Julio Aristegui Villamil: el médico de los pobres / Julio Aristegui Villamil: the Physician of the Poor

Julio Miguel Aristegui Villamil se gradúa de Doctor en Medicina en la Universidad de La Habana en 1929 y regresa a Cárdenas, su ciudad natal, a ejercer su profesión. Sus ideas progresistas lo afilian a la Izquierda Médica, dentro de la Federación Médica de Cuba. Por el ejercicio desinteresado de su profesión la población le llega a nombrar "el médico de los pobres" (AU).

Julio Miguel Aristegui Villamil graduated as doctor in Medicine in the University of Havana in 1929 and came back to Cardenas, his home city, to practice his profession. His progressive ideas led him to enroll in the Izquierdad Médica (Medical Left translated in English), a group inside the Medical Federation of Cuba. Because of the selfless practice of his profession, the people began to call him "the doctor of the poors" (AU).

Avaliação econômica das anticitocinas adalimumabe, etanercepte e infliximabe no tratamento da artrite reumatoide no Estado do Paraná / Economic evaluation of anticitokines adalimumab, etanercept and infliximab for treatment of rheumatoid arthritis in Paraná State, Brazil

Este estudo objetivou realizar uma avaliação econômica das anticitocinas adalimumabe (ADA), etanercepte (ETA) e infliximabe (IFX) para o tratamento da artrite reumatoide no Estado do Paraná, sob a perspectiva do SUS. Os dados de eficácia e segurança dos tratamentos foram buscados na literatura, e os custos foram calculados com valores gastos pelo SUS para cada um dos tratamentos. Foi elaborado o modelo de Markov para obter a relação custo-efetividade de cada tratamento. A relação custo-efetividade incremental (ICER) comparado ao tratamento padrão também foi calculada para cada anticitocina. Análises de sensibilidade e taxas de desconto foram aplicadas. Na avaliação custo-efetividade, encontraram-se custos por QALY de R$ 511.633,00, R$ 437.486,00 e R$ 657.593,00 para ADA, ETA e IFX, respectivamente. O ICER por QALY foi R$ 628.124,00, R$ 509.974,00 e R$ 965.927,00 para ADA, ETA e IFX, respectivamente. Nas análises de sensibilidade, o ETA e o ADA apresentaram valores próximos. Cabe aos gestores públicos e aos médicos prescritores a escolha adequada para cada paciente, entre os tratamentos disponibilizados.

This study aimed to perform an economic evaluation of anticytokines adalimumab (ADA), etanercept (ETA) and infliximab (IFX) for the treatment of rheumatoid arthritis in the State of Parana, in Brazil, in the perspective of the Brazilian Unified Health System. Data on efficacy and safety of treatment were collected in literature, and costs were calculated on the amounts spent by the Government for each treatment. A Markov model was performed to get the cost-effectiveness of each treatment. The incremental cost-effectiveness relationship (ICER) compared to a standard treatment was also calculated for each anticytokine. Sensitivity analysis and discount rates were applied. In assessing cost-effectiveness we found the following values (cost at R$ per QALY): 511,633.00, 437,486.00 and 657,593.00 (respectively for ADA, ETA and IFX). The ICER (R$ per QALY) was 628,124.00, 509,974.00 and 965,927.00 (for ADA, ETA and IFX). In the sensitivity analysis, ETA and ADA showed similar values. It is for public managers and physicians the choice for each patient, among the treatments available.

Fraturas do fêmur proximal no idoso: estudo de custo da doença sob a perspectiva de um hospital público no Rio de Janeiro, Brasil / Hip fractures in the elderly: cost of illness study in a public hospital perspective, Rio de Janeiro, Brazil

O artigo visa a estimar o custo direto médico do tratamento hospitalar de pacientes idosos com fraturas de fêmur proximal, no Hospital Municipal Lourenço Jorge, na cidade do Rio de Janeiro. Estudo observacional, prospectivo, para estimar a utilização de recursos e custos diretos médicos associados à hospitalização por fratura de fêmur proximal em idosos, em 2007 e 2008, sob a perspectiva do prestador de serviços. Foi utilizado um instrumento de coleta de dados através do qual foram registrados recursos identificados na revisão prospectiva dos prontuários. Aos recursos utilizados foram atribuídos custos em reais (R$) baseando-se em valores do ano 2010. Foram realizadas análises descritivas dos custos e utilização de recursos, bem como avaliada a associação de variáveis clínicas e demográficas com o custo final observado. Foram incluídos 82 pacientes, 81,7 por cento do sexo feminino, idade média de 76,96 anos, hospitalização média de 12,66 dias. A mediana de custo por paciente foi de R$ 3.064,76 (IC95 por cento: 2.817,63 a 3.463,98). Hospitalização clínica e procedimento cirúrgico foram responsáveis por 65,61 por cento e 24,94 por cento dos custos, respectivamente. Pacientes submetidos ao tratamento cirúrgico até o quarto dia de hospitalização apresentaram mediana de custos menor do que pacientes submetidos após o quarto dia (R$ 2.136,31 e R$ 3.281,45, p<0,00001). Observou-se também diferença significativa nos custos finais por tipo de procedimento cirúrgico realizado. O custo do tratamento das fraturas de fêmur proximal no idoso foi significativamente maior nos pacientes submetidos à cirurgia após o quarto dia de hospitalização. Hospitalização clínica e procedimento cirúrgico foram os principais componentes do custo final observado.

This paper aims to assess direct medical costs associated to hospital treatment of hip fractures in the elderly in the Municipal Hospital Lourenço Jorge (HMLJ), Rio de Janeiro. Observational, prospective study to assess resource utilization and direct medical costs associated to elderly hip fracture hospitalization in 2007 and 2008, under the health care provider perspective. A standard data collection instrument was used to register identified resources during prospective medical charts review. The resource utilization was converted into Brazilian Real (R$), based on 2010 prices. Descriptive analysis of costs and resource utilization and their association with clinical and demographic variables were performed. Eighty two patients were included, 81.7 percent female, mean age of 76.96 years, hospitalization mean time of 12.66 days. Median total costs per patient were R$ 3,064.76 (IC95 percent: 2,817.63 - 3,463.98). Clinical hospitalization and surgical procedure were responsible for 65.61 percent and 24.94 percent of costs, respectively. Median costs for patients submitted to surgical procedure until the fourth day of hospitalization were lower than median costs for patients submitted after the fourth day (R$ 2,136.45 and R$ 3,281.45, respectively, p<0.00001). A significant difference in average costs per type of surgical procedure was also observed. Cost associated to inpatient treatment of hip fractures in the elderly was higher in patients who performed surgery after the fourth day of hospitalization. Clinical hospitalization and surgical procedure were the main cost components observed.

Economía y salud / Economy and health

La salud y su cuidado tienen un impacto económico significativo tanto en el plano individual-familiar como en el nivel estatal. En virtud del progreso constante de la Medicina, así como de los costos inherentes de la investigación que posibilita dicho progreso, junto con una declinación del ingreso de recursos, los sistemas de salud han entrado globalmente en una crisis que amenaza su viabilidad a largo plazo. Los más difundidos, basados en el principio de terceros pagadores, si bien lograron mejorar el acceso a la atención para una gran proporción de la población, trasladaron el impacto de su crisis de viabilidad económica a la calidad de la atención que reciben los pacientes, en un intento de contener los costos asistenciales. Esta visión excesivamente simplista ha llevado a un serio deterioro de un aspecto primario e irresignable de la atención como es la relación médico-paciente. La metodología farmacoeconómica ofrece un enfoque más racional, aunque con resultados a mediano y largo plazo, consistente en desarrollar medios para incrementar la eficiencia en el uso (asignación) de los recursos disponibles. El análisis F-E genuino, sin embargo, debe basarse en outcomes válidos provenientes de evidencia de calidad y de considerar la totalidad de los costos, incluso los "ocultos" y los "intangibles", aún cuando manifiesta o tácitamente sean asumidos por los pacientes o la sociedad en su conjunto. Por el contrario, soslayarlos no los hará desaparecer y cualquier recomendación surgida de tal análisis estará viciada de invalidez. Los médicos ya no pueden permanecer ajenos a las consecuencias económicas del ejercicio de su profesión. Conocer y mantener actualizadas las normas aceptadas de diagnóstico y tratamiento de las enfermedades más prevalentes de su práctica debe incluir la confrontación F-E de las mismas para saber si representan verdaderamente la mejor alternativa a ofrecer a los pacientes y la comunidad.

Health care has a major economic impact both at individual and social/government levels. Due to the constant advance in medical science, along with the inherent increase in costs and declining resources, health care systems face a long-term viability crisis. With the aim of cost-containment, the more widely accepted systems -based in the third party payers principle- have brought their economic viability crisis to the quality level of the patient assistance. This oversimplified view affected seriously to the physician-patient relationship, such a very basic and irreplaceable aspect of the medical assistance. F-E offers a more rational approach, even taking in account its medium and long-term results, based in development of ways to improve efficiency in use of available resources. A genuine F-E analysis should be based on validated, high-quality outcomes evidence and consider costs as a whole, including "hidden" and "intangibles". Even though patients or the society frequently affords these ones. In the opposite, "forgetting" them will not make to disappear and any guide or recommendation based on such analysis should be considered non-valid. Doctors cannot remain away from the economic consequences of their activity. In addition to knowledge and updating of modern and proven diagnostic or therapeutic guidelines of each specialty, they must be challenged by the specific F-E approach in order to establish if truly represent the "gold standard option" to offer patients and the Community as a whole.

Economics of health care: an ethical dilemma

Health care has become a lucrative business where firms enter the market to earn exorbitant amount of money. In this article we have made an attempt to highlight the inequitable Agency relation governing interaction between patients and health care providers. In the absence of any robust legal frame work, patients with mental illness are at risk of exploitation and abuse

Costos de la atención de infección respiratoria aguda, parasitosis, infecciónde vías urinarias y desnutrición en el servicio de pediatría del Hospital José María Velasco Ibarra, Provincia Napo, 1997 / Cost of respiratory infection, acute diarrheic illness, parasitosis, urinary tract infection and malnutrition treatment. In the Velasco Ibarra Hospital Pediatric Service, Napo Province, 1997

Dentro del proceso de reforma del sector salud se ha creado la necesidad de desarrollar sistemas de información contable que permitan establecer sistemas de control tomando en consideración los escasos recursos financieros.La presente investigación que se la efectuó en la provincia del Napo en su capital Tena, Caso: Hospital Provincial Velasco Ibarra pretendió conocer cúanto le cuesta la atención institucional, por servicio y por paciente atendido y Hospitalizado por Infección Respiratoria Aguda, Infección Diarréica Aguda, parasitosis, Infección de Vías Urinarias y Desnutrición, siendo estas partologías las más freceuntes en el servicio de Pediatría