ABSTRACT
Background: Efficiency in the use ofresources in health systems and hospitals has been a matter ofinterestfor administrators as well asforpolicy makers. The growing costs due to higher levéis of demand from the population require a better use and allocation ofsuch costs. Aim: To assess the technical efficiency in 28 hospitals in Chile, considering the period from May to October, 2011. Material and Methods: The average number ofavailable beds, the number ofstaffand the expenses on consumer and service goods were used as production inputs and, on the other hand, the expenditures adjusted by the Diagnosis-Related Groups (IR-DRG) were used as producís. To assess the technical efficiency, the Data Envelopment Analysis technique was used. Results: The levéis of inefficiency fluctuóte from 20 to 23.3%. In other words, with a 20% increase in hospital discharges and maintainingfixed inputs, hospitals could become efficient. Conclusions: The incorporation of methodologies to determine efficiency allows gathering new knowledge for people who manage resources as well asforpolicy makers by optimizing practices and having better allocation criteria.
Subject(s)
Humans , Efficiency, Organizational/standards , Health Care Rationing/statistics & numerical data , Health Resources/statistics & numerical data , Hospitals/standards , Benchmarking , Chile , Diagnosis-Related Groups , Efficiency, Organizational/statistics & numerical data , Health Care Rationing/standards , Health Resources/standards , Hospitals/statistics & numerical data , Models, Theoretical , Quality of Health Care/statistics & numerical dataABSTRACT
A garantia do direito à assistência farmacêutica no ordenamento jurídico brasileiro a partir da Constituição de 1988 deu vazão a um aumento das demandas judiciais para efetivação desse direito. Esse fenômeno vem sendo chamado de judicialização da assistência farmacêutica. Estudos sobre o tema têm revelado tanto deficiências no acesso dos usuários do Sistema Único de Saúde aos medicamentos das listas oficiais de assistência farmacêutica como dificuldades do sistema de justiça e do próprio procedimento judicial para lidar com a temática. Este artigo discute essas questões considerando o arcabouço conceitual que informa a política de medicamentos e a política de assistência farmacêutica brasileiras, sobretudo os conceitos de medicamentos essenciais e de alocação de recursos escassos.
The guarantee of pharmaceutical care as a legal right established by the Brazilian federal constitution of 1988 led to an increase in lawsuits to put that right into practice. This phenomenon has been dubbed the judicialization of pharmaceutical care. Studies on this topic have revealed, on the one hand, deficiencies in the access of Unified Health Care (SUS) users to drugs included in Ministry of Health pharmaceutical care lists, and, on the other hand, limitations of the legal system to deal with the situation. The present article addresses these issues in the context of the conceptual framework that supports the Brazilian drug policy and pharmaceutical care policy, especially the notions of essential drugs and allocation of scarce resources.
Subject(s)
Humans , Drugs, Essential/supply & distribution , Health Services Accessibility/legislation & jurisprudence , Legislation, Drug , National Health Programs/legislation & jurisprudence , Patient Rights/legislation & jurisprudence , Pharmaceutical Services/legislation & jurisprudence , Brazil , Constitution and Bylaws , Developing Countries , Health Care Rationing , Health Care Rationing/legislation & jurisprudence , Health Care Rationing/standards , Health Policy , Health Services Accessibility , Models, Theoretical , Pharmaceutical Services/supply & distribution , Pharmacopoeias as Topic , Resource Allocation , Resource Allocation/legislation & jurisprudence , Resource Allocation/standards , Social Justice/legislation & jurisprudence , Social Justice/standardsABSTRACT
Diversos factores participan como determinantes en el aumento sostenido de los costos de atención de la salud, lo que ha obligado a los gobiernos de todos los países del mundo a priorizar la asignación de los recursos disponibles entre diversas opciones de gasto en salud. Ante esta situación es de suma importancia lograr una mayor eficiencia en la aplicación de los recursos existentes. En este artículo se presentan los pasos básicos para la realización de evaluaciones económicas en salud, escasas aún en Cuba, con el objetivo de contribuir a su mejor comprensión. Se profundiza en dos de las acciones específicas de este tipo de estudio: la identificación de opciones de comparación y el análisis de resultados. A pesar del paso de avance dado en el campo metodológico con la Guía de Evaluación Económica en Salud cubana todavía se debe insistir en el rigor metodológico de este tipo de estudios
A number of factors are involved as determinants in the sustained increase of health care costs, all of which has forced the governments worldwide to prioritize the allocation of the available resources among several health expenditure choices. In the face of this situation, it is extremely important to achieve higher efficiency in the use of existing resources. This paper presented the basic steps to make health economic assessments, still very limited in Cuba, in order to contribute to a better understanding. It delved into two specific actions of this type of study, that is, identification of comparison options and analysis of results. Despite the step forward represented by the Cuban Health Economic Assessment Guideline in the methodological field, it is necessary to insist on the methodological rigor that this type of studies must have
Subject(s)
Health Care Rationing/methods , Health Care Rationing/standards , Health Care Costs/standardsABSTRACT
O artigo avalia como a descentralização dos recursos e ações do Programa Nacional de DST e AIDS influenciou as transferências de recursos para os programas de prevenção ao HIV/AIDS entre usuários de drogas injetáveis no Rio de Janeiro, Brasil (1999-2006). Foram avaliados os efeitos da política de descentralização sobre as transferências de recursos para os Programas de Redução de Danos (PRD) no Rio de Janeiro. A descentralização das transferências para os PRD no Rio de Janeiro se efetivou em 2006, com a virtual supressão do financiamento federal direto, obrigando estes programas a buscarem fontes alternativas de financiamento. Constata-se uma fragilidade dos PRD no Estado, agravada pela redução recente do volume de recursos. Dos 22 programas, existentes em 2002, o Estado passou a contar, em 2006, com apenas dois programas, financiados pelo Estado e por um município. A descontinuidade dessas ações pode vir a favorecer a reemergência da epidemia de AIDS nesta população, o que reclama um processo de descentralização mais gradual e melhor pactuado dessas iniciativas.
This paper assesses how decentralization of resources and initiatives by the Brazilian National SDT/AIDS Program has impacted the transfer of funds for programs to prevent HIV/AIDS among injecting drug users in Rio de Janeiro, Brazil (1999-2006). The effects of the decentralization policy on Rio de Janeiro's Syringe Exchange Programs (SEPs) are assessed in detail. Decentralization effectively took place in Rio de Janeiro in 2006, with the virtual elimination of any direct transfer from the Federal government. The elimination of direct transfers forced SEPs to seek alternative funding sources. The structure of local SEPs appears to be weak and has been further undermined by current funding constraints. Of 22 SEPs operating in 2002, only two are still operational in 2006, basically funded by the State Health Secretariat and one municipal government. The current discontinuity of SEP operations may favor the resurgence of AIDS in the IDU population. A more uniform, regulated decentralization process is thus needed.
Subject(s)
Humans , Harm Reduction , HIV Infections/prevention & control , Health Care Rationing/economics , National Health Programs/standards , Program Evaluation , Public Policy , Acquired Immunodeficiency Syndrome/economics , Acquired Immunodeficiency Syndrome/prevention & control , Brazil , Delivery of Health Care/standards , Financing, Government , Health Care Reform , Health Plan Implementation , HIV Infections/economics , Health Care Rationing/standards , Needle-Exchange Programs/economics , Needle-Exchange Programs/standards , Policy Making , Substance Abuse, Intravenous/prevention & controlABSTRACT
Reflexão sobre a forma de distribuição dos recursos públicos na área de saúde e as conseqüências decorrentes. Questiona-se a eqüidade da justiça distributiva. Propõe-se uma leitura contextual dos números oficiais, através de inter-relações que possibilitem a compreensão do significado das cifras governamentais. AIDS e Diabetes, escolhidas como paradigmas, representam, respectivamente, os grupos das Doenças Transmissíveis e das Não Transmissíveis. Os números oficiais relativos às duas doenças estão correlacionados em alguns aspectos pontuais: gastos com medicamentos, prevalência, evolução de taxas de mortalidade. Alerta-se para as diferenças de atenção oficial marcantes entre as duas doenças e para as conseqüências sofridas por pessoas atingidas por Diabetes e por outras doenças não transmissíveis, decorrentes da insuficiência de recursos públicos destinados ao seu atendimento.
Reflection about the way of distributing public resources in the area of health and the ensuing consequences. The fairness of distributive justice is questioned. We propose a contextual reading of the official figures through interrelations that make it possible to understand the meaning of government figures. AIDS and Diabetes, which have been chosen as paradigms, represent, respectively, the groups of Transmitted Diseases and Non-Transmitted Diseases. The official figures relating to the two diseases are correlated in some precise aspects such as expenses on drugs, prevalence, and evolution of mortality rates. We alert to the remarkable differences in official attention between these two diseases and to the consequences suffered by people affected with Diabetes and other non-transmitted diseases, arising from the insufficiency of public resources allotted for their health care.
Reflexión sobre la forma de distribución de los recursos públicos en el área de salud y las consecuencias provenientes. Se cuestiona la equidad de la justicia distributiva. Se propone una lectura contextual de los números oficiales, a través de interrelaciones que posibiliten la comprensión del significado de las cifras gubernamentales. SIDA y Diabetes, escogidas como paradigmas, representan, respectivamente, los grupos de las Enfermedades Transmisibles y de las No Transmisibles. Los números oficiales relativos a dos enfermedades están correlacionados en algunos aspectos puntuales: gastos con medicamentos, prevalencia, evolución de tasas de mortalidad. Se alerta para las diferencias de atención oficial fuertes entre las dos enfermedades y para las consecuencias sufridas por personas acometidas por Diabetes y por otras enfermedades no transmisibles, provenientes de la insuficiencia de recursos públicos destinados a su atención.
Subject(s)
Humans , Acquired Immunodeficiency Syndrome/economics , Diabetes Mellitus/economics , Health Care Rationing/standards , Resource Allocation/standards , Acquired Immunodeficiency Syndrome/drug therapy , Acquired Immunodeficiency Syndrome/epidemiology , Brazil/epidemiology , Cost of Illness , Diabetes Mellitus/drug therapy , Diabetes Mellitus/epidemiologyABSTRACT
This study focuses on equity in health and specifically the geographic distribution of financial resources. The author reviews the main contemporary theories of social justice and discusses the concept of equity in general and specifically in the health field. Based on the discussion of selected international experiences (United Kingdom, Spain, and Italy), the Resource Allocation Working Party (RAWP) formula used in the United Kingdom is identified as the most adequate distributive methodology, sizing the relative needs based on the population's demographic and epidemiological profiles. Finally, the results are presented from a simulation performed for the Brazilian case, showing that a more equitable geographic distribution of financial resources would require a redistribution favoring the States of the North and Northeast. The article concludes by highlighting that a comparison of actual fund outlays by the Ministry of Health in 1994 and the results of the simulation with the RAWP methodology for the Brazilian case show that the principles written into Brazilian legislation were absent from the geographic distribution of financial resources.
Subject(s)
Female , Humans , Male , Health Services Accessibility/economics , Health Care Rationing/economics , Social Justice , Brazil , Health Care Rationing/standards , Europe , Health Policy , National Health Programs , Socioeconomic Factors , United KingdomABSTRACT
Diferencias crecientes en la salud entre y dentro de los países están relacionadas con las diferencias de ingreso y status que persisten y se acentúan a pesar del crecimiento económico. Se define inequidad como toda diferencia evitable en el nivel de salud que es considerada como injusta. Se distingue la equidad en la atención de salud de la equidad en el nivel de salud de la población. En la primera preocupa que la distribución de los recursos asignados a la atención médica sea orientada según necesidades de la población, localizando según vulnerabilidad y capacidad de pago. La máxima es ofrecer igual acceso e igual tratamiento a igual necesidad. Se discuten herramientas técnicas para lograrlo. Equidad en la atención en salud no permite alcanzar equidad en el nivel de salud. Tampoco la superación de la pobreza o la modificación de estilos de vida. Menores tasas de mortalidad de distintos grupos sociales no se relacionan con la riqueza total sino con una mejor distribución del ingreso al interior de la sociedad. A mayor distancia entre los grupos sociales, menor inversión en capital social, lo cual a su vez determinaría una menor cohesión social, factor determinante en el progreso de las naciones
Subject(s)
Humans , Health Services Accessibility/trends , Consumer Behavior , Health Care Rationing/standards , Health Services Needs and Demand/trends , Health Status , Health Policy/trends , Poverty/trends , Delivery of Health Care/economicsABSTRACT
Centrando suas observaçöes nos anos 80, confronta as necessidades da sociedade com as açöes do Estado na área da saúde. Percebe desperdício de recursos e várias situaçöes propensas à geraçäo de crises nas organizaçöes, setores e instituiçöes do subsistema de saúde brasileiro. Propöe um método de alocaçäo de recursos federais, objetivando minimizar desigualdades entre as Unidades da Federaçäo, a partir de seus desempenhos na área de saúde
Subject(s)
Humans , Male , Female , Healthcare Financing , Health Policy , Health Services Needs and Demand , Health Systems/organization & administration , Brazil , Health Care Rationing/standards , Government , Health Care Economics and Organizations , Health Status Indicators , Poverty , Public Administration , Social Conditions , Social SecurityABSTRACT
Tenta demonstrar que o método CENDES/OPS poderia ser classificado como uma técnica pertencente ao conjunto chamado de avaliaçöes econômicas. Sua diferença residiria näo na técnica, mas no desenho do uso da mesma e no papel de quem as executa, no da tomada de decisäo, sobre a formulaçäo de planos e alocaçäo de recursos em saúde