ABSTRACT
Los costos de atención integral para enfermedades trasmisibles, en el régimen subsidiado o contributivo indirecto del sistema de salud del Perú., son la base para la formulación de políticas publicas para garantizar el derecho a la salud, por esto, mediante un arreglo metodologico, se construyo un modelo de estimación de costos de atención integral para enfermedades trasmisibles, el cual, es verificación y validación por expertos. Primero se priorizaron dengue, malaria, tuberculosis y enfermedad diarreica aguda como grupos de diagnósticos, de acuerdo a aspectos demográficos, determinantes sociales, indicadores de mortalidad y morbilidad. Sucesivamente se construye el modelo teorico "Costo Atención Integral (CAI) = Æ© C (Capital)+ CVI (Costo variable indireccto) + CVD (Costo variable direccto) +CC (Costo por contingencia) + CP/S (Costo paciente/sociedad), obteniendo valores estimados de 3,66+0,40 y 3,71+0,34 respectivamente para costos totales; mientras que el costo paciente/sociedad arrojaron valores de 2,98+0,49 de verificación y validación de 2,68+0,32; estimaciones indicativas que los componentes del sistema propuesto pesquisan los costos reales de los procesos de atención se salud del régimen sidsidiario, es decir alta adecuación de los procesos, utilidad de insumos y materiales, uso eficiente en los diferentes entornos del sistema; como una herramienta crucial de información para la comparación e identificación de las intervenciones de tipo preventivo más costo-efectivas(AU)
The costs of comprehensive care for communicable diseases, in the subsidized or indirect contributory regimen of the Peruvian health system, are the basis for the formulation of public policies to guarantee the right to health, for this reason, through a methodological arrangement, it was built a comprehensive care cost estimation model for communicable diseases, which is verified and validated by experts. First, dengue, malaria, tuberculosis and acute diarrheal disease were prioritized as diagnostic groups, according to demographic aspects, social determinants, mortality and morbidity indicators. Successively, the theoretical model "Comprehensive Care Cost (CCI) = Æ© C (Capital) + IVC (Indirect variable cost) + DVC (Direct variable cost) + CC (Contingency cost) + P/SC (Patient/society cost) is built , obtaining estimated values of 3.66+0.40 and 3.71+0.34 respectively for total costs; while the patient/society cost yielded values of 2.98+0.49 for verification and validation of 2.68+0.32; indicative estimates that the components of the proposed system investigate the real costs of the health care processes of the subsidiary regime, that is to say, high adequacy of the processes, usefulness of supplies and materials, efficient use in the different environments of the system; as a crucial information tool for the comparison and identification of the most cost-effective preventive interventions(AU)
Subject(s)
Humans , Male , Female , Communicable Diseases , Health Care Costs , Comprehensive Health Care , Costs and Cost Analysis , Patients , Policy Making , Health Systems , Morbidity , Right to HealthABSTRACT
Resumo O objetivo do estudo é analisar a evolução do preço do tenofovir (TDF) no Brasil à luz das diferentes iniciativas para sua redução. Os critérios para a seleção do caso foram: ter sido objeto de pelo menos uma estratégia de enfrentamento da barreira patentária, que no caso foi o subsídio ao exame do pedido da patente (oposição à patente); e ter sido objeto de uma Parceria para Desenvolvimento Produtivo (PDP) para produção local. Os principais resultados sugerem que os subsídios ao exame apresentados em 2005 e 2006 contribuíram para a decisão de indeferimento do pedido de patente em 2009. Estima-se que o Brasil pagou cerca de US$ 200 milhões a mais pelo monopólio gerado a partir de um pedido de patente pendente. Houve uma redução do preço do TDF entre 2003 e 2013, inclusive durante a vigência da PDP (2011 a 2013). Em 2010, após o anúncio da PDP, também houve uma diminuição de 40% no preço do TDF ofertado pela Gilead, que refletiu no preço de oferta do produto PDP. No entanto, o preço pago no Brasil para o produto nacional foi cerca de dez vezes mais caro que o genérico ofertado internacionalmente.
Abstract This study aimed to analyze the evolution of the price of tenofovir (TDF) in Brazil considering the different initiatives for its reduction. The selection criteria for the case were: to have been subject to at least one strategy to overcome patent barrier, which in the case was the support to examination of the patent application (patent opposition); and have been subject of a local production Partnership for Productive Development (PDP). The main results suggest that patent opposition presented in 2005 and 2006 contributed to the decision to reject the patent application in 2009. Brazil is estimated to have paid around US$ 200 million more for the monopoly due to the patent pending application period. There was a reduction in the price of TDF between 2003 and 2013, including during the PDP (2011 to 2013). In 2010, after the PDP announcement, there was an additional 40% decrease in the price of the TDF offered by Gilead, which reflected in the price offered by the PDP. However, the price paid in Brazil for the national product was about ten times higher than the generic offered internationally.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome , Anti-Retroviral Agents/economics , Drug Price , Drugs, Generic , HIV , Patent , Tenofovir , Unified Health SystemABSTRACT
Essa dissertação teve por objetivo propor um novo critério para a concessão do subsídio, na forma de tarifa social, para os serviços públicos de abastecimento de água e esgotamento sanitário no Distrito Federal.A aplicação de subsídios às contas de água e esgotamento sanitário no Brasil teve início por meio de política nacional da década de 1970 e foi novamente estimulada a partir da edição da Lei Federal nº 11.445, de 5 de janeiro de 2007, atual marco regulatório do setor de saneamento, que ainda acrescentou o papel das agências reguladoras como responsáveis pelo valor cobrado pelas tarifas aplicadas no setor. Os resultados avaliados nesse estudo referem-se à pertinência dos critérios adotados para a concessão do subsídio na forma de tarifa social; ao impacto da cobrança da tarifa pelos serviços de abastecimento de água e esgotamento sanitário sobre a renda das famílias do Distrito Federal e às formas alternativas de acesso à água e esgotamento sanitário, encontradas pelos estratos menos favorecidos em termos de renda, na capital federal.A partir da pesquisa realizada foi possível demonstrar a relevância da tarifa social como subsídio a cobrança pelos serviços de abastecimento de água e esgotamento sanitário; conhecer os critérios utilizados e propor uma alternativa para a concessão deste benefício.Por último, foi possível observar a importância da aplicação da tarifa social, pelo comprometimento observado na cobrança dos serviços de abastecimento de água e esgotamento sanitário, sobre a renda das famílias do Distrito Federal, considerado alto se comparado a estudos nacionais e internacionais...
This dissertation aimed to propose a new criterion for the grant of subsidy in the form of social tariffs for public services of water supply and sanitation in the Federal District.The application of subsidies to water bills and sewage in Brazil began through national politics in the 1970s and was again stimulated from the enactment of Federal Law nº 11.445, of January 5th, 2007, the current regulatory framework for the sector sanitation, which also added the role of regulatory agencies as responsible for the amount charged by the tariffs in the sector. The results evaluated in this study refer to the relevance of the criteria adopted for the grant of subsidy in the form of social tariff; the impact of the fee collection for water and sewage on the household income of the Federal District and alternative forms of access to water and sanitation, found by the least advantaged in terms of income, in the federal capital supply services.From the survey it was possible to demonstrate the relevance of the social tariff and subsidy billing for water supply and sanitation services; to know the criteria used and to propose an alternative to granting this benefit.Finally, we observed the importance of applying the social tariff, the impairment observed in the collection of water and sanitation services on household income of the Federal District, considered high compared to national and international studies...
Subject(s)
Humans , Basic Sanitation , Financing, Government , Health Care Coordination and Monitoring , Sanitation/economics , Sanitation Services TariffsABSTRACT
Introduction: Since 2004, Teleton´s Volunteer Corp through their ProgramAbre is working to eliminate architectural barriers in the homes of rehabilitation services users. Most of these homes are obtained by the families through State financial aid. This on site work has shown low levels of accessibility, thus a full and autonomous use of the home is restricted. Objective: To establish design criteria for social homes from the Solidary Fund 1 (FSV1), regarding unnoticed accessibility characteristics. Method: Sample gathering was obtained with the collaboration of the Housing and Town Planning Ministry (MINVU). Regions with greatest concentration of granted subsidies from FSV1 during the year 2011 were selected. Based on 15 counterproposals, the concept of unnoticed accessibility was implemented in the homes. Design criteria complied with current FSV1regulations. Results: The design process resulted in 15 cases of social homes with different degrees of accessibility. Discussion: The objective of this study allowed the accomplishment of accessibility solutions for social homes from FSV1, with marginal built surface increase. As a second gain, they allowed for the design of construction plants, which improve housing conditions for families, throughout their entire life cycle independent of health conditions. Conclusions: Accessible social home proposals were implemented with marginal increase.
Introducción: Desde el año 2004 el programa Abre del Voluntariado Teletón trabaja a través de la eliminación de barreras arquitectónicas en las viviendas de familias usuarias de Teletón, que en su mayoría acceden a viviendas sociales obtenidas mediante subsidios estatales. Esta realidad en terreno ha permitido visualizarlos bajos niveles de accesibilidad que estas viviendas poseen, dificultando el acceso, uso pleno y autónomo de los recintos. Objetivo: Establecer criterios de diseño que permitan que las viviendas sociales del fondo solidario 1 (FSV1) posean características de accesibilidad desapercibida. Material y Método: La recopilación de la muestra de tipos de vivienda social se realizó en colaboración con el Ministerio de Vivienda y Urbanismo (MINVU), trabajando con las Regiones de mayor concentración de subsidios del FSV1 asignados durante el año 2011.Se desarrollaron 15 contrapropuestas en las cuales se implementó el concepto de accesibilidad desapercibida. Los criterios de diseño se enmarcaron en el reglamento actual del FSV1. Resultados: El proceso de diseño culminó con la obtención de 15 casos de viviendas sociales con distintos grados de accesibilidad. Discusión: Desde los objetivos propuestos en este estudio, se ha podido brindar soluciones de accesibilidad para las viviendas sociales del FSV1, sin que ello implicase un aumento considerable de la superficie construida. De igual manera, se han podido diseñar plantas de edificación que permiten mejorar las condiciones de habitabilidad, independiente de la condición de salud del grupo familiar en todo su ciclo de vida. Conclusiones: Las propuestas de vivienda social accesible se lograron con un aumento marginal de superficie.
Subject(s)
Architectural Accessibility , Financing, Government , Housing , ChileABSTRACT
Lograr una alimentación saludable, que cumpla con los requerimientos calóricos y nutricionales debe ser la meta de las políticas alimentario-nutricionales de un país. Cumplir este objetivo en comunidades desprotegidas, en transición nutricional o de escasos recursos económicos puede requerir la intervención del estado a través de programas de subsidios de alimentos para mejorar la capacidad adquisitiva de los alimentos por parte de estas poblaciones. Un mecanismo utilizado para mejorar la distribución y el acceso a los alimentos, es a través de mercados, supermercados y expendios de alimentos que proporcionen algún beneficio en términos del ahorro al momento de la adquisición de los productos. Con la finalidad de revisar sistemáticamente literatura que presenta estudios de evaluación de expendios de alimentos para programas de alimentación, se realizó una búsqueda en diferentes bases de datos. Al finalizar la búsqueda sistemática se obtuvieron 7 trabajos acorde al tema. Los hallazgos más importantes reportados en estos trabajos fueron los siguientes: la cercanía del expendio de alimentos fue sumamente importante para la adquisición de los alimentos, la oferta de alimentos es determinante (no puede adquirirse lo que no puede encontrarse en un anaquel del expendio), los expendios que ofrecían algún tipo de elemento educativo, promovieron más el conocimiento de salud de la población y finalmente el factor de desigualdad entre la oferta en los mercados de las zonas más afluentes respecto a las zonas menos favorecidas económicamente, pues la diferencia en calidad es importante con detrimento de los vecindarios más desprotegidos. Es importante entonces tomar en cuenta los expendios de alimentos para el buen funcionamiento y cumplimiento de las metas de los programas de subsidio de alimentos(AU)
Promoting a healthy intake of food for reaching the caloric and nutrient requirements of the population should be the aim of the food and nutrition policies of a country. In order to accomplish this objective, in nutrition transition communities and/or low income populations, government intervention might be required through food assistance programs for improving purchase food power and increase the availability of high quality foods at affordable prices. A way to facilitate the distribution and ameliorate the accessibility of different foods is to incorporate supermarket, markets and other types of food stores to canalize the programs objectives in particular to improve savings for the acquisition of foods. The aim of this systematic review was to search in data bases evidence based literature on the topic of food stores used in assistance food programs. 7 articles related to the topic were found. The main findings to describe how important were the markets for improving the distribution and accessibility of high quality foods were: closeness of the store to neighborhoods, the availability of foods since what cannot be found cannot be purchased, nutrition education at the store and disparities in the quality of foods between affluent and low income neighborhoods. All this reasons should taken into account when programming the actions to be taken for food assistance programs(AU)
Subject(s)
Humans , Male , Female , Food Security , Nutritional Transition , Food Assistance/legislation & jurisprudence , Nutritional Requirements , Products Distribution , Diet, Food, and Nutrition , Food HandlingABSTRACT
Se describieron los procesos vividos por 13 de las Empresas Solidarias de Salud ( E.S.S.) de Antioquia durante el período de 1.993 a 1996, con énfasis en: Identificación de la población objeto, fases de conformación (Gestión Sanitaria y Gestión Empresarial), determinación de la demanda, estructura administrativa y organizacional, servicios de salud y situación económica. Todas cumplieron el diseño del Ministerio de Salud para conformarse y vienen prestando servicios a sus beneficiarios. Han mostrado importantes logros en Participación Comunitaria y en la estructuración del Régimen Subsidiado en Salud. Presentan limitaciones administrativas y organizacionales, carencias en sistemas de información y desactualización en sus estados contables. Las E.S.S. son altenativa en Participación Comunitaria y autogestión de los municipios de Colombia en la Administración del Subsidio a la Demanda en Salud para la población más pobre y vulnerable, con particular énfasis en promoción y prevención buscando una nueva cultura de la salud...
The processes lived by 13 of the Solidarity Health Companies (E:S:S:) of Antioquia During the 1993-1996 period were described with emphasis on: identification of the population object, conformation phases (Sanitary Effort, Entrepereunial Effort), determination of demand, administrative and orgazational structure, health services and economic situation. All companies fulfilled the Health Ministry design to be certified and come lending services to their beneficiary. Also have shown important achlevements in Community Participation and in the setup of the Regime Subsididized in Health. These companies present administrative and organizational limitations and lack of information systems. Their countabble states are outdated. The E:S:S companies are alternative in Community Participation and auto effort of the municipallities of Colombia. This is a applied by the Subsidy Administrastion of Health Demand for the poorest and vulnerable population. They have a particular emphasis in promotion and prevention to seek a new culture of health.