Tabaco y tabaquismo en Cuba: de la economía agrícola a la economía de la salud

El consumo de cigarrillos y tabacos crea una externalidad que tiene mayor relevancia en el detrimento de la calidad de vida y de la expectativa de vida que experimenta el individuo fumador con relación a los que no consumen cigarrillos o tabacos. el costo psicosocial no cuantificado de forma financiera supera con creces cualquier expectativa de beneficio económico. El presente artículo versa en torno al impacto socioeconómico del tabaquismo en Cuba. La distribución económica inducida por el tabaquismo conlleva a la persistencia de una inequidad socioeconómica tal, que se agudiza con el número de fumadores y la intensidad del consumo de cigarrillos y tabáquico. Este fenómeno contradice el principio socialista de distribución con arreglo al trabajo, donde los no fumadores no deberían cargar con las consecuencias del tabaquismo y los propios fumadores no deberían ser inducidos a persistir en el consumo tabáquico. La sutileza de los costos sociales atribuibles al tabaquismo y el impacto de los beneficios del comercio interior y exterior, no permiten valorar en su completa dimensión los principales efectos del tabaquismo desde el aspecto socioeconómico.

The cigarettes and tobacco consumption creates an externality that is more relevant in the detriment of the life quality and life expectancy experienced by the individual smoker, in relation to those who do not consume cigarettes or tobacco. The psychosocial cost not financially quantified far exceeds any expectation of economic benefit. This article deals with the socioeconomic impact of smoking in Cuba. The economic distribution induced by smoking leads to the persistence of such socioeconomic inequity, which worsens with the number of smokers and the intensity of cigarette and tobacco consumption. This phenomenon contradicts the socialist principle of distribution according to work, where non-smokers should not bear the consequences of smoking and smokers themselves should not be induced to persist in smoking. The subtlety of the social costs attributable to smoking and the impact of the benefits of domestic and foreign trade do not allow a full assessment of the main effects of smoking from the socioeconomic aspect.

Dimensionamento da 'economia política' na 'economia da saúde': para refletir sobre o conceito de sustentabilidade / Dimensioning of 'political economy' in 'health economics': reflecting on the concept of sustainability

RESUMO Este artigo teve como objetivo mapear a produção da economia da saúde no Brasil e seus principais temas, destacando a relevância da economia política, com o intuito de refletir sobre a sustentabilidade do Sistema Único de Saúde. Para tanto, realizou-se uma pesquisa quantitativa exploratória, por meio de coleta de dados nos currículos de pesquisadores doutores em economia da saúde na Plataforma Lattes (CNPq) em 2018. Recuperaram-se os pesquisadores por meio do termo 'economia da saúde' e 'economia política'. Classificaram-se suas produções nas áreas temáticas de 'financiamento', 'política de saúde', 'gestão em saúde', 'análise de custo-efetividade'. Identificaram-se 471 currículos de doutores associados ao termo 'economia da saúde', dos quais 53,9% (254) foram considerados 'economistas da saúde'. Entre os temas mais trabalhados, 42,5% (108) enfatizam a 'análise de custo-efetividade', 20,9% (53) salientam a 'gestão em saúde' e 20,5% (52) ressaltam o 'financiamento'. Dos 254, apenas 11,0% (28) produzem em 'economia política'. A preponderância da produção em 'gestão em saúde' e 'análise de custo-efetividade' sugere que os pesquisadores da economia da saúde estão majoritariamente alinhados ao pensamento neoclássico. Além disso, a produção de conhecimento pelos paradigmas da 'economia política' é rarefeita.

ABSTRACT This article aims to map the production of health economics in Brazil and its main themes, highlighting the relevance of political economy, with the aim of reflecting on the sustainability of the Unified Health System (SUS). For that purpose, a quantitative exploratory research was carried out, through data collection in curricula of health economics researchers at the Plataforma Lattes (CNPq) in 2018. Researchers were retrieved through the term 'health economics' and 'political economy'. Their productions were classified in the thematic areas of 'financing', 'health policy', 'health management', 'cost-effectiveness analysis'. 471 curricula of doctors associated with the term 'health economics' were identified, of which 53.9% (254) were considered 'health economists'. Among the most addressed topics, 42.5% (108) focus on 'cost-effectiveness analysis', 20.9% (53) on 'health management', and 20.5% (52) on 'financing'. Of the 254, only 11.0% (28) show a production in 'political economy'. The preponderance of productions in 'health management' and 'cost-effectiveness analysis' suggests that health economics researchers are mostly aligned with the neoclassical thinking. Moreover, the production of knowledge by the paradigms of 'political economy' is scarce.

Memorias del Simposio de Salubristas del Caribe y las Américas / Memories of the Caribbean and America Public Health Symposium i: en

El Simposio de Salubristas del Caribe y las Américas presentó 3 ediciones (2017, 2018 y 2019) y estuvo auspiciado por la Sociedad Cubana de Salud Pública, el Capítulo Provincial de Salud Pública, la Dirección Provincial de Salud, la Universidad de Ciencias Médicas, el Consejo Provincial de Sociedades Científicas de la Salud, el Policlínico Docente Camilo Torres Restrepo, así como la Asociación Nacional de Economistas y Contadores. Conjuntamente con este evento se desarrollaron los talleres de ética y valores y de Economía de la Salud. En la tercera edición se celebró también la Jornada de residentes en Medicina General Integral. Se intercambiaron experiencias, que en el marco de la proyección salubrista, han tenido impacto en las esferas económica, social y científica. Por su importancia y acuerdo de los presentes, las conclusiones tomadas en sesión plenaria fueron enviadas a los decisores provinciales para contribuir a mejorar la calidad de los procesos atencionales, docentes e investigativos.

The Caribbean and America Public Health Symposium presented 3 editions (2017, 2018 and 2019) and was sponsored by the Cuban Society of Public Health, the Provincial Chapter of Public Health, Health Provincial Management, the University of Medical Sciences, the Provincial Council of Health Scientific Societies, Camilo Torres Restrepo Teaching Polyclinic, as well as the National Association of Economists and Accountants. Along with this event Ethics and Values and Health Economy workshops were developed. In the third edition the Day of residents in Comprehensive General Medicine also took place. Experiences were exchanged that in the mark of the public health projection, have had impact in the economic, social and scientific spheres. Due to its importance and agreement of the present people, the conclusions taken in plenary session were sent to the provincial decision makers to contribute in the improvement of quality in the care giving, teaching and investigative processes.

Experiencias de capacitación a manipuladores de alimentos desde la promoción de salud / Experiences of the food handlers´ training from the health promotion

RESUMEN Introducción: las personas que manipulan alimentos son responsables de la elaboración inocua de los mismos, son claves para desarrollar y fomentar una cultura alimentaria saludable. Objetivo: describir el desarrollo del curso "El manipulador de alimentos y la promoción de Salud" impartido por la Escuela Nacional de Salud Pública, durante el curso 2015-2016. Materiales y métodos: se realizó un estudio descriptivo, de corte transversal.El universo lo constituyó 97 cursistas. Resultados: las principales necesidades de aprendizaje fueron: normas jurídicas cubanas para la manipulación de alimentos inocuos, (97=100 %); buenas prácticas de manufactura en la limpieza y desinfección en establecimientos de alimentos, (96=93,12%); conocimiento de enfermedades trasmitidas por los alimentos, (89= 86,33 %); la necesidad de poseer conocimientos relacionados con los alimentos saludables y factores que influyen en su calidad, (60=58,20 %). Las principales expectativas declaradas al inicio del curso fueron cumplidas en un 100 %. El 91,75 % de los cursistas expresaron sentirse muy satisfechos. Conclusiones: el curso impartido desde la perspectiva de la promoción de la salud, posibilitó que los manipuladores de alimentos se empoderen de los conocimientos necesarios para contribuir a garantizar la inocuidad de los alimentos, en sus comunidades y escenarios laborales y así lograr una alimentación saludable y de calidad... (AU)

ABSTRACT Introduction: people handling food are responsible for their innocuous elaboration and are very important for developing and fomenting a healthy food culture. Objective: to describe the conduction of the training "The Food Handler and Health Promotion", taught at the National School of Public Health, during the school year 2015-2016. Materials and methods: a cross-sectional, descriptive study was carried out. The universe was formed by 97 trainees. Results: the main learning necessities were: Cuban juridical norms for handling innocuous food (97=100 %); good manufacturing practices in food establishments cleaning and disinfestation (96=93.12%); knowledge on food-transmitted diseases (89= 86.33 %); necessity of having knowledge related to healthy food and factors influencing on their quality (60=58.20 %). The main expectations declared at the beginning of the training were 100 % fulfilled. 91.70 % of the trainees said they were satisfied. Conclusions: the training from the point of view of health promotion provided the food handlers the necessary knowledge for them to contribute to warrant the food innocuousness in their communities and working places, achieving that way a healthy, qualitative feeding... (AU)

La estrategia integral de salud: un enfoque necesario / Health comprehensive strategy: a necessary approach

En la cobertura universal de salud se destaca la importancia del financiamiento en los sistemas de salud y de los recursos de la población para acceder a los servicios sanitarios, donde también influyen otros aspectos, como la falta de voluntad política, de conocimiento, organización y preparación de las autoridades y los directivos de los diferentes sectores y niveles, para lograr una atención que se corresponda con los determinantes sociales de la salud. A pesar de que se definen los problemas exógenos que afectan a la salud de la población y que influyen en los sistemas de salud, como el medio ambiente, los desastres naturales, entre otros; no se precisa cómo estos sistemas deben interactuar de forma más activa con los fenómenos que los originan y los factores que intervienen, por lo que en este artículo se realizan algunas propuestas a tales efectos.

In the health universal covering, the importance of financing the health systems and the population's resources stands out to make the health services disposable, where there is also the influence of other aspects such as the lack of political will, knowledge, organization and training of authorities and heads of the different sectors and levels, to achieve a care in correspondence with the health social determinants. Although exogenous problems which affect the population's health and that influence in the health systems, as environment, natural disasters, among others are defined, is not stated how these systems should interact in a more active way with the phenomena that originate them and the factors that intervene, so that some proposals to such effects are described in this work

Términos económicos más utilizados en la salud (II parte) / Most used economic terms in health (II part)

En este artículo se ofrece el resto de los términos económicos, organizados alfabéticamente de la letra E a la Z, con lo cual se completa el glosario iniciado en el número anterior de esta revista. Se espera que pueda ser útil a todos los estudiantes y profesionales de las ciencias médicas que lo necesiten como material de consulta, y para todos aquellos lectores que deseen incrementar su acervo cultural en la esfera económica.

In this work the rest of the economic terms alphabetically organized are offered from E to Z letters, with which the glossary initiated in the previous number of the present journal is completed. It is expected that this glossary can be useful to all the students and professionals of the medical sciences that need it as consultation material, and for all those readers that want to increase their cultural heritage in the economic sphere.

Términos económicos más utilizados en la salud (II parte) / Most used economic terms in health

Se ofrecen 525 términos económicos organizados alfabéticamente, cuya mayoría comúnmente se emplean en la salud; algunos han sido actualizados por los autores según los cambios de la economía en los momentos actuales, lo que puede contribuir a enriquecer la cultura de estudiantes, profesores y trabajadores no vinculados directamente a la esfera económica, pero que indirectamente participan de ella. El empleo de una serie de vocablos en los Lineamientos de la Política Económica y Social del Partido y la Revolución aprobados en el VI Congreso del Partido Comunista de Cuba, que no eran de uso común en este país por su diferencia socioeconómica con la economía imperante en el mundo, constituyó el motivo fundamental para la confección de este glosario.

Five hundred and twenty five economic terms alphabetically organized are offered, the majority of them are commonly used in health; some of them have been updated by the authors according to the changes of economy in the current moments, which can contribute to enrich the culture of students, professors and workers not directly linked to the economic sphere, but that participate of it indirectly. The use of a series of words in the Guidelines of the Party and Revolution Economic and Social Politics approved in the VI Congress of the Cuban Communist Party, that were not commonly used in this country due to its socioeconomic difference with the prevailing economy in the world, constituted the fundamental reason for making this glossary.

Ahorro del sistema de salud por la regulación directa de precios de venta de medicamentos biotecnológicos en Colombia / Savings in the Health System due to the Direct Regulation of the Sale Prices of Biotechnological Medicines in Colombia / Poupança no sistema de saúde pela regulamentação direta de preços de venda de medicamentos biotecnológicos na Colômbia

Resumen Se desarrolló un análisis retrospectivo sobre las ventas de trece biotecnológicos regulados, entre junio del 2010 y junio del 2014, en dos escenarios: valores facturados después de la regulación de precios y valores supuestos, calculados a partir del precio de venta promedio de los seis meses anteriores a la regulación, más el índice de precios al consumidor en salud. La diferencia entre ambos escenarios supone un ahorro al sistema. Los biotecnológicos analizados generaron un ahorro de USD $95 000 000 en dicho periodo; en el primer año el 10.2%, el segundo año el 17.2% y en el tercero el 30.5%. El biotecnológico que más ahorro representó fue el rituximab (40,9%), equivalente a USD $38 510 787. La regulación directa de precios de medicamentos biotecnológicos le ha generado ahorros significativos al sistema de salud, visto desde las ventas registradas en Audifarma. Probablemente, el ahorro económico que ha generado esta política es superior a lo estimado inicialmente por el Gobierno.

Abstract We developed a retrospective analysis on the sales of thirteen biotechnological regulated medicines between June, 2010, and June, 2014, in two scenarios: amounts billed after the price and assumed value regulation, calculated based on the average sale price during the six months prior to the regulation, plus the health consumer price index. The difference between both scenarios entails a saving for the system. The biotechnological medicines analyzed generated savings for US $95 Million in said period; 10.2% during the first year, 17.2% during the second, and 30.5% during the third. The biotechnological medicine that generated the most savings was rituximab (40.9%), equivalent to US $38,510,787. The direct regulation of biotechnological medicines has generated significant savings for the healthcare system, as seen from the sales registered by Audifarma. Probably, the economic savings generated by this policy are above the initial government estimates.

Resumo Análise retrospectiva sobre as vendas de treze biotecnológicos regulados entre junho de 2010 e junho de 2014 desenvolvida em dois cenários: valores faturados após regulamentação de preços e valores supostos, calculados a partir do preço de venda médio dos seis meses prévios à regulamentação, mais o índice de preços ao consumidor em saúde. A diferença entre ambos cenários supõe poupança para o sistema. Os biotecnológicos analisados geraram poupança de USD $95 000 000 nesse período; no primeiro ano o 10.2%, o segundo ano o 17.2% e no terceiro o 30.5%. O biotecnológico que mais poupança gerou foi o rituximab (40,9%), equivalente a USD $38 510 787. A regulamentação direta de preços de medicamentos biotecnológicos gerou poupança significativa ao sistema de saúde, visto desde as vendas registradas em Audifarma. Provavelmente, a poupança econômica gerada por esta política é superior do estimado inicialmente pelo Governo.

Big-data based data mining of health economy management / 中华医院管理杂志

The paper described the role of big data for health economy development and the present data mining and integration of health economy management.It pointed out the importance of overall data criteria management,IT system integration management,healthcare data collection,and normalization of data mining and integration process.The authors also recommended new concepts,technology reserve and institutional development,to provide powerful technical support for the macro decision making,budget allocation,performance analysis,and performance appraisal of the health economy.

Economic Operation of Xuzhou TCM Hospital under Medical Insurance Total Prepaid System in 2010-2013 / 中国中医药信息杂志

Objective To analyze the relationship between measures and economic benefit under the total medical insurance prepaid system in Xuzhou TCM hospital.Methods The trend of financial data of Xuzhou TCM hospital from 2010 to 2013, its incomes, assets, and liabilities were analyzed to evaluate its profitability, operating capacity and solvency.Results Income:The annual average income was 439.81 million yuan, with an annual average growth rate of 12%;the annual average net profit was 24.36 million yuan, with an annual average growth rate of 0.004% (excluding the profit adjustment factors in 2010). Assets:The annual average total assets was 355.82 million yuan, in which 73.21 million yuan was the added value in 2010 compared with 2009 and the growth rate was 17.22%;247.71 million yuan has been reduced in 2011 compared with 2009;45.11 million yuan has increased in 2012 compared with 2011, while in 2013, 35.58 million yuan has increased compared with 2012. The state owned assets has increased significantly. Liabilities:The annual total liabilities were 114.86, 84.03, 112.35, and 120.52 million yuan respectively from 2010 to 2013;the average debt level was 105.61 million yuan. The rate of assets and liabilities were 23.04%, 33.52%, 37.98%, and 36.37% respectively from 2010 to 2013;the annual average debt rate was 29.68%. Profitability:The average net operating margin, net interest rate of total assets and net assets yield rate were 5.54%, 6.85% and 9.73% respectively, which showed the gradually increased profitability. Hospital operating capacity:The average total assets turnover rate was 124% from 2010 to 2013. The solvency of the hospital:asset liability ratio of the hospital was 29.68% from 2010 to 2013 on average, which was in the low level of debt.Conclusion Under the total prepaid system, the measures of the hospital are proper. Economic operation of the hospital is favorable, giving the consideration of combining both economic benefit and social benefit.

Impacto de la competencia económica del especialista en medicina general integral sobre el desarrollo socioeconómico de Cuba / Impact of the economic competence of the specialist in general comprehensive medicine on the Cuban social and economic development

La Economía de la Salud, con sus inicios en países desarrollados, constituye una disciplina que ha venido desarrollándose en los últimos años como una especialidad científica y cuyo objeto de estudio es la toma de decisiones en el sistema de servicios y programas sanitarios, desde un punto de vista económico; por ello se impone que el especialista en medicina general integral adquiera una adecuada competencia económica para el cabal cumplimiento de sus funciones, esencialmente en las actividades de promoción de salud, prevención de enfermedades, diagnóstico precoz, tratamiento oportuno y rehabilitación, con vistas al logro de un mayor progreso social.

Health Economy, with its emergence in developed countries, constitutes a discipline which is being developed in the last years as a scientific specialty and whose study object is the decisions making in the services system and sanitary programs, from an economic point of view; that is why it is important that the specialist in general comprehensive medicine acquires an appropriate economic competence for the precise fulfilment of his functions, essentially in the activities of health promotion, diseases prevention, early diagnosis, opportune treatment and rehabilitation, with the aim of achieving a huger social progress.

Una oportunidad para la economía de la salud en Cuba Salud 2012 / Opportunity for health economy in Cuba Salud 2012

La Convención Internacional de Salud Cuba Salud 2012 se celebró en el Palacio de Convenciones de La Habana del 3 al 7 de diciembre de 2012. La convención cubrió una amplia gama de tópicos, incluida la disciplina economía de la salud. Se realizaron tres grupos de actividades sobre esta disciplina: un curso precongreso, una mesa redonda y presentaciones orales o carteles de trabajos seleccionados por expertos. Los delegados coincidieron en que la reunión fue una oportunidad para el intercambio, en ella se trazaron metas de trabajo para el desarrollo y el trabajo integrado en la disciplina

The international health convention Cuba Salud 2012 was held in Havana´s Convention Center from 3 to 7 December, 2012. It covered a wide range of topics including Health Economy. Three groups of activities related to this discipline were carried out: a pre-congress course, a round table and oral presentations or posters selected by the experts. The participants agreed that this meeting had been the opportunity for exchange of ideas, where new working goals for the development of and the integrated work within this discipline were put forward

Influencia del marco regulatorio de los productos farmacéuticos en la salud pública² Análisis a partir de la ratificación por Colombia del Convenio ADPIC y de los Tratados de Libre Comercio con los Estados Unidos y la Unión Europea / Influence of the Regulatory Framework for Pharmaceuticals in Public Health Analysis from Colombia's ratification of the Agreement on Intellectual Property Rights Trade-Related (TRIPS) and the Free Trade Agreements with the United States and the European Union / Influência do marco regulatório dos produtos farmacêuticos na saúde pública Análise a partir da ratificação pela Colômbia do Convênio ADPIC e dos Tratados de Livre Comércio com os Estados Unidos e a União Europeia

Este artículo tiene por objetivo estudiar la relación entre la disponibilidad, los precios de los medicamentos y los intereses de salud pública. Para ello hemos utilizado una metodología de análisis de los intereses económicos implicados y también un método sistemático de tratamiento de la legislación nacional, comunitaria andina e internacional vigente. Igualmente hemos acudido a metodologías de derecho comparado entre nuestro ordenamiento jurídico nacional con los de otros países de mundo occidental. Existe un estrecho vínculo entre la disponibilidad y los precios de los medicamentos y los intereses de salud pública. Nuestro actual sistema legal reconoce a los inventores de nuevos medicamentos como un "monopolio" para negociar en el mercado farmacéutico. Para proteger los intereses públicos nuestra regulación establece algunos límites a los derechos de los inventores. Los derechos de propiedad se limitan en el tiempo y bajo algunas circunstancias es obligatorio autorizar a otros a usar la patente bajo un contrato de licenciamiento. La Organización Mundial del Comercio ha establecido (Decisión del Consejo de la OMC, Ronda Doha 2003) otros límites a estos derechos en caso de condiciones excepcionales. Nuestra Constitución Nacional otorga prevalencia a los intereses públicos sobre los privados. Es un deber de los gobiernos establecer un sistema justo en el cual los inventores puedan obtener una recompensa económica por sus creaciones y la sociedad pueda satisfacer sus necesidades de salud.

This article aims to study the relationship between availability, prices of medicines and public health interests. We have used an analysis methodology of the economic interests involved and a systematic method of treatment of national, international, community and Andean current legislation. Also we have relied on comparative law methodologies between our domestic law and the ones of other countries in the Western World. There is a close link between the availability and prices of medicines and public health interests. Our current legal system recognizes to the inventors of new medicines as a "monopoly" to negotiate in the pharmaceutical market. To protect public interests, our regulation establishes some limits to the rights of inventors. Property rights are limited in time and under some circumstances it is mandatory to authorize others to use the patent under a licensing agreement. The World Trade Organization (WTO) has established (Decision of the Council of the WTO Doha Round, 2003.) other limits to these rights in case of exceptional conditions. Our Constitution gives prevalence to public interests over private ones. It is the duty of governments to establish a fair system in which inventors can obtain a financial reward for their creations and society can satisfy its health needs.

Este artigo tem por objetivo estudar a relação entre a disponibilidade, os preços dos medicamentos e os interesses de saúde pública. Para isso, utilizamos uma metodologia de análise dos interesses econômicos implicados e também um método sistemático de tratamento da legislação nacional, comunitária andina e internacional vigente. Da mesma maneira, recorremos a metodologias de direito comparado entre nosso ordenamento jurídico nacional com os de outros países de mundo ocidental. Existe um estreito vínculo entre a disponibilidade e os preços dos medicamentos e os interesses de saúde pública. Nosso atual sistema legal reconhece aos inventores de novos medicamentos como um "monopólio" para negociar no mercado farmacêutico. Para proteger os interesses públicos, nossa regulação estabelece alguns limites aos direitos dos inventores. Os direitos de propriedade se limitam no tempo e, sob algumas circunstâncias, é obrigatório autorizar outros a usarem a patente sob um contrato de licenciamento. A Organização Mundial do Comércio estabeleceu (Decisão do Conselho da OMC, Ronda Doha 2003) outros limites a esses direitos em caso de condições excepcionais. Nossa Constituição Nacional outorga prevalência aos interesses públicos sobre os privados. É um dever dos governos estabelecer um sistema justo no qual os inventores possam obter uma recompensa econômica por suas criações e a sociedade possa satisfazer suas necessidades de saúde.

Major Health Economic Issues and Reform Orientation of Indonesia’s Health System / 中国卫生经济

Based on the health service delivery system and its performance, it shows the major issues faced by Indonesian health system, including heavy disease burden of NCD, imbalance allocation of medical care and resources, poor access to health service in rural area, low level of government health budget and so on. Presently, the reform in Indonesian health system is in the direction of equity and self-government, via participation of community, private sector or civil society, availability of comprehensive, equitable health care and health resource, to enhance health system and improve population health.

Costo institucional de la crisis hipertensiva en el policlínico "Antonio Maceo" / Institutional cost of hypertensive crisis in the Antonio Maceo polyclinic

Introducción: la hipertensión arterial afecta la salud de las poblaciones en todas las partes del mundo. Representa por sí misma una enfermedad y también un factor de riesgo para otras afecciones cardiovasculares. Su impacto es en el área de la epidemiología, la salud pública, y en el aspecto económico. Objetivo: determinar el costo institucional de la atención al paciente con crisis hipertensiva en el servicio urgencia del policlínico "Antonio Maceo" de La Habana en el primer semestre del año 2008. Métodos: se realizó un estudio del tipo de descripción de costos. El enfoque metodológico utilizado fue el costo de la enfermedad, siguiendo los pasos recomendados en la Guía Metodológica para las Evaluaciones Económicas en Salud en Cuba. Los costos fueron expresados en pesos cubanos no convertibles del año 2008. La perspectiva de análisis adoptada fue la institucional. El universo de estudio estuvo constituido por 216 pacientes. En el cálculo del costo total institucional se consideraron las variables: costo por medicamentos, por medios diagnósticos, por salarios, entre otras. Resultados: se estudiaron 209 pacientes con urgencia hipertensiva (96,8 por ciento) y 7 con emergencia hipertensiva (3,2 por ciento). El costo total de la atención del paciente con crisis hipertensiva ascendió a 5 451,68 pesos en moneda nacional y el costo promedio por paciente fue de 25,23. Conclusiones: el costo mayor en la atención al paciente con crisis hipertensiva estuvo relacionado con el salario directo. La adecuada dispensarización y tratamiento de los pacientes hipertensos pudiera disminuir el costo de la atención médica.

Introduction: high blood pressure affects the health of populations at world scale. By itself represent a disease and a risk factor for other cardiovascular affections. Its impact is on the epidemiology, public health areas and in the economic feature. Objective: to determine the institutional cost of the patient care with hypertensive crisis in the emergency service of the "Antonio Maceo" polyclinic of La Habana during the first semester of 2008. Methods: a cost description study was conducted. The methodological approach used was that of disease cost, following the rules recommended in Methodological Guide for Health Economic Assessments of Cuba. Costs were expressed in non-convertible Cuban pesos of 2008. Analysis perspective adopted was the institutional one. Study universe included 216 patients. In the estimation of institutional total cost the following variable were considered: drug, diagnostic means, wages costs among others. Results: authors studied 209 patients diagnosed with hypertensive urgency (96,8 percent) and 7 with hypertensive emergency (3,2 percent). Total cost of patient care with hypertensive crisis rose to 5 451 68 pesos in national money and the mean cost by patient was of 25,23. Conclusions: the higher cost in patient care with hypertensive crisis was related to the net wage. The appropriate dispensarization and treatment of hypertensive patients could to decrease the medical care cost.

Copagamentos no Sistema Público Brasileiro: anomalia ou tendência? / Joint payment in the Brazilian Public Health System: anomaly or tendency?

O copagamento como complemento ao financiamento de unidades públicas de saúde é uma recomendação específica do Banco Mundial para reformar sistemas de saúde e tem sido amplamente utilizado no contexto internacional. O Brasil é uma exceção. O objetivo do trabalho foi analisar a situação do copagamento no Sistema Único de Saúde diante da constatação de sua ocorrência em dois municípios de uma microrregião de Minas Gerais. A questão principal a ser respondida foi: trata-se de um caso anômalo, isolado, ou uma prática não privilegiada pelas análises da implementação da política de saúde no Brasil na atualidade, uma tendência a ser monitorada?.

Joint payment as a complement to finance public health unities is a specific recommendation by the World Bank in order to rearrange health systems, and it has been widely used throughout the world. Brazil is an exception. The aim of the article is to analyze the situation of joint payment in Sistema Único de Saúde - SUS - (Unique Health System) in two cities of a micro-region in Minas Gerais State. The main question to be answered was if we were facing an anomalous isolated case or if it was a practice non-privileged by the analyses of implementation of public health currently in Brazil, a tendency to be monitored.

Efectividad de programas de reducción de la pobreza en la nutrición infantil y los determinantes económicos de la desnutrición en países de escasos recursos: [revisión] / Effectiveness of poverty reduction programs on child malnutrition and economic determinants of malnutrition in low-income countries: [review]

Con el objetivo de determinar la efectividad de las intervenciones de reducción de la pobreza y la magnitud de efecto de los determinantes económicos en la nutrición en ámbitos rurales y pobres de países de escasos recursos, se desarrolló una revisión basada en publicaciones indizadas en Medline y en la Biblioteca Cochrane (BC) hasta el año 2005. Se seleccionó los estudios sobre intervenciones/programas de mejora económica familiar que tienen por objetoreducir la desnutrición y aquellos sobre determinantes económicos de la desnutrición. La calidad metodológica de las investigaciones fue evaluada según los criterios y clasificación de BC, siendo seleccionados tres artículos sobre efectividad de intervenciones económicas en la nutrición y once artículos sobre determinantes económicos de la desnutrición. Seencontró que el incremento de los ingresos familiares puede mejorar la desnutrición al acrecentar el poder de compra de los hogares y la ingesta de calorías, en especial en los más pobres. Sin embargo, la producción y disponibilidad de alimentos, la distribución de los gastos en el hogar, el saneamiento ambiental, la inequidad, el nivel educativo y la escasez de tiempo de la madre, la distribución de los alimentos en el hogar y la urbanización, entre otros; influyen en el estado nutricional pudiendo sobreestimar o subestimar el impacto de los ingresos familiares en la nutrición.

In order to define the effectiveness of interventions addressed to poverty reduction and the degree of effect that the economic determinants have in the nutrition in rural and poor areas of low-resource countries, we performed a revision based on publications indexed to Medline (accessed by PUBMED) and the Cochrane Library (CL) up to year 2005. We chose the studies about interventions/programmes of family economic improvement that have as objective to reduce the malnutrition and those addressing malnutrition determinants. The methodological quality of the researches was evaluatedaccording to the criteria and classification of the CL, and we selected three articles about effectiveness of economic interventions in the malnutrition and eleven articles about economic determinants of malnutrition. We found that the upgrading of the family income can improve the malnutrition while enhancing the acquisitive power of the homes and thenumber of calories taken, especially amongst the poorest. Nevertheless, the production and availability of the food, the distribution of the expenses inside the homes, the environmental sanitation, inequity, the educational level and the lack of time of the mother, the distribution of provisions inside the houses and the urbanization, among others, influence the nutritional status, allowing overestimation or subestimation of the impact of the family outcomes in the nutrition.

Empréstimos externos para o setor saúde no Brasil: soluções ou problemas / Foreign loans for the health sector in Brazil: solutions or problems

No presente artigo discute-se o alinhamento das políticas do governo brasileiro, a política acordada com as agências multilaterais de financiamento - Banco Mundial e Banco Interamericano de Desenvolvimento - BID, a partir da análise do pagamento da dívida externa dos empréstimos contraídos pelo Governo Federal para o setor saúde, dentro do orçamento do Ministério da Saúde. O estudo está circunscrito ao período de 1995 a 2004 e foi desenvolvido por meio de um estudo exploratório, utilizando os recursos da pesquisa documental. Descrevem-se os gastos em saúde do Ministério da Saúde no período de 1995 a 2004, apontando para a instabilidade e a dificuldade de evolução do orçamento, os gastos em saúde em países selecionados, e o comportamento do pagamento da dívida externa total do Governo Federal, da saúde e dos projetos do Banco Mundial e do BID. Por fim, conclui-se que o percentual de recursos públicos gastos em saúde no Brasil é baixo, quando comparado com os gastos públicos do grupo de países de renda alta. Conclui-se, ainda, que a política econômica dos governos FHC e Lula seguiu as orientações de política econômica indicadas pelas agências de crédito - entre elas o compromisso com o pagamento da dívida -consubstanciadas nos documentos dos acordos de empréstimos condicionados, e quando verificado o comportamento dos pagamentos da dívida externa dos empréstimos contraídos pelo Governo Federal para investimentos no setor saúde.

Construction of Economical Mode of Health-economy Management with Scientific Developing View / 医疗卫生装备

The important meaning of the construction of an economical-type mode of health economy management is expounded, and the measure and principle of it should be taken and followed. This management mode can relieve the social problem of "high expense and difficulties in medieine.

Evaluación de los sistemas de salud: estudio multivariante del logro en salud en los países europeos / Evaluation of the health systems: multivariant study of the profit in health in the European countries

La mayoría de países del mundo dedica un alto porcentaje de su presupuesto al sistema sanitario, y este porcentaje crece año tras año. Cobrando así, cada vez más importancia la evaluación de los sistemas sanitarios y su desempeño. El objetivo de este estudio es determinar las principales variables socioeconómicas que influyen sobre la esperanza de vida ajustada por discapacidad (EVAD) en los países europeos. Se han tomado 16 variables de carácter social, económico, sanitario y medioambiental, para los periodos de 2003 y 2004 en 22 países europeos. La información de de las 15 variables explicativas ha sido trasformada mediante un análisis factorial. Con el análisis de regresión, se ha obtenido la relación entre la EVAD y el resto de variables explicativas. Por último se ha realizado una agrupación de los países mediante un análisis cluster.

The majority of the countries in the world dedicate a high percentage of their budget to their Health Care System. In addition, this percentage grows year by year. For that reason, theHealth Care evaluation and its repercussion in the improvement of the population health are very important. The aim of this paper is to determine the mean socioeconomic variables thatinfluence the healthy life expectancy in the european countries. Taking 16 variables of social, economic, sanitary and environmental character, for the periods 2003 and 2004 in 22 europeancontries. The information of the 15 variables is transformed by a factorial analysis. The relation between the variables and the healthy life expectancy by means of a regression analisys. And a classification of the countries is made using the analysis cluster.