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1.
Rev. argent. salud publica ; 14: 1-7, 20 de Enero del 2022.
Article in Spanish | LILACS, BINACIS, ARGMSAL | ID: biblio-1361917

ABSTRACT

INTRODUCCIÓN: La protección financiera en salud implica que todas las personas accedan a los servicios de salud que necesiten sin sufrir dificultades financieras para pagarlos. Dicha protección se estima mediante indicadores como el gasto catastrófico y empobrecedor en salud. El trabajo tuvo por objetivo estimar esos indicadores para Argentina en el período 2017-2018. MÉTODOS: Se construyeron y analizaron las variables del gasto en salud y los indicadores de gasto catastrófico y empobrecedor en salud a través del procesamiento de la Encuesta Nacional de Gastos de los Hogares (ENGHo) de 2017-2018. Asimismo, se realizó una comparación con la ENGHo 2004-2005. RESULTADOS: Los hogares destinaron un 6,4% del gasto total a bienes y servicios de salud, y un 4,9% del ingreso total. Según la ENGHo 2017-2018, el 11,4% y el 3,3% de los hogares del país incurrió en gasto catastrófico en salud para umbrales del 10% y 25% del gasto total del hogar, respectivamente. Respecto al período 2004- 2005, el indicador cayó con cualquier umbral utilizado. Por su parte, como consecuencia del gasto de bolsillo en salud, los hogares considerados pobres aumentaron en 1,8 puntos porcentuales. DISCUSIÓN: La caída del gasto catastrófico entre los dos períodos en análisis podría exponer un avance en la protección financiera del país. El análisis revela la importancia de contar con datos sobre necesidad, utilización y gasto en servicios de salud de manera simultánea para lograr una mejor comprensión de esta problemática.


Subject(s)
Health Expenditures , Financial Risk Protection , Catastrophic Health Expenditure , Impoverishing Health Expenditure
2.
Ciênc. Saúde Colet ; 27(1): 325-334, jan. 2022. tab
Article in Portuguese | LILACS | ID: biblio-1356048

ABSTRACT

Resumo O objetivo deste estudo foi avaliar os gastos catastróficos em saúde (GCS) e sua associação com condições socioeconômicas nos anos de 2009, 2011 e 2013 em Minas Gerais. Realizou-se um estudo transversal com dados da Pesquisa por Amostra de Domicílios. A variável dependente foi o GCS, em cada ano da pesquisa. Foram considerados catastróficos os gastos que ultrapassaram os limites de 10% e 25% da renda familiar. A associação entre o gasto catastrófico e as variáveis independentes foi testada por meio de regressão de Poisson. As prevalências de GCS variaram de 9,0% a 11,3% e 18,9% a 24,4% nos limites de 10% e 25%, sendo que o ano de 2011 apresentou os menores valores. A maior proporção dos gastos com saúde (94%) foi relativa aos gastos com medicamentos. A prevalência de CGS foi menor entre responsáveis pelo domicílio com maior escolaridade quando comparados àqueles sem estudo nos limites de 10% e 25%. Famílias com maior escore de riqueza apresentaram, nos dois limites, prevalência de GCS menores do que aquelas do primeiro quintil. Concluiu-se que os gastos com saúde afetaram significativamente o orçamento das famílias em Minas Gerais, sendo o gasto com medicamentos o principal componente dos gastos. Os achados reforçam o papel do SUS para minimizar o GCS e reduzir as desigualdades socioeconômicas.


Abstract This study aimed to assess catastrophic health expenditures (CHE) and its association with socioeconomic conditions in 2009, 2011 and 2013 in Minas Gerais, Brazil. A cross-sectional study was carried out with data from the Household Sample Survey. The dependent variable was the CHE in each year of the survey. Expenditures that exceeded 10% and 25% of household income were considered catastrophic. The association between catastrophic health expenditure and independent variables was tested by the Poisson regression. The prevalence of CHE ranged from 9.0% to 11.3% and 18.9% to 24.4% within the limits of 10% and 25%, and 2011 recorded the lowest values. The largest proportion of health expenditure (94%) was related to the acquisition of medicines. The prevalence of CHE was lower among those responsible for the household with 12 or more years of study than those with no formal education. Households with a higher wealth score had, in both limits, lower prevalence of CHE than those of the first quintile. We concluded that health expenditures significantly affected the budget of households in Minas Gerais and the purchase of medicines was the main component of spending. The findings reinforce the role of the Brazilian Unified Health System (SUS) in minimizing CHE and reducing socioeconomic inequalities.


Subject(s)
Humans , Catastrophic Illness , Health Expenditures , Socioeconomic Factors , Brazil/epidemiology , Cross-Sectional Studies , Surveys and Questionnaires
3.
Cad. Saúde Pública (Online) ; 38(3): e00354320, 2022. tab, graf
Article in Portuguese | LILACS | ID: biblio-1364638

ABSTRACT

Estudos com edições anteriores da Pesquisa de Orçamentos Familiares (POF) indicam que, no Brasil, pagar um plano de saúde aumenta o percentual da renda gasto com saúde e não reduz a probabilidade de ter gastos excessivos com saúde. Descrevem-se relações entre gastos com planos de saúde, renda e faixas etárias, destacando o efeito de ter plano sobre a probabilidade de comprometer mais de 40% da renda com despesas relacionadas à saúde. Análise de microdados da POF 2017/2018 para determinar o comprometimento da renda domiciliar per capita dos pagantes de planos por faixa etária e por tipo de plano, e regressão logística para fatores associados a comprometer mais de 40% da renda com despesas de saúde. Em 12 meses, R$ 78,1 bilhões foram gastos com planos médicos por 22,1 milhões de pessoas. O comprometimento da renda com planos individuais aumenta consistentemente com a idade, passando de 4,5% da renda domiciliar per capita (< 19 anos) para 10,6% dessa renda (79 anos ou mais). A probabilidade de comprometer mais de 40% da renda com despesas de saúde diminui com a renda, cresce com a idade e é maior para quem paga plano de saúde. A despesa apenas com os planos supera 40% da renda domiciliar per capita para 5,6% das pessoas com 60 anos ou mais que pagam planos individuais e para 4% das que pagam planos empresariais. As pessoas nas faixas de idade mais altas e faixas de renda mais baixas são as com maior probabilidade de comprometer mais de 40% da renda com despesas de saúde. Rever as regras de reajuste por idade dos planos é uma alternativa para tentar mitigar esse problema.


According to studies using previous editions of the Household Budgets Survey (POF) in Brazil, paying for a healthcare plan increases the percentage of income spent on health and fails to reduce the probability of incurring excessive health expenditures. The study's objective was to describe relations between expenditures on healthcare plans, income, and age groups, highlighting the effect of having a plan on the probability of committing more than 40% of income on health-related expenditures. An analysis of the POF 2017/2018 determined the commitment of per capita household income for payers of plans by age group and type of plan and logistic regression for factors associated with committing more than 40% of income to health-related expenditures. In 12 months, 22.1 million Brazilians spent BRL 78.1 billion on private medical insurance. The share of income spent on individual plans increases consistently with age, from 4.5% of per capita household income (at < 19 years) to 10.6% of this income (at 79 years or older). The probability of committing more than 40% of income to health expenditures decreases with income, increases with age, and is higher for those paying for health plans. Spending on healthcare plans alone exceeds 40% of per capita household income for 5.6% of Brazilians 60 years or older who pay for individual plans and for 4% of those who pay for company plans. Persons in the oldest age groups and in the lowest income brackets show the highest likelihood of spending more than 40% of their income on healthcare. A revision of the plans' adjustment by age is an alternative for attempting to mitigate this problem.


Estudios con ediciones anteriores de la Encuesta de Presupuestos Familiares (POF) indican que, en Brasil, pagar un plan de salud aumenta el porcentaje de la renta gastado con salud y no reduce la probabilidad de tener gastos excesivos con la salud. El objetivo fue describir las relaciones entre gastos con planes de salud, renta y franjas de edad, destacando el efecto de tener un plan sobre la probabilidad de comprometer más de un 40% de la renta con gastos relacionados con la salud. Se realizó un análisis de microdatos de la POF 2017/2018 para determinar el comprometimiento de la renta domiciliaria per cápita de los pagadores de planes por franja etaria y por tipo de plan, así como una regresión logística para factores asociados con comprometer más de un 40% de la renta con gastos de salud. En 12 meses, BRL 78,1 mil millones se gastaron con planes médicos por 22,1 millones de personas. El comprometimiento de la renta con planes individuales aumenta consistentemente con la edad, pasando de 4,5% de la renta domiciliaria per cápita (< 19 años) al 10,6% de esa renta (79 años o más). La probabilidad de comprometer más de un 40% de la renta con gastos de salud disminuye con la renta, crece con la edad y es mayor para quien paga un plan de salud. El gasto solo con los planes supera un 40% de la renta domiciliaria per cápita para un 5,6% de las personas con 60 años o más que pagan planes individuales y para un 4% de los que pagan planes empresariales. Las personas en las franjas de edad más altas y franjas de renta más bajas son las que tienen mayor probabilidad de comprometer más de un 40% de la renta con gastos de salud. Revisar las reglas de reajuste por edad de los planes es una alternativa para intentar mitigar ese problema.


Subject(s)
Humans , Adult , Young Adult , Budgets , Health Expenditures , Poverty , Brazil , Income
4.
Cad. Saúde Pública (Online) ; 38(1): e00311620, 2022. tab, graf
Article in English | LILACS | ID: biblio-1355971

ABSTRACT

This study aimed to analyze part of the financial resources used to fund public health actions in the 26-Brazilian capitals, from 2008 to 2018. This is a time-trend ecological study involving revenue and expenditure indicators provided by the Information System on Public Budget for Health (SIOPS). The values were deflated based on the Extended National Consumer Price Index of 2018 in Brazil to allow the comparison over the years. The mean annual variation of health investments, in Brazilian Reais (BRL) was assessed using linear regressions. Pearson's correlation coefficients were estimated between federal revenues and expenditures with the capitals' resources. All capitals presented statistically significant positive correlations for the origin of the budget resource invested in health. The lowest coefficient was found in the capital city of Macapá (Amapá State) (r = 0.860) and the highest, in Fortaleza (Ceará State) (r = 0.997). Belo Horizonte (Minas Gerais State) was the capital with the highest annual increase in federal transfers (about BRL 67.91 per year) and Teresina (Piauí State) presented the highest annual increase in health expenditures among the capitals (about BRL 55.42 per year). We found a increase in the transfers of the Brazilian Unified National Health System (SUS) and municipal resources in almost all capitals, but there are still inequalities in the distribution of financial resources among Brazilian capitals from different regions. Health funding is affected by the municipalization of SUS and it is not the single factor affecting the access and quality of health services.


O estudo teve como objetivo analisar parte dos recursos utilizados para financiar ações de saúde pública nas 26 capitais brasileiras entre 2008 e 2018. O estudo ecológico de tendências temporais envolveu indicadores de receitas e gastos fornecidos pelo Sistema de Informação sobre Orçamento Público em Saúde (SIOPS). Os valores foram deflacionados com base no Índice de Preços ao Consumidor Amplo de 2018 no Brasil para permitir a comparação ao longo dos anos. A variação anual média dos investimentos em saúde, em Reais (BRL), foi avaliada com o uso de regressões lineares. Os coeficientes de correlação de Pearson foram estimados entre as receitas e gastos federais com os recursos das capitais. Todas as capitais apresentaram correlações estatisticamente positivas com a origem do recurso orçamentário investido em saúde. O menor coeficiente foi encontrado na cidade de Macapá (Amapá) (r = 0,860), e o mais alto em Fortaleza (Ceará) (r = 0.997). Belo Horizonte (Minas Gerais) foi a capital com o maior aumento anual em transferências federais (cerca de BRL 67,91 por ano) e Teresina (Piauí) apresentou o maior aumento anual nos gastos em saúde (cerca de BRL 55,42 por ano). Houve um aumento real nas transferências no Sistema Único de Saúde (SUS) e nos recursos municipais em quase todas as capitais, mas ainda persistem desigualdades na distribuição dos recursos financeiros entre as capitais brasileiras das cinco regiões. O financiamento da saúde é afetado pela municipalização do SUS, e não é o único fator que afeta o acesso e a qualidade dos serviços de saúde.


El objetivo fue analizar la parte de recursos financieros utilizados para financiar acciones de salud públicas en 26 capitales brasileñas, entre 2008 y 2018. Se trata de un estudio ecológico de tendencia temporal, implicando indicadores de ingresos y gastos proporcionados por el Sistema de Información sobre el Presupuesto Público para Salud (SIOPS). Se deflactaron los valores basados en el Índice de Precios al Consumidor, ampliado de 2018 en Brasil, para permitir la comparación a lo largo de los años. La variación anual media de inversiones en salud, en Reales brasileños (BRL), fue evaluada usando regresiones lineales. Se estimaron los coeficientes de correlación de Pearson entre los ingresos y gastos federales, respecto a los recursos de las capitales. Todas las capitales presentaron estadísticamente correlaciones positivas significativas respecto a la fuente presupuestaria originaria invertida en salud. El coeficiente más bajo se encontró en la capital de Macapá (Amapá) (r = 0.860) y el más alto en Fortaleza (Ceará) (r = 0.997). Belo Horizonte (Minas Gerais) fue la capital con el incremento anual más alto en transferencias federales (cerca de BRL 67.91 por año) y Teresina (Piauí) presentó el incremento anual más alto en gastos de salud entre todas las capitales (sobre BRL 55.42 por año). Hubo un incremento real de transferencias en el Sistema Único de Salud brasileño (SUS), así como recursos municipales en casi todas las capitales, pero existen todavía inequidades en la distribución de recursos financieros entre las capitales brasileñas de diferentes regiones. La financiación de la salud está afectada por la municipalización del SUS, y no es el único factor que afecta al acceso y calidad de los servicios de salud.


Subject(s)
Humans , Budgets , Brazil , Public Health , Health Expenditures , Healthcare Financing
6.
An. Facultad Med. (Univ. Repúb. Urug., En línea) ; 8(2): e203, dic. 2021. ilus, tab
Article in Spanish | LILACS, BNUY, UY-BNMED | ID: biblio-1358035

ABSTRACT

Introducción: La incidencia de fracturas de cadera presenta un aumento dramático desde la mediana edad, constituyendo un problema de salud prevalente en adultos mayores. Se realizó una revisión bibliográfica de los registros internacionales de fracturas de cadera y un estudio epidemiológico multicéntrico para conocer la incidencia, los costos y la mortalidad de esta patología en nuestro país. Material y métodos: Se realizó una búsqueda, revisión y análisis de todos los registros internacionales de fracturas de cadera existentes en el mundo. Posteriormente, se llevó a cabo un análisis descriptivo observacional retrospectivo y multicéntrico en 4 instituciones de pacientes mayores de 50 años intervenidos quirúrgicamente con osteosíntesis por fractura de cadera en el año 2019. En los datos anonimizados se evaluaron edad, sexo, tipo de fractura, incidencia y costos. Se incluyeron y asociaron, además, datos estadísticos y económicos del Registro del Fondo Nacional de Recursos. Se utilizó el software estadístico SPSS para establecer asociaciones univariadas, bivariadas y multivariadas. Para comparar las proporciones se empleó el test estadístico de chi cuadrado. Resultados: Se resume la revisión de registros en una tabla. El análisis multicéntrico contó con 646 pacientes con fracturas de cadera. Destacamos la alta prevalencia de esta patología en pacientes mayores de 79 años (63,1%) y en el sexo femenino (77,6%), en concordancia con los registros internacionales, con asociación significativa entre ambas variables (p < 0,0001). A diferencia de otros registros, y quizás dato erróneo, la fractura más frecuente fue la del cuello de fémur (43%). El tiempo entre la fractura y la cirugía y los días de internación fueron de 2,6 y 7,2 días, respectivamente, en la institución de asistencia más efectiva. Nuestro cálculo mostró una incidencia de fractura de cadera en Uruguay que oscila entre 235 y 391 en 100.000 habitantes mayores de 50 años. El costo calculado de la serie evaluada fue de unos U$S 2.855.320 y, en general, esta patología provoca un gasto para nuestro país que se aproxima a U$S 20.000.000 por año. Conclusión: La fractura de cadera presenta una elevada incidencia, costos y morbimortalidad en la población de adultos mayores, comparable con datos internacionales. Es necesario contar con un Registro Nacional de Fracturas de Cadera que permita conocer datos estadísticos certeros para poder establecer políticas adecuadas de prevención, tratamiento y control de gastos.


Introduction: The incidence of hip fractures dramatically increases from middle age on, posing a prevalent health problem in elderly people. A literature review of the international hip fracture registers, as well as a multicenter, epidemiological study were carried out in order to assess the incidence, costs, and mortality of this pathology in our country. Material and methods: All international hip fracture registers in the world were searched, reviewed and analyzed. An observational, retrospective, multicenter descriptive analysis was then carried out in 4 health-care centers for patents over 50 years of age who underwent surgery with osteosynthesis due to hip fracture in 2019. Age, sex, type of fracture, incidence and costs were assessed from the anonymized data. Statistical and economic data from the National Resources Fund Register were also included and associated. The SPSS statistical software was used to establish univariate, bivariate, and multivariate associations. The chi-squared statistical test was used to compare proportions. Results: Review of the registers is summarized in a table. The multicenter analysis included 646 patients with hip fractures. Worth of note is the high prevalence of this pathology in patients over 79 years of age (63.1%) and females (77.6%), in line with the international registers, and a significant association between both variables (p < 0.0001). Unlike other registers, and probably due to inaccurate data, the most frequent fracture was that of femoral neck (43%). The time from fracture to surgery and inpatient days were 2.6 and 7.2 days, respectively, in the most effective health care center. Our calculation showed a hip fracture incidence in Uruguay between 235 and 391 per 100,000 inhabitants over 50 years of age. The estimated cost of the assessed series was about U$S 2,855,320, and in general this pathology generates an annual expense of about U$S 20,000,000 for our country. Conclusion: Hip fractures have high incidence, costs and mortality and morbidity in the elderly population comparable with international data. It is necessary to have a National Hip Fracture Register that provides accurate statistical data in order to establish adequate prevention, treatment and cost control policies.


Introdução: A incidência de fraturas de quadril apresenta um aumento dramático a partir da meia-idade, constituindo um problema de saúde prevalente em idosos. Uma revisão bibliográfica dos Registros Internacionais de Fratura de Quadril e um estudo epidemiológico multicêntrico foram realizados para determinar a incidência, os custos e a mortalidade dessa patologia em nosso país. Material e métodos: Foi realizada uma busca, revisão e análise de todos os Registros Internacionais de fraturas de quadril existentes no mundo. Posteriormente, foi realizada uma análise observacional descritiva retrospectiva e multicêntrica, em 4 Instituições, de pacientes maiores de 50 anos, submetidos à cirurgia com osteossíntese, para fratura de quadril em 2019. Nos dados anônimos foram avaliados idade e sexo, tipo de fratura , incidência e custos. Dados estatísticos e econômicos do Registro do Fundo Nacional de Recursos também foram incluídos e associados. O software estatístico SPSS foi usado para estabelecer associações univariadas, bivariadas e multivariadas. O teste estatístico do qui quadrado foi usado para comparar as proporções. Resultados: a revisão dos registros é resumida em uma tabela. A análise multicêntrica incluiu 646 pacientes com fraturas de quadril. Destaca-se a alta prevalência dessa patologia em pacientes maiores de 79 anos (63,1%) e no sexo feminino (77,6%), de acordo com registros internacionais, com associação significativa entre as duas variáveis ​​(p <0,0001). Ao contrário de outros registros, e talvez dados errôneos, a fratura mais frequente foi a do colo do fêmur (43%). O tempo decorrido entre a fratura e a cirurgia e os dias de internação foram de 2,6 e 7,2 dias, respectivamente, na instituição assistencial mais efetiva. Nosso cálculo mostrou uma incidência de fratura de quadril no Uruguai, variando entre 235 e 391 em 100.000 habitantes com mais de 50 anos de idade. O custo calculado da série avaliada foi em torno de US $ 2.855.320 e, em geral, essa patologia acarreta um gasto para o nosso país que é próximo a US $ 20.000.000 por ano. Conclusão: A fratura de quadril tem alta incidência, custo e morbimortalidade na população idosa, comparável a dados internacionais. É necessário um Cadastro Nacional de Fraturas de Quadril, que permita conhecer dados estatísticos precisos, para estabelecer políticas adequadas de prevenção, tratamento e controle de custos.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Health Expenditures , Hip Fractures/epidemiology , Uruguay/epidemiology , Registries , Epidemiology, Descriptive , Incidence , Retrospective Studies , Hip Fractures/classification , Hip Fractures/mortality , Hospitalization/statistics & numerical data
7.
Gerais (Univ. Fed. Juiz Fora) ; 14(spe): 1-19, dez. 2021. ilus, tab
Article in Portuguese | LILACS, INDEXPSI | ID: biblio-1350789

ABSTRACT

Um dos aspectos mais estudados em intervenções psicoterápicas são os procedimentos empregados em psicoterapia que resultam em melhores benefícios ao paciente em um menor espaço de tempo, ou seja, a avaliação da eficiência do processo psicoterápico, prezando-se não apenas pela ética com o paciente, mas também pela redução de gastos com tratamentos. Diante disso, o objetivo deste estudo foi levantar quais os principais instrumentos utilizados com essa finalidade. Por meio de busca sistematizada de literatura, foram resgatados 5.938 artigos que, após triagem por meio de critérios de inclusão e exclusão, resultaram em um conjunto de 157 estudos analisados em sua íntegra, o que permitiu identificar 114 instrumentos e técnicas. Após a apresentação dos instrumentos mais recorrentes na literatura, algumas considerações foram tecidas a respeito do panorama atual de avaliação de processos psicoterapêuticos, como, por exemplo, a escassez de instrumentos brasileiros e as contribuições desta pesquisa para futuros estudos nessa temática.


One of the most studied aspects in psychotherapeutic interventions are the procedures used in psychotherapy that result in better patient benefits in a shorter period, the evaluation of psychotherapeutic process's efficiency, considering ethics toward the patient, and reducing treatment costs. This study aimed to identify the main instruments used for this purpose. Through a systematized review of literature, 5,938 articles were found, which, after screening by inclusion and exclusion criteria, resulted in a set of 157 studies and the identification of 114 instruments and techniques. After presenting the most recurrent instruments in the literature, some considerations were made regarding the current panorama of evaluation of psychotherapeutic processes, such as the scarcity of Brazilian instruments and the contributions of this research to future studies in this subject.


Subject(s)
Psychotherapy , Health Care Costs , Health Expenditures , Psychotherapeutic Processes , Psychosocial Intervention
8.
An. Fac. Cienc. Méd. (Asunción) ; 54(3): 51-60, Dec. 2021.
Article in Spanish | LILACS | ID: biblio-1352907

ABSTRACT

Introducción: Ante el COVID-19 se reorganizaron hospitales en el sistema de salud de Paraguay donde el financiamiento predominante es el gasto de bolsillo. Objetivos: Analizar el gasto de bolsillo en el hospital respiratorio integrado de Encarnación. Materiales y métodos: Estudio cuantitativo, observacional, descriptivo entre agosto 2020 y febrero 2021. Incluyó una muestra no aleatoria de 95 casos. Se aplicó una encuesta telefónica a un informante clave. Las variables dependientes fueron: gasto de bolsillo, razón gasto/ingreso y razón gasto/días de internación. Las independientes fueron: sexo, adulto mayor, ingreso a UTI, seguro médico y diagnóstico de COVID-19. El gasto excesivo se definió como mayor a 0,1 del ingreso y el catastrófico como mayor a 0,25 del ingreso. La asociación significativa se determinó mediante pruebas de Chi2 y Mann-Whitney (p<0,05). Resultados: El 97,8% tuvo gasto de bolsillo principalmente por medicamentos y descartables. El gasto total promedio fue 1,98 millones Gs, el gasto diario promedio 215,4 mil Gs y la razón gasto/ingreso 1,13. En cuidados intensivos el gasto total promedio fue 7,18 millones Gs (el máximo fue 18,41 millones Gs), el gasto diario promedio 666,8 mil Gs (el máximo fue 2,85 millones Gs diarios) y la razón gasto/ingreso 3,83. El gasto fue excesivo en el 87% de los casos y catastrófico en el 52% de los casos. El gasto se asoció significativamente con la edad mayor a 60 años, el haber ingresado a UTI y el diagnóstico de COVID-19, no así con el sexo ni con la tenencia de seguro. Conclusión: Los mecanismos de protección financiera fueron insuficientes para evitar gastos excesivos y catastróficos durante la hospitalización.


Introduction: Faced with COVID-19, hospitals were reorganized in the Paraguayan health system where the predominant financing is out-of-pocket expenses. Objectives: To analyze the out-of-pocket expenditure in the Encarnacion integrated respiratory hospital. Materials and methods: Quantitative, observational, descriptive study between August 2020 and February 2021. It included a non-random sample of 95 cases. A telephone survey was applied to a key informant. The dependent variables were: out-of-pocket expense, expense / income ratio, and expense / hospital days ratio. The independent ones were: sex, elderly, admission to ICU, medical insurance and diagnosis of COVID-19. Excessive spending was defined as greater than 0.1 of income and catastrophic as greater than 0.25 of income. The significant association was determined by Chi2 and Mann-Whitney tests (p <0.05). Results: 97.8% had out-of-pocket expenses mainly for medications and disposables. The average total expense was Gs 1.98 million, the average daily expense was Gs 215.4 thousand and the expense / income ratio was 1.13. In intensive care, the average total expenditure was 7.18 million Gs (the maximum was 18.41 million Gs), the average daily expenditure was 666.8 thousand Gs (the maximum was 2.85 million Gs per day) and the expense / income ratio 3.83. The expense was excessive in 87% of the cases and catastrophic in 52% of the cases. The expense was significantly associated with age over 60 years, having been admitted to the ICU and the diagnosis of COVID-19, not with sex or with insurance. Conclusion: The financial protection mechanisms were insufficient to avoid excessive and catastrophic expenses during hospitalization.


Subject(s)
COVID-19 , Health Expenditures , Hospitals , Persons
9.
Ciênc. Saúde Colet ; 26(8): 3289-3300, ago. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1285964

ABSTRACT

Resumo Medicamentos neuropsiquiátricos são utilizados para variadas condições neurológicas e psiquiátricas. O objetivo deste artigo é analisar evolução e determinantes dos gastos públicos com esses medicamentos em Minas Gerais de 2010 a 2017. Dados do Sistema Integrado de Administração de Materiais e Serviços (SIAD) foram usados para estimar volumes de aquisição e gastos. Realizou-se análise de decomposição e, para os medicamentos antiparkinsonianos foi avaliado o elenco adquirido, aplicando-se, ainda, a técnica de Drug Utilization (DU90%). O gasto anual diminuiu 36%, passando de R$ 111,7 milhões em 2010 para R$ 40,9 milhões em 2017, tendo como fatores determinantes a queda de preços e de volume, associada às mudanças do drugmix, optando-se pela aquisição de produtos, em média, mais caros. Destaca-se o aumento dos gastos para a classe dos antiparkinsonianos, porém, com significativa mudança no elenco adquirido. Esse estudo contribuiu para um melhor entendimento dos gastos públicos com medicamentos neuropsiquiátricos. A redução do volume pode elevar o risco de desabastecimento. Com relação aos antiparkinsonianos, não há evidências que sugiram aumento da oferta para a população.


Abstract Neuropsychiatric drugs are used for a wide variety of neurological and psychiatric conditions. This article aims to analyze the trend and determinants of public expenditure of these medicines in Minas Gerais, from 2010 to 2017. Data from the Integrated Materials and Services Administration System (SIAD) database were used to estimate volumes of acquisition and expenditure. A breakdown analysis was performed, and the list of purchased drugs was reviewed, and the Drug Utilization technique (DU90%) applied concerning anti-Parkinson drugs. Annual expenditure dropped by 36%, from R$ 111.7 million in 2010 to R$ 40.9 million in 2017, and the determinant factors were the falling prices and volume, associated with changes in the drug mix, which favored the acquisition, on average, of more expensive products. Higher levels of expenditure for anti-Parkinson drugs stand out, however, with a significant change in the list purchased. This study contributed to a better understanding of public spending on neuropsychiatric drugs. A reduced volume can increase the risk of shortages. Regarding anti-Parkinson drugs, there is no evidence to suggest an increased supply to the population.


Subject(s)
Humans , Pharmaceutical Preparations , Brazil , Health Expenditures
10.
Ciênc. Saúde Colet ; 26(6): 2075-2082, jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278706

ABSTRACT

Resumo A cidade do Rio de Janeiro implantou em larga o modelo das Organizações Sociais (OSS) para a gestão da Atenção Primária à Saúde (APS). Esta opção torna a compreensão da experiência da cidade muito relevante, especialmente porque até então o modelo organizacional das OSS tinha sido adotado dominantemente na gestão hospitalar do SUS. Assim, é analisada a experiência de desenvolvimento da APS em dois momentos conflitantes da gestão municipal em relação ao modelo das OSS: a implantação e desenvolvimento das PPP (2009-2016); e o seu desmantelamento (2017-2020). Utilizou-se o Estudo de Caso, Revisão Bibliográfica e análise dos dados públicos do DATASUS/Ministério da Saúde. Identificou-se que: a adoção da terceirização com base nas OSS pode ser diretamente associada à rápida expansão da APS na cidade e a melhoria de indicadores de cobertura da APS; que a difusão do modelo das OSS está associada à alta prioridade dada ao gasto com saúde no orçamento municipal; que a sustentabilidade da adoção do modelo da OSS não foi dependente da condição econômica do município, mas da escolha política do governo no período 2009-2016. O arranjo das PPP produziu avanços organizacionais importantes, mas não impediram o veto ao modelo das OSS levada adiante ao longo da gestão de 2017-2020.


Abstract The city of Rio de Janeiro has implemented, on a large scale, the model of Social Organizations (OSS) for the management of Primary Health Care (PHC). This option makes the understanding of the city's experience very relevant, especially since, until then, the OSS organizational model had been adopted predominantly in the SUS hospital management. Thus, the experience of PHC development at two conflicting moments of municipal management in relation to the OSS model is analyzed: the implementation and development of the PPPs (2009-2016); and their dismantling (2017-2020). Case Studies, Literature Review and analysis of public data from DATASUS/Ministry of Health were used. It was verified that: the adoption of outsourcing based on OSS can be directly associated with the rapid expansion of PHC in the city and PHC coverage improvement indicators; the diffusion of the OSS model is associated with the high priority given to health expenditures in the municipal budget; the sustainability of the adoption of the OSS model did not depend on the municipality's economic status, but on the government's political choice in the period of 2009 to 2016. The PPP arrangement resulted in important organizational advances, although it did not prevent the veto of the OSS model carried out during the 2017-2020 term.


Subject(s)
Humans , Primary Health Care , Family Health , Brazil , Cities , Health Expenditures
11.
An. bras. dermatol ; 96(3): 295-300, May-June 2021. tab
Article in English | LILACS | ID: biblio-1285052

ABSTRACT

Abstract Background: Psoriasis is a chronic disease that derives great costs to the health care system. In Colombia, due to deficiencies in this system, patients are more likely to incur in out-of-pocket expenses; money that has never been quantified in this country. Objectives: To quantify out-of-pocket expenses and to analyze their relation to patients' clinical and labor characteristics in a cohort of psoriatic patients. Methods: A single-center, cross-sectional study was performed, evaluating psoriasis patients. Results: A total of 100 psoriasis patients were analyzed. We identified that patients with higher dermatology life quality index and in phototherapy treatment were the ones that had higher out-of-pocket costs (p = 0.006 and 0.005, respectively). We found no correlation between out-of-pocket costs and occupational status, psoriasis area severity index or other types of treatment. The largest amount of money was used to buy medications and bus transportation with a maximum up to 440.50 and 528.60 USD, respectively. Among the 100 participants the total expense was 11131.90 USD in a 6-month period. Study limitations: Lack of measurement of the labor productivity and labor absenteeism secondary to sick leave. Conclusion: Out-of-pocket costs are similar with what was shown in previous studies. We found statistically significant differences for the DLQI in comparison with out-of-pocket expenses, regardless of the PASI level. Phototherapy treatment also had statistically significant differences in relationship with out-of-pocket expenses, when compared to other treatments, because it requires higher expenses in transportation, copayments, and alimentation during appointment assistance.


Subject(s)
Humans , Psoriasis/therapy , Dermatology , Outpatients , Quality of Life , Referral and Consultation , Severity of Illness Index , Cross-Sectional Studies , Health Expenditures , Colombia
12.
Ciênc. Saúde Colet ; 26(6): 2323-2333, jun. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1278683

ABSTRACT

Resumo À luz da análise comparada de sistemas de saúde (SS), discutimos três fenômenos estratégicos para a universalização do SUS: a) os gastos tributários em saúde; b) o financiamento estatal de planos privados de servidores públicos; c) a demanda sindical por planos privados. Dentre os tipos-ideais de SS, o SUS é universal na lei, mas híbrido na prática: beveridgeano na atenção primária à saúde (APS) e misto no cuidado especializado/hospitalar; sem ser universal na realidade (gastos públicos são só 43% dos gastos totais em saúde). Há grande subsídio estatal ao setor privado, via gastos tributários em saúde (30% do orçamento federal na saúde) e financiamento de planos privados para servidores públicos, o que gera incoerência, segmentação do sistema de saúde e iniquidades. Apesar do apoio genérico ao SUS, os movimentos sindicais vem usando planos de saúde na contratação coletiva (76% deles), reforçando o setor privado. A redução dos gastos tributários em saúde - incluindo o financiamento estatal dos planos privados de servidores - aumentaria significativamente o orçamento do SUS e facilitaria a articulação entre sanitaristas e sindicalistas, aproximando a grande força dos sindicatos da longa luta pela universalidade do SUS e da APS.


Abstract In the light of the comparative analysis of health systems, we discuss three strategic phenomena for the SUS universalization, as follows: a) health tax expenditures; b) State funding of private plans for public servants; and c) trade union's demand for private health plans. Among the ideal types of health systems, SUS is universal in law, but hybrid in practice: Beveridgian in primary health care (PHC) and mixed in specialized/hospital care; without really being universal (public spending is only 43% of total health expenditure). There is a massive state subsidy to the private sector, through health tax expenditures (30% of the federal health budget) and financing of private plans for public servants, which generates incoherence, segmentation of the health system and inequities. Despite the general support to the SUS, the union movements have been using private health plans in collective recruitment (76% of them), reinforcing the private sector. Reducing health tax expenditures - including state funding of servants' private plans - would significantly increase the SUS budget and facilitate articulation between health workers and trade unionists, bringing the high strength of unions closer to the long struggle for the universality of the SUS and PHC.


Subject(s)
Humans , Health Expenditures , Insurance, Health , Private Sector , Labor Unions
13.
Ciênc. Saúde Colet ; 26(4): 1521-1532, abr. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1285915

ABSTRACT

Resumo Em um contexto de restrição orçamentária e de medidas de austeridade fiscal, discutir aspectos relacionados à gestão eficiente dos recursos públicos é um desafio. O objetivo deste estudo foi avaliar a eficiência técnica de municípios catarinenses nos gastos públicos com saúde e sua relação com as condições para a gestão em saúde nos anos de 2009 e 2015. Para medir a eficiência, optou-se pela Análise Envoltória de Dados. O Índice G foi empregado para analisar a autocorrelação espacial da eficiência. Para a avaliação das condições para a gestão em saúde, adotou-se o modelo proposto por Calvo et al. Do total de municípios analisados, 35,5% e 29% foram considerados eficientes, respectivamente para os anos de 2009 e 2015. Os resultados sugerem não haver associação entre as condições para a gestão em saúde e a eficiência técnica no estado de Santa Catarina. O estudo revelou a necessidade de se avançar na busca por melhores resultados de eficiência em Santa Catarina, devendo ser considerada a distribuição espacial destes resultados sobre o território, com enfoque sobre os clusters de ineficiência que podem explicar o fraco desempenho em saúde de algumas regiões do estado.


Abstract In a context of budget constraints and fiscal austerity measures, the discussion of issues related to the efficient management of public resources is a major challenge. The scope of this study was to assess the technical efficiency of municipalities of the State of Santa Catarina in public health expenditures and its relationship with health management conditions in the years 2009 and 2015. In order to measure efficiency, the decision was made to use Data Envelopment Analysis. The G Index was used to analyze the spatial efficiency autocorrelation. For the evaluation of the conditions for health management, the model proposed by Calvo et al. was adopted. Of the total number of municipalities analyzed, 35.5% and 29% were considered efficient, for the years 2009 and 2015, respectively. The results suggest that there is no association between the conditions for health management and technical efficiency in the State of Santa Catarina. The study revealed the need to move forward in the quest for better results in terms of efficiency in the State of Santa Catarina, taking into consideration the spatial distribution of these results over the territory, focusing on clusters of inefficiency that may explain the poor performance in health of some regions of the state.


Subject(s)
Humans , Public Health , Health Expenditures , Brazil , Cities , Spatial Analysis
14.
Mem. Inst. Invest. Cienc. Salud (Impr.) ; 19(1)abr. 2021. ilus, tab
Article in Spanish | LILACS, BDNPAR | ID: biblio-1337621

ABSTRACT

La cobertura y acceso universal de salud requiere de protección financiera, lo que puede evaluarse a través del gasto de bolsillo ante una enfermedad. El objetivo del trabajo fue analizar la asociación entre el gasto de bolsillo de salud y la pobreza en Paraguay. Se utilizó la Encuesta Permanente de Hogares del 2014 para determinar la razón entre gasto de bolsillo ante una enfermedad con los ingresos del hogar, con las transferencias estatales para pobres, con la canasta básica de consumo y de alimentos. Fueron incluidos 5.165 hogares de los cuales 21,49% eran pobres. Hubo gasto de bolsillo en el 45,19% de los hogares asociándose significativamente con la pobreza (OR: 1,8; IC95%: 1,57 a 2,06). El 1,99% de los hogares tuvo gasto de bolsillo mayor a 25% de sus ingresos y el 5,98% mayor a 10% de sus ingresos, ambos indicadores se asociaron significativamente con la pobreza (OR: 3,70; IC95%: 2,50 a 5,50 y OR: 3,04; IC95%: 2,40 a 2,06, respectivamente). Hubo empobrecimiento en el 1,44% de los hogares, y la brecha de la pobreza pasó de 34,58% a 37,67%. Entre los hogares pobres el gasto de bolsillo fue equivalente a 4,9 días de consumo, a 11,5 días de alimentación y a 42% del valor de transferencias estatales. Estos hallazgos reflejan una insuficiente protección financiera del sistema de salud en Paraguay


Universal health coverage and access requires financial protection, which can be assessed through out-of-pocket costs for illness. The objective of the study was to analyze the association between out-of-pocket health spending and poverty in Paraguay. The 2014 Permanent Household Survey was used to determine the ratio between out-of-pocket expenses for illness and household income, state transfers for the poor, and the basic consumption and food basket. Five thousand one hundred sixty five households were included, of which 21.49% were poor. There was out-of-pocket spending in 45.19% of the households, significantly associated with poverty (OR: 1.8; 95%CI: 1.57 to 2.06), 1.99% of households had out-of-pocket expenses greater than 25% of their income and 5.98% greater than 10% of their income, both indicators were significantly associated with poverty (OR: 3.70; 95%CI: 2.50 to 5.50 and OR: 3.04; 95%CI: 2.40 to 2.06, respectively). There was impoverishment in 1.44% of households, and the poverty gap went from 34.58% to 37.67%. Among poor households, out-of-pocket spending was equivalent to 4.9 days of consumption, 11.5 days of food, and 42% of the value of state transfers. These findings reflect insufficient financial protection for the health system in Paraguay


Subject(s)
Humans , Health Expenditures , Universal Health Coverage , Poverty , Public Health
15.
Curitiba; s.n; 20210304. 129 p. ilus, tab, graf.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1222786

ABSTRACT

Este estudo está inserido na linha de pesquisa o Processo de Cuidar em Saúde e Enfermagem, e integra o Grupo de Pesquisa Multiprofissional em Saúde do Adulto da Universidade Federal do Paraná. Introdução: a toxicidade financeira é um efeito colateral do tratamento oncológico, que descreve o ônus financeiro experimentado pelo paciente com câncer, o qual tem dificuldade para custear o tratamento e os custos decorrentes da doença. O questionário COmprehensive Score for Financial Toxicity foi desenvolvido e validado para mensurar a toxicidade financeira dos pacientes com câncer. Objetivo: traduzir, adaptar transculturalmente e validar o questionário COmprehensive Score for Financial Toxicity para a cultura brasileira. Método: pesquisa metodológica dividida em duas etapas: a primeira, denominada tradução e adaptação transcultural, utilizou o referencial metodológico do grupo Functional Assessment of Chronic Illness Therapy, e a segunda, validação das propriedades psicométricas, foi realizada de acordo com o referencial de Pasquali. A primeira etapa foi concluída em julho de 2018, e a segunda foi realizada entre setembro de 2018 e janeiro de 2020. Participaram da primeira etapa, quatro tradutores, dois profissionais de saúde e 15 pacientes com diagnóstico de câncer no pré-teste, e da segunda etapa, 126 pacientes com câncer. Quarenta e três (43) pacientes realizaram tratamento em instituição privada e 83 em instituição pública no sul do Brasil. Para a etapa de validação, foi realizada o coeficiente Alfa de Cronbach para verificação da consistência interna, a análise fatorial exploratória, análise fatorial confirmatória. Resultados: a participação dos tradutores, desenvolvedores e especialistas conferiu a validade de conteúdo do questionário. O coeficiente alfa de Cronbach, encontrado no pré-teste, foi de 0,83. As Análises fatorial exploratória e confirmatória revelaram que o questionário COmprehensive Score for Financial Toxicity, versão brasileira, mede um único construto, ou seja, a toxicidade financeira com valor de - ??2/????= 179,78, CFI=0,00, PGFI= 0,302, RMSEA=1,196 e Pclose=0,000. O alfa de Cronbach da segunda etapa foi de 0,815. Ao realizar a comparação do escore entre as amostras, foi possível constatar que a amostra da instituição privada possui escore 24,02 e a amostra da instituição pública, escore 16,33, indicando que aqueles que possuem plano privado de saúde, tem menor toxicidade financeira (p=0,001). Conclusão: o questionário COmprehensive Score for Financial Toxicity é válido e confiável para mensurar a toxicidade financeira dos pacientes com câncer no Brasil.


This study is included in the research line the Process of Caring for Health and Nursing and is part of the Multiprofessional Research Group on Adult Health at the Federal University of Paraná. Introduction: financial toxicity is a side effect of cancer treatment, which describes the financial burden experienced by cancer patients, who have trouble affording the treatment and the costs resulting from the disease. The COmprehensive Score for Financial Toxicity questionnaire was developed and validated to measure the financial toxicity of cancer patients. Objective: to translate, cross-culturally adapt and validate the COmprehensive Score for Financial Toxicity questionnaire for the Brazilian culture. Method: this is a methodological research divided into two stages: the first, named translation and cross-cultural adaptation, which used the methodological framework of the Functional Assessment of Chronic Illness Therapy group, and the second, psychometric properties validation, which was carried out according to Pasquali's framework. The first stage was accomplished in July 2018, and the second from September 2018 and January 2020. Four translators, two health professionals and 15 patients diagnosed with cancer in the pre-test participated in the first stage, and 126 cancer patients in the second stage. Forty-three (43) patients underwent treatment in a private institution and 83 in a public institution in southern Brazil. For the validation stage, Cronbach's alpha coefficient was calculated to check internal consistency and exploratory factorial analysis, confirmatory factorial analysis was performed. Results: the participation of translators, developers and specialists checked the questionnaire content validity. Cronbach's alpha coefficient, found in the pre-test, was 0.83. The exploratory and confirmatory factorial analyzes showed that the questionnaire COmprehensive Score for Financial Toxicity, Brazilian version, measures a single construct, that is, the financial toxicity with a value of - ??2/???? = 179.78, CFI=0.00, PGFI = 0.302, RMSEA = 1.196 and Pclose=0.000. Cronbach's alpha for the second stage was 0.815. When comparing the score between the samples, it was possible to verify that the private institution sample has a score of 24.02 and the sample of the public institution, a score of 16.33, indicating that those who have a private health plan have less financial toxicity (p=0.001). Conclusion: the COmprehensive Score for Financial Toxicity questionnaire is valid and reliable for measuring the financial toxicity of cancer patients in Brazil.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Quality of Life , Health Expenditures , Cost of Illness , Costs and Cost Analysis , Financial Stress , Neoplasms , Validation Study
16.
Goiania; SES-GO; 21 jan. 2021. 1-3 p. mapas.
Non-conventional in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, CONASS, SES-GO | ID: biblio-1148393

ABSTRACT

O Sistema único de Saúde (SUS) tem o desafio de equilibrar uma crescente demanda de serviços de saúde de um país de proporções continentais como o Brasil, frente à necessidade de administrar recursos escassos, considerando a complexidade das instituições de saúde (DELA PASE, 2015), e enfrentando ainda limitações na qualidade da atenção, na incorporação de novas tecnologias, na gestão de seus recursos e na distribuição equitativa dos serviços (LAFORGIA, 2009, apud MPMA, 2017). Diante deste cenário, o Ministério da Saúde (MS) instituiu o Programa Nacional de Gestão de Custos (PNGC), tendo por objetivo promover a cultura de gestão de custos no âmbito do SUS, com foco na qualidade do gasto, oferecendo ferramentas e capacitação para auxiliar os gestores na melhoria dos processos, para produzir informação gerencial e apoiar a tomada de decisões (BRASIL, 2018).


The Unified Health System (SUS) has the challenge of balancing a growing demand for health services in a country of continental proportions such as Brazil, given the need to manage scarce resources, considering the complexity of health institutions (DELA PASE, 2015), and also facing limitations in the quality of care, in the incorporation of new technologies, in the management of its resources and in the equitable distribution of services (LAFORGIA , 2009, apud MPMA, 2017). Given this scenario, the Ministry of Health (MS) instituted the National Cost Management Program (PNGC), aiming to promote the culture of cost management within the SUS, focusing on the quality of spending, offering tools and training to assist managers in improving processes, to produce management information and support decision-making (BRASIL, 2018).


Subject(s)
Budgets/methods , Health Expenditures/standards , Costs and Cost Analysis/methods
17.
Acta Medica Philippina ; : 216-223, 2021.
Article in English | WPRIM | ID: wpr-876876

ABSTRACT

@#Objective. This research aimed to determine the in-patient expenditure of COVID-19 adult patient s and their out-of-pocket (OOP) payments at the University of the Philippines-Philippine General Hospital (UP-PGH) after the new PhilHealth case rate coverage was instituted last 15 April 2020. It also intended to present the preliminary data on the expenses incurred by COVID patients during the initial phase of the pandemic in the country. Methods. This study was a retrospective chart review of admitted COVID-19 patients aged 19 years old and above from 15 April to 14 August 2020 at UP-PGH that availed of PhilHealth COVID-19 case rate benefits package (C19C1-C4). Data were analyzed to extract overall expenses, out-of-pocket (OOP) charges, cost centers utilization, and other hospitalization expenditure sources. Results. Of the 691 COVID-19 patients included during the study period, 55.72% were male, mostly belonging to the 61-70 age range with a median age of 58. The average in-hospital stay was 14.20 days, and 76.99% were under charity services, with the moderate (42.84%) and mild (25.33%) pneumonia cases accounting for 68.17% of the admissions. Total hospital expenses clustered around Php51,000 to 200,000 (~USD 1,041 to 4,156), most spending between Php101,000 to 150,000 (~USD 2,078 to 3,118). The top three cost centers and expenditure sources were pharmacies, personal protective equipment (PPE) usage, and laboratory. The average OOP payment for patients less than 60 years old was higher, ranging from Php 25,899 to Php 44,428.63 (USD 538 to USD 924.44) compared to patients older than 60 (Php4,005.60 to Php 32,920.20 ~ USD 83.35 to 684.98). The most OOP charges were for the age group 19-30, amounting to Php 44,428.63 (USD 924.44). Conclusion. Preliminary findings of this study gave an actual representation of the expenses of COVID-19 patients, which can guide future utilization of the national health insurance during unexpected pandemics. Early price regulation of new therapeutic interventions, diagnostic tests, and medical supplies, e.g., PPEs, disinfectants, air filters, are measures that can be implemented.


Subject(s)
Health Expenditures , COVID-19 , Insurance, Health
18.
Article in English | WPRIM | ID: wpr-880690

ABSTRACT

OBJECTIVES@#To understand the influence of medical insurance policy reforms in Guangxi on the hospitalization expenses of breast cancer patients by analyzing the composition and changing trend in breast cancer diagnosis and treatment expenses in the Guangxi Medical University Cancer Hospital, and to provide the evidence for the improvement of medical insurance policy reform.@*METHODS@#A total of 3 950 breast cancer patients were collected from 2014 to 2017 and analyzed. Kruskal-Wallis test and multiple linear regression model were used to discuss the breast cancer related epidemiology and analyze the composition of hospitalization expenses and its influential factors.@*RESULTS@#The median hospitalization cost of breast cancer patients in our hospital from 2014 to 2017 was 29 266.94 Chinese Yuan. Single factor analysis showed that the impact of year, hospitalization days, age, payment method, tumor stage, and treatment method on hospitalization cost was significant (all @*CONCLUSIONS@#Reasonably controlling hospitalization days and actively promoting the integration of urban and rural medical insurance can effectively reduce the economic burden for breast cancer patients.


Subject(s)
Breast Neoplasms/therapy , Cancer Care Facilities , China/epidemiology , Female , Health Expenditures , Hospitalization , Humans , Policy , Universities
19.
Article in English | WPRIM | ID: wpr-880688

ABSTRACT

OBJECTIVES@#The rapid growth of health expenditure has always been the focus of health policy. This study aims to project health expenditure in Shanghai and to carry out policy simulations on the impact of chronic disease prevention programs on health costs in the Healthy Shanghai Initiative.@*METHODS@#Based on the Shanghai health accounts, component-based model was used to project Shanghai total health expenditure of 2020-2035, and the policy stimulation was implemented.@*RESULTS@#In 2020-2035, Shanghai's health expenditure is expected to grow continually, the proportion of total health expenditure in GDP will exceed 8.00% in 2023, reach 9.00% in 2025, and 10.03% in 2035. The proportion of current health expenditure in GDP will exceed 8.00% in 2024 and reach 9.55% in 2035. The chronic disease prevention plan help saving the medical expenditure of respiratory diseases,endocrine system diseases, and circulatory system diseases, accounting 3.28% to 10.58% of total health expenditure.@*CONCLUSIONS@#The sustainability of health financing in Shanghai is facing challenges under the new normal of economy. It is necessary to promote the prevention and control of chronic diseases and strengthen cost control from both the supply and demand sides.


Subject(s)
China/epidemiology , Chronic Disease , Health Expenditures , Humans
20.
Article in Chinese | WPRIM | ID: wpr-878691

ABSTRACT

Objective To describe the inpatient care expenditure of the terminally ill patients in the geriatric ward of Peking Union Medical College Hospital and facilitate future research on the economic outcomes of hospice and palliative care.Methods The histories of patients admitted to the Department of Geriatrics of Peking Union Medical College Hospital during 2018 were reviewed by trained doctors.According to the diagnosis and overall health state,terminally ill patients were selected and enrolled in the study.Demographics,health and disease information,prescriptions,and expenditure details were retrieved from the HIS system.Results In 2018,35 patients were terminally ill and eligible for hospice care,including 20 males and 15 females,with the average age of(78±8)years(59-91 years),the average age-adjusted Charlson Comorbidity Index of 10±3,and the median Barthel index of 40(10,70).These patients had malignant tumor(23 cases),heart failure(4 cases),end-stage renal disease(1 case),end-stage liver disease(2 cases),dementia(4 cases)and other severe diseases(3 cases).The patients received standard care within the scope of internal medicine and geriatrics.Finally,8 patients died during hospitalization,and 27 were discharged alive.The 35 patients had the median length of stay of 15(12,23)days,the median inpatient expenditure of CNY 21 500(13 800,37 600),and the median daily expenditure of CNY 1425(970,2503).The percentage of expenditure was(28.5±12.3)% for medication,(33.2±18.0)% for tests and examinations,and 11.5%(6.4%,15.8%)for accommodation and medical services.The medications for symptom control costed CNY(77±58)per day on average,accounting for(5.2±3.5)% of the total expenditure.Conclusions The inpatient expenditure for terminally ill patients in the tertiary grade A hospital was higher than that reported in community hospitals providing hospice care.In terms of expenditure constitution,the money spent on medications and tests/examinations were similar,and the percentage of expenditure on medications for symptom control was low.There is a need for further research on the economic impact of hospice and palliative care among terminally ill patients in China.


Subject(s)
Aged , Aged, 80 and over , China , Female , Health Expenditures , Hospitalization , Humans , Inpatients , Male , Terminally Ill
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