and biological covariates equally distributed between the groups with and without private health insurance coverage (1,174 pairs). Logistic regression model was then used and the results showed that the chance of Papanicolaou smear screening is 26.1 percent higher (OR=1.261; p=0,096; CI 95 percent= [0.96;1.66]) for women with health insurance coverage when compared to women without health insurance coverage at 10 percent of significance. The results indicate the need of extending periodic cervical cancer screening for all women, reducing the inequalities still present nowadays.
Subject(s)
Adult , Aged , Female , Humans , Middle Aged , Insurance, Health/statistics & numerical data , Vaginal Smears/statistics & numerical data , Propensity ScoreABSTRACT
The clearing procedure of health care insurance cost in Viet Nam is actually basing on ceiling-limited service cost. Many limitations are shown in this clearing procedure. Moreover, the hospital cost frame which was promulgated according to the interministerial circular N0 14/TTLB between the Ministry of Health and the Ministry of Finance is not appropriate. Items of health expenditure are increasing. In this article, some solutions for improving the clearing procedure are presented such as replacing this clearing procedure by predetermined portions or diagnosis groups. However, it is necessary to implement short-term and long-term solutions for improving the clearing procedure of health care insurance cost by service