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1.
Article in English | AIM, AIM | ID: biblio-1353242

ABSTRACT

Background: To improve healthcare access and mitigate healthcare costs for its population, Nigeria established a National Health Insurance Scheme (NHIS) in 1999. The NHIS remains Nigeria's leading vehicle for achieving universal health coverage; nonetheless, questions remain regarding its quality and effectiveness. Studies on patient satisfaction have served as a useful strategy to further understand the patient experience and the efficacy of health systems. Aim: To synthesise current knowledge on patient satisfaction with the NHIS. Methods: The authors performed a systematic review of primary literature from 1999 to 2020 reporting on NHIS patient satisfaction in eight databases (including PubMed, Embase, and Africa-wide Information). Results: This search returned 764 unique records of which 21 met criteria for full data extraction. The 21 qualifying studies representing 11 of the 36 Nigerian states, were published from 2011 to 2020, and found moderate overall satisfaction with the NHIS (64%). Further, when disaggregated into specific domains, NHIS enrolees were most satisfied with provider attitudes (77%) and healthcare environments (70%), but less satisfied with laboratories (62%), billings (62%), pharmaceutical services (56%), wait times (55%), and referrals (51%). Importantly, time trends indicate satisfaction with the NHIS is increasing ­ although to differing degrees depending on the domain. Conclusion: The beneficiaries of the NHIS are moderately satisfied with the scheme. They consider it an improvement from being uninsured, but believe that the scheme can be considerably improved. The authors present two main recommendations: (1) shorter wait times may increase patient satisfaction and can be a central focus in improving the overall scheme, and (2) more research is needed across all 36 states to comprehensively understand patient satisfaction towards NHIS in anticipation of potential scheme expansion


Subject(s)
Patient Satisfaction , Systematic Review , Insurance, Health , Program Evaluation , Costs and Cost Analysis , Nigeria
2.
Ciênc. Saúde Colet ; 26(supl.1): 2529-2541, jun. 2021. tab, graf
Article in Portuguese | LILACS | ID: biblio-1278834

ABSTRACT

Resumo Este artigo objetivou descrever a cobertura de plano de saúde no Brasil. Foram analisados dados das edições de 2013 e 2019 da Pesquisa Nacional de Saúde. A cobertura de plano de saúde médico ou odontológico foi analisada segundo características sociodemográficas, econômicas, de trabalho, situação censitária e Unidade da Federação. A cobertura de plano de saúde médico ou odontológico foi 27,9% (IC95%: 27,1-28,8) para 2013 e 28,5% (IC95%: 27,8-29,2) para 2019. Os resultados mostram que a cobertura continua concentrada nos grandes centros urbanos, nas regiões Sudeste e Sul, entre aqueles com melhor nível socioeconômico e aqueles que possuem algum vínculo de trabalho formal. Em 2019, dentre os trabalhadores formalizados, somente 30,7% relatou que o pagamento da mensalidade é feito diretamente a operadora, sendo 72,7% dentre os trabalhadores informais. Cerca de 92% dos planos de saúde médico cobrem internação e dentre as mulheres com plano de saúde, quase 20% delas não possuem cobertura para o parto. Apenas 11,7% das mulheres com idade entre 15 e 44 anos possuem cobertura para o parto através do plano de saúde. Os resultados mostram que a cobertura por plano de saúde mantém-se bastante desigual, reforçando a importância do Sistema Único de Saúde para a população brasileira.


Abstract This paper aimed to describe health insurance coverage in Brazil. Data from the 2013 and 2019 editions of the National Health Survey (PNS) were analyzed. The medical or dental health insurance coverage was analyzed according to demographic and socioeconomic characteristics, work status, urban/rural area, and Federation Unit. Coverage of medical or dental health insurance was 27.9% (95% CI: 27.1-28.8) for 2013 and 28.5% (95% CI: 27.8-29.2) for 2019. The results show coverage is still concentrated in large urban centers, in the Southeast and South, among those with better socioeconomic status and some formal employment. In 2019, only 30.7% of formal workers reported the monthly payment is made directly to the providers, while 72.7% of informal workers reported this information. About 92% of medical health insurance covers hospitalization, and almost 20% of women with health insurance are not covered for labor. Only 11.7% of women aged between 15 and 44 are covered for childbirth by health insurance. The results show the health insurance coverage is still quite unequal, reinforcing the Unified Health System (SUS) importance for the Brazilian population.


Subject(s)
Humans , Female , Adolescent , Adult , Young Adult , Rural Population , Insurance, Health , Socioeconomic Factors , Brazil , Health Surveys , Insurance Coverage
3.
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
4.
Ciênc. Saúde Colet ; 26(6): 2083-2096, jun. 2021. tab, graf
Article in English, Portuguese | LILACS | ID: biblio-1278711

ABSTRACT

Resumo A Atenção Primária à Saúde (APS) é porta de entrada e eixo estruturante do Sistema de Saúde brasileiro, o que impõe a necessidade de avaliação de sua qualidade. Este estudo objetivou avaliar os serviços públicos de Atenção Básica quanto aos atributos da APS por meio do PCATool na ótica de usuários em Fortaleza. Trata-se de um estudo transversal, de junho a dezembro de 2019, com 233 usuários adultos de 19 Unidades de APS (UAPS). Foram coletados dados sociodemográficos e epidemiológicos dos usuários e sobre a estrutura das UAPS. Utilizou-se modelo multinível para analisar características de usuários e UAPS em relação ao escore de APS medido via PCATool. Participantes foram, na maioria, mulheres, de 30 a 59 anos, pardos, com Ensino Médio completo, sem seguro privado, com moradia própria do tipo casa, de famílias até 4 pessoas. "Acessibilidade" obteve o menor escore, 2,8, e "Utilização" obteve o maior escore, 8,1. O Escore Essencial da APS foi 6,0, enquanto o Escore Geral foi 5,7. Houve influência positiva (p<0,05) no Escore Geral por: equipes completas, maior número de agentes comunitários e presença de residência de Medicina de Família e Comunidade. Concluiu-se que os serviços públicos de Fortaleza avaliados possuem baixo desempenho de APS na ótica dos usuários adultos.


Abstract Primary Health Care (PHC) is the "front door" and keystone of Brazil's public health system, meaning that the evaluation of the quality of primary care services is of utmost importance. Using the Primary Care Assessment Tool (PCAT), this study evaluated the performance of public PHC services in Fortaleza from the view of adult service users. We conducted a cross-sectional study of 233 adult service users from 19 primary care centers (PCCs) between June and December 2019, collecting data on the sociodemographic and epidemiological characteristics of users and structural features of PCCs. The association between user and PCC characteristics and primary care attribute scores was measured by multilevel logistic regression. Most participants were women, aged between 30 and 59 years, brown, house owners, had completed high school, did not own health insurance, and belonged to families with at least 4 members. The lowest and highest-scoring attributes were "first contact accessibility" and "first contact utilization" (2.8 and 8.1, respectively). The overall essential and general scores were 6.0 and 5.7, respectively. Having complete health teams, more community health workers, and a family and community medicine residency program had a positive effect on the general score (p<0.05). Overall, the public services analyzed in Fortaleza received a low performance rating from the adult service users.


Subject(s)
Humans , Female , Adult , Primary Health Care , Insurance, Health , Quality of Health Care , Brazil , Cross-Sectional Studies , Community Health Workers , Health Services Accessibility , Middle Aged
5.
Evid. actual. práct. ambul ; 24(1): e002113, 2021. tab
Article in Spanish | LILACS | ID: biblio-1179134

ABSTRACT

Antecedentes. La continuidad del cuidado (CoC) suele describir en qué medida los pacientes ven al mismo profesional a lo largo del tiempo. Constituye un elemento necesario para garantizar la longitudinalidad en la atención, elemento clave dela atención primaria y de la medicina familiar en particular, entendido como el cuidado centrado en la persona a lo largo del tiempo, independientemente del tipo de problema consultado. Esta ha sido vinculada con una serie de beneficios para los pacientes y algunos indicadores duros de utilización de servicios de salud, por ejemplo visitas a la central de emergencias(CE), internaciones hospitalarias y mortalidad. En Argentina y América Latina no habíamos podido identificar estudios que dieran cuenta del nivel local de CoC o de su impacto en la utilización de los servicios de salud. Objetivo. Cuantificar los niveles de CoC de los afiliados de un Seguro de Salud de un Hospital Universitario Privado y describir su asociación con la utilización de servicios de salud, tales como consultas a la CE e internaciones hospitalarias. Métodos. Estudio observacional, descriptivo, de cohorte retrospectiva; realizado sobre la totalidad de afiliados que hubieran realizado al menos dos consultas programadas con un médico de atención primaria entre 2015 y 2016.Las mediciones principales consistieron dos indicadores: el índice del proveedor usual de cuidados y el índice de continuidad del cuidado (UPC y COC, respectivamente, por sus iniciales en inglés) -cuyos valores oscilan entre 0 y 1, y se interpretan como: el paciente siempre fue atendido por diferentes médicos vs siempre por el mismo médico-y el recuento de visitas a la CE e internaciones hospitalarias. Resultados. Fueron identificados 112.062 pacientes con una mediana de edad de 59 (P5-P95;4 a 87) años. Las medianas(P5-P95) de los indicadores de continuidad, UPC y COC, fueron 0,66 (0,25 a 1) y 0,33 (0,04 a 1), respectivamente. Se observó una asociación inversa y estadísticamente significativa entre los indicadores de CoC y la cantidad de visitas a la CE, evidenciada por una razón de incidencia decreciente de consultas contra quintilos crecientes de COC (tomando como referencia el quintilo más bajo de continuidad). Esta asociación no pudo demostrarse para las internaciones. Conclusiones. Los niveles de CoC alcanzados y su impacto en la utilización de servicios de salud reflejan valores semejantes a los de otros estudios publicados fuera de nuestra región y podrían aportar elementos útiles para delinear estrategias tendientes a la mejora de la calidad de la atención médica. (AU)


Background. Continuity of care (CoC) usually describes the extent to which patients see the same professional over time. It is a necessary element to ensure continuity of care, a key element of primary care and family medicine, in particular, understood as person-centred care over time, regardless of the type of problem consulted. It has been linked to a series of benefits for patients as well as to hard indicators of health services utilization (e.g. emergency room [ER] visits, hospitalizations) and mortality. In Argentina and Latin America, we have not been able to identify studies that account for the local level of CoC and its impact. Objective. To quantify the CoC levels among members of a private university hospital's health insurance scheme and to describe its association with the use of health services, such as ER visits and hospitalizations. Methods. Observational, descriptive, retrospective cohort study; conducted on the total number of members who hadmade at least two schedurivled consultations with a primary care physician between 2015 and 2016.The main outcomes were two indicators: the usual provider continuity index and the continuity of care index (UPC and COC, respectively) -both range between 0 and 1, and are interpreted as: the patient was always treated by different doctorsvs. always by the same doctor- and the number of visits to the ER and hospitalizations. Results. A total of 112,062 patients with a median age of 59 (P5-P95, 4 to 87) years were identified. The median (P5-P95) of the continuity indicators, UPC and COC, was 0.66 (0.25 to 1) and 0.33 (0.04 to 1), respectively. A significant inverse association was observed between the CoC indicators and the number of ER visits, evidenced by adecreasing incidence rate of consultations versus increasing quintiles of CoC (taking the lowest quintile of continuity as a reference). This association was not observed for hospitalizations. Conclusions. The levels of CoC reached and their impact on the use of health services reflect similar values to those of other studies published outside our region and could provide useful elements for outlining strategies aimed at improvingthe quality of medical care. (AU)


Subject(s)
Humans , Male , Female , Middle Aged , Quality of Health Care/statistics & numerical data , Continuity of Patient Care/statistics & numerical data , Argentina , Physician-Patient Relations , Primary Health Care/statistics & numerical data , Retrospective Studies , Patient-Centered Care , Family Practice , Health Services/statistics & numerical data , Hospitals, University/statistics & numerical data , Insurance, Health/statistics & numerical data
6.
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
7.
J. bras. econ. saúde (Impr.) ; 12(2): 164-169, Agosto/2020.
Article in Portuguese | LILACS, ECOS | ID: biblio-1118330

ABSTRACT

Objetivos: Este trabalho discute os recentes impactos do avanço tecnológico no mercado da saúde e a crescente importância do aumento de custos em toda a sua cadeia e investiga uma alternativa para aumentar o acesso a essas novas tecnologias por um maior número de pessoas na saúde suplementar. Nesse contexto, o objetivo geral proposto para este trabalho foi evidenciar as visões de gestores de saúde com papel de destaque no Brasil a respeito do uso de modelos de compartilhamento de risco (risk sharing) em diferentes geografias e em diferentes financiadores no sistema. Pretendeu-se aprofundar o tema com o cumprimento dos seguintes objetivos específicos, também sob a perspectiva dos participantes da pesquisa: verificar a utilização desses modelos de pagamento e, consequentemente, determinar as características e adaptações necessárias a eles; identificar os desafios para a consolidação do risk sharing na saúde suplementar; verificar o impacto do risk sharing nos custos com saúde das operadoras a partir da percepção dos entrevistados. Métodos: Trata-se de estudo qualitativo, com entrevistas em profundidade com os principais gestores e formadores de opinião em saúde de diferentes instituições no Brasil, totalizando 25 entrevistas. A análise de conteúdo foi escolhida como método de interpretação e construção das categorias para a análise. Resultados: Os resultados foram agrupados nas seguintes categorias: as sugestões e adaptações sugeridas para o melhor funcionamento na realidade brasileira; as críticas e desafios aos modelos propostos. Os resultados sugerem que o compartilhamento de risco pode ser uma alternativa capaz de promover uma nova forma de relacionamento entre os pagadores e a indústria fabricante, substituindo o tradicional modelo de remuneração, que limita a relação linear com todos os setores, buscando sempre o objetivo de atender o paciente com novas alternativas de acesso. Conclusões: Em meio à complexidade do sistema de saúde brasileiro, é importante que os players avaliem novas alternativas de remuneração e incorporação tecnológica. Os desafios são inúmeros, desde a efetivação do perfil dos pacientes elegíveis até a aplicabilidade do risk sharing que ocorre a partir do interesse de ambas as partes em trazer novas tecnologias ao sistema, sem impactos orçamentários significativos, desde que seja viável clínica e economicamente, gerando valor em saúde, na efetividade e nos resultados de desfecho em taxa de sobrevida real


Objectives: This paper discusses the recent impacts of technological advancement on the health market, the growing importance of increasing costs throughout its chain, and investigates an alternative to increasing the access of these new technologies to a greater number of people within supplementary health. In this context, the general objective proposed for this work was to highlight the views of health managers with a prominent role in Brazil regarding the use of risk-sharing models in different regions and in different payers in the system. It was intended to deepen the theme with the fulfillment of the following specific objectives, also from the perspective of the research participants: verify the use of these payment models and consequently determine the characteristics and necessary adaptations for them; identify the challenges for the consolidation of risk-sharing in Supplementary Health; to verify the impact of risk-sharing on health costs of operators based on interviewees' perceptions. Methods: This is a qualitative study with in-depth interviews with main health managers and opinion makers from different institutions in Brazil, totaling 25 interviews. Content analysis was chosen as a method of interpretation and construction of categories for analysis. Results: The results were grouped into the following categories: the suggestions and adaptations suggested for the best operation in the Brazilian reality; criticisms and challenges to the proposed models. The results suggest that risk-sharing may be an alternative capable of promoting a new form of relationship between payers and the manufacturing industry, replacing the traditional remuneration model, which limits the linear relationship with all sectors, always seeking the objective of assisting the patient with new access alternatives. Conclusions: Amid the complexity of the Brazilian health system, it is important for players to evaluate new alternatives for remuneration and technological incorporation. The challenges are innumerable from the realization of the profile of eligible patients and the applicability of risk-sharing that occurs from the interest of both parties in bringing new technologies to the system, without significant budgetary impacts, as long as it is clinically and economically viable, generating health value, effectiveness, and outcomes in survival rates in real world evidences


Subject(s)
Prepaid Health Plans , Drug Industry , Supplemental Health , Access to Essential Medicines and Health Technologies , Insurance, Health
8.
Ciênc. Saúde Colet ; 25(8): 2973-2983, Ago. 2020. tab
Article in Portuguese | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1133123

ABSTRACT

Resumo O estudo descreve as coberturas de planos de saúde e compara a ocorrência de fatores de risco (FR) e proteção de Doenças Crônicas Não Transmissíveis, na população com e sem planos de saúde nas capitais brasileiras. Foram analisados dados do inquérito telefônico Vigitel. Foi utilizado o modelo de regressão de Poisson para estimar a razão de prevalência (RP), comparando FR entre quem tem ou não plano de saúde. A cobertura de planos foi de 49,1%, mais elevada em Goiania, Vitória, Florianópolis e Belo Horizonte, entre adultos acima de 55 anos e com maior escolaridade. A população com planos de saúde apresenta prevalências mais elevadas de fatores de proteção como consumo de frutas e hortaliças (RP = 1,3 IC95% 1,2-1,3), prática de atividade física no tempo livre (RP = 1,2 IC95% 1,2-1,3), mamografia (RP = 1,2 IC95% 1,1-1,3) e Papanicolau (RP = 1,1 IC95% 1,2-1,3), e menor prevalência de FR como tabagismo (RP = 0,7 IC95% 0,6-0,8), avaliação de saúde ruim (RP = 0,8 IC95% 0,6-0,9), obesidade (RP = 0,8 IC95% 0,7-0,9), carne com gordura (RP = 0,9 IC95% 0,8-0,9) e leite com gordura (RP = 0,9 IC95% 0,8-0,9). Independentemente da escolaridade, a população que tem planos de saúde apresenta geralmente, melhores indicadores, como hábitos mais saudáveis e maior cobertura de exames preventivos.


Abstract This study describes the coverage of health insurance and compares the occurrence of risk factors (RF) and protective factors of noncommunicable diseases in the population with and without health insurancesin Brazilianstate capitals. Data from the telephone survey Vigitel was analyzed. The Poisson regression model was used to estimate the prevalence ratio (PR), comparing RF among those who did or did not have a health insurance. Plan coverage was 49.1%, and the highest prevalences were in Goiania, Vitória, Florianópolis, and Belo Horizonte. Adults over 55 years of age and with higher education were more likely to have an insurance. The population with health insurance hada higher prevalence of protective factors, such as fruit and vegetable consumption (PR = 1.3 95% CI 1.2-1.3), physical activity in their free time (PR = 1.2 (95% CI: 1.2-1.3), mammographies (RP = 1.2 IC95% 1.1-1.3) and pap smears (PR = 1.1 IC95% 1.2-1.3), and lower prevalence of RFs such as smoking (RP = 0.7, 95% CI 0.6-0.8), poor health (RP = 0.8 CI95% 0.6-0.9), obesity (RP = 0.8 IC95% 0.7-0.9), consumption of meat with fat (RP = 0.9 IC95% 0.8-0.9) and whole milk (RP = 0.9 IC95% 0,8-0.9). Regardless of educational level, the population that has health insurancesgenerally has better indicators, such as healthier habits and greater coverage of preventive exams.


Subject(s)
Humans , Female , Adult , Noncommunicable Diseases/epidemiology , Socioeconomic Factors , Brazil/epidemiology , Exercise , Prevalence , Cross-Sectional Studies , Risk Factors , Protective Factors , Insurance, Health
9.
Rev. chil. infectol ; 37(2): 111-116, abr. 2020. tab
Article in Spanish | LILACS | ID: biblio-1126096

ABSTRACT

Resumen Introducción: El virus papiloma humano (VPH) causa infecciones transmitidas sexualmente. Objetivos: Conocer la prevalencia de infecciones genitales por VPH, identificar factores clínico-epidemiológicos asociados a dicha prevalencia y determinar la frecuencia de los tipos virales. Material y Métodos: Se estudiaron muestras endo-cervicales de 505 mujeres entre 15 y 49 años, que concurrieron para estudio de exudado vaginal al laboratorio del Instituto de Previsión Social, residentes de Posadas, Misiones, entre enero de 2012 y junio de 2013. Se amplificó una sección de 450 pares de bases del genoma viral perteneciente al fragmento L1 del VPH. La detección del genotipo se realizó mediante el estudio del polimorfismo de la longitud de los fragmentos de restricción (RFLP). Resultados: La prevalencia de la portación de VPH total fue 30,7%, y de éstos 71,6% correspondió a los de alto riesgo (principalmente VPH 16 [35,1%], 58 [10,8%] y 31 [8,1%]). La detección del VPH fue mayor en mujeres de 15 a 24 años (OR: 1,48; IC 95% :1,01-2,18) y con más parejas sexuales (OR:1,81; IC 95%: 1,02-3,22). No hubo asociación con el embarazo, la estabilidad de la pareja, métodos anticonceptivos, edad de inicio de las relaciones sexuales ni tabaquismo. Conclusiones: Los resultados de identificación y tipificación de VPH en este estudio aportan información sobre una prevalencia elevada de VPH en mujeres sexualmente activas, así como porcentajes elevados de genotipos oncogénicos en esta región.


Abstract Background: Human papilloma virus (HPV) is one of the most frequent sexually transmitted infections, especially among young people. Aims: To describe the prevalence of genital HPV infections, to identify clinical-epidemiological factors associated with them and to determine the frequency of viral strains. Methods: Endocervical samples were studied of 505 women between 15 and 49 years old, who attended the laboratory of the Institute of Social Security, residents of Posadas, Misiones, for the study of vaginal exudate, between January 2012 and June 2013. A 450-base pair fragment within the HPV L1 region was amplified. Genotype detection was performed through the study of the restriction fragment length polymorphism (RFLP). Results: The prevalence of total HPV carriage was 30.7%, and of these 71.6% corresponded to high risk (mainly HPV 16 [35.1%], 58 [10.8%] and 31 [8.1%]). HPV detection was higher in women aged 15 to 24 years (OR: 1.48, 95% CI: 1.01-2.18) and with more sexual partners (OR: 1.81, 95% CI: 1, 02-3.22). There was no association with pregnancy, stability of the couple, contraceptive methods, age at onset of sexual intercourse, or smoking. Conclusions: The identification and typing of HPV in this study provides information regarding the high prevalence of HPV and the substantial proportion of cases with oncogenic genotypes among sexually active women in this region of Argentina.


Subject(s)
Humans , Female , Pregnancy , Adolescent , Adult , Middle Aged , Young Adult , Insurance, Health , Papillomaviridae , Argentina , DNA, Viral , Prevalence , Risk Factors , Papillomavirus Infections
10.
Acta fisiátrica ; 27(1): 41-44, mar. 2020.
Article in Portuguese | LILACS | ID: biblio-1129957

ABSTRACT

Objetivo: Investigar a influência de fatores relacionados aos aspectos multidimensionais do envelhecimento em um grupo de idosos com baixo peso assistidos pelo setor privado de saúde. Métodos: Estudo transversal conduzido com 243 idosos com índice de massa corpórea <23 kg/m², todos assistidos por uma operadora de planos de saúde, no município de São Paulo, SP, Brasil, alocados em dois grupos: baixo peso e extremo baixo peso. Para a coleta dos dados empregou-se inquérito contendo informações relacionadas aos aspectos multidimensionais do envelhecimento. Os dados obtidos foram submetidos a análise descritiva das variáveis, com posterior análise comparativa através dos testes t Student e Qui-Quadrado ou exato de Fisher, quando necessário. Para variáveis com significância estatística, aplicou-se regressão logística e calculou-se as Odds Ratio, com intervalo de confiança de 95%. Resultados: Observou-se que, a idade avançada (p=0,044), dificuldade de mobilidade (p=0,011) e baixos níveis de atividade física (p=0.021) influenciam significativamente os idosos em estado nutricional de extremo baixo peso. Por meio do modelo de regressão logística, verificou-se que para cada uma hora de atividade física praticada pelos idosos deste grupo, os riscos de evolução para extremo baixo peso diminuem em até 14%. Conclusão: A pratica regular e orientada de atividade física praticada por idosos com algum grau de déficit nutricional é capaz de prevenir e/ou retardar desfechos indesejados em grupos susceptíveis.


Objective: Investigate the influence of factors related to multidimensional aspects of aging in a group of elderly assisted by the private health sector. Methods: Cross-sectional study conducted with 243 elders with a body mass index <23 kg/m² assisted by a health plan in the city of São Paulo, SP, Brazil, with them being allocated into two groups: low weight and extreme low weight. For data collection, a survey developed by the researchers themselves containing information related to multidimensional aspects of aging was employed. The obtained data were submitted to a descriptive analysis of the variables and a subsequent comparative analysis through Student's t-distribution, Chi-squared or Fisher's exact tests, when necessary. For variables with statistical significance, logistic regression was applied and the odds ratio, with a 95% confidence interval, was calculated. Results: It was observed that advanced age (p=0.044), mobility difficulty (p=0.011) and low levels of physical activity (p=0.021) significantly influence the elderly in extremely low weight nutritional status. Moreover, through the logistic regression model, it was found that, for this group, every hour of physical activity practiced by underweight elders, the risks of evolution to an extreme low weight status decrease by up to 14%. Conclusion: The regular and oriented practice of physical activity by the elderly with some degree of nutritional deficit is able to prevent and/or delay unwanted outcomes in susceptible groups.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Aged, 80 and over , Thinness/prevention & control , Exercise , Health Services for the Aged , Logistic Models , Nutritional Status , Cross-Sectional Studies , Insurance, Health , Life Style
12.
Ciênc. cuid. saúde ; 19: e50520, 20200000.
Article in Portuguese | LILACS, BDENF | ID: biblio-1119573

ABSTRACT

Objective:to clarify the perception of beneficiaries of a health insurance company and their caregivers regarding the Chronic Patients Management program. Methods:descriptive study with a qualitative approach. Data were collected in May and June 2019 through semi-structured interviews with nine beneficiaries participating in the Chronic Patient Management program and seven caregivers. The data assessment was realized through a thematic content analysis. Results: from the interviews analysis, two categories emerged: Support network through the management of the chronic condition and Limitations experienced. In the first category, it was found that the management of the chronic condition by a case manager is seen by the participants and caregivers, as a refuge and support during the illness, contributing to the reduction of costs and burdens for both groups. The second category showed that the limitations were due to administrative barriers inherent to health services and the lack of knowledge when performing case management. Final considerations: with this strategy, there was a burden reduction both on patients and caregivers. However, such results could be enhanced with the consolidation and improvement of the healthcare team, carrying out case discussions and elaborating care plans, mainly by implementing home visits in the program.


Objetivo: elucidar a percepção dos beneficiários de uma Operadora de Saúde e seus cuidadores a respeito do programa de Gestão de Doentes Crônicos. Método: estudo descritivo de abordagem qualitativa. Os dados foram coletados em maio e junho de 2019 por meio de entrevista semiestruturada com nove beneficiários participantes do programa de Gestão de Doentes Crônicos e sete cuidadores. A apreciação dos dados sucedeu por análise de conteúdo modalidade temática.Resultado: da análise das entrevistas emergiram duas categorias: Rede de apoio mediante o gerenciamento da condição crônica e Limitações experienciadas. Na primeira categoria, constatou-se que o Gerenciamento da condição crônica por um Gestor de caso é visto pelos participantes e cuidadores como refúgio e amparo durante o adoecimento e, dessa forma, contribui na diminuição dos encargos e sobrecarga para ambos os grupos. Já na segunda categoria, depreende-se que as limitações decorreram por entraves administrativos inerentes dos serviços de saúde e pelo desconhecimento de estarem realizando a Gestão de Caso. Considerações Finais: Com essa estratégia houve a diminuição da sobrecarga do paciente e do cuidador, contudo tais resultados poderão ser potencializados com a solidificação e aperfeiçoamento da equipe, realização de discussões de casos, elaboração de planos de cuidados e, principalmente, ao se implantarem visitas domiciliares no programa,


Subject(s)
Humans , Male , Female , Chronic Disease , Caregivers , Patient Care Team , Patients , Health , Nursing , Health Strategies , Supplemental Health , Disease Prevention , Health Promotion , Health Services , House Calls , Insurance, Health , Nurses
13.
Rev. saúde pública (Online) ; 54: 20, 2020. tab, graf
Article in English | LILACS | ID: biblio-1094413

ABSTRACT

ABSTRACT OBJECTIVE To compare the access to and effective use of health services available among international migrants and Chileans. METHODS Secondary analysis of the National Socioeconomic Characterization Survey (CASEN - Caracterización Socioeconómica Nacional ), version 2017. Indicators of access to the health system (having health insurance) and effective use of health services (perceived need, appointment or coverage, barriers and need satisfaction) were described in immigrants and local population, self-reported. Gaps by immigrant status were estimated using logistic regressions, with complex samples. RESULTS Immigrants were 7.5 times more likely to have no health insurance than local residents. Immigrants presented less perceived need than local residents, together with a greater lack of appointments (OR: 1.7 95%CI: 1.2-2.5), coverage (OR: 2.7 95%CI: 2.0-3.7) and unsatisfied need. The difference between immigrants and locals was not statistically significant in barriers to health care access (α = 0.005). CONCLUSIONS Disadvantages persist regarding the access to and use of health services by immigrants as opposed to Chileans compared with information from previous years. It is necessary to reduce the gaps between immigrants and people born in Chile, especially in terms of health system access. This is the first barrier to effective use of services. The generation of concrete strategies and health policies that consider an approach of social participation of the immigrant community is suggested to bring the health system closer to this population.


RESUMEN OBJETIVO Comparar el acceso y uso efectivo de servicios de salud disponibles entre migrantes internacionales y chilenos. MÉTODOS Análisis secundario de la encuesta poblacional de Caracterización Socioeconómica Nacional (CASEN), versión 2017. Se describieron indicadores de acceso al sistema de salud (tener previsión de salud) y uso efectivo de servicios de salud (necesidad sentida, consulta o cobertura, barreras y satisfacción de la necesidad) en inmigrantes y locales, autorreportados. Las brechas por condición de inmigrante se estimaron utilizando regresiones logísticas, con muestras complejas. RESULTADOS Los inmigrantes presentaron 7,5 veces más chances de no tener previsión de salud que los locales. Los inmigrantes presentaron una menor necesidad sentida que los locales, en conjunto con una mayor falta de consulta (OR: 1,7 IC95%: 1,2-2,5), cobertura (OR: 2,7 IC95%: 2,0-3,7) e insatisfacción de necesidades. La diferencia entre inmigrantes y locales no fue estadísticamente significativa en barreras de acceso a atención en salud (α = 0,005). CONCLUSIONES Persisten las desventajas en acceso y uso a servicios de salud en inmigrantes en comparación con los nacidos en Chile en contraste con información de años anteriores. Es necesario reducir las brechas entre inmigrantes y nacidos en Chile, sobre todo en cuanto a pertenencia a un sistema de salud. Esta es la primera barrera para un uso efectivo de servicios. Se sugiere generar estrategias concretas y políticas en salud que consideren un enfoque de participación social de la comunidad inmigrante y, adicionalmente, acerquen al sistema de salud a esta población.


Subject(s)
Humans , Male , Female , Public Policy , Needs Assessment/statistics & numerical data , Emigrants and Immigrants/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Insurance, Health/statistics & numerical data , Rural Population/statistics & numerical data , Socioeconomic Factors , Transients and Migrants/statistics & numerical data , Urban Population/statistics & numerical data , Chile , Residence Characteristics , Cross-Sectional Studies , Health Surveys , Health Status Disparities , Self Report
14.
Acta Medica Philippina ; : 686-691, 2020.
Article in English | WPRIM | ID: wpr-876825

ABSTRACT

@#Objectives. The health financing scheme brought by the Universal Health Care Act has a significant change in the landscape of allocating funds for health services, as well as in the delineation of roles among the key actors. Consistent with the law, the protection from the health financial risks of Filipinos must be guaranteed. This study aimed to determine the roles of the government and other key agencies in financing population-based and individual-based health services in the Philippines. Methods. A systematic review of literature was done to generate evidence for the policy brief and proposed policy alternatives. The UP Manila Health Policy Development Hub organized a roundtable discussion in collaboration with the Department of Health participated by key stakeholders from various sectors involved in the policy issue. Systematic review and insights from the discussion were analyzed to produce consensus policy recommendations. Results. Given the current procurement and financing, the DOH should fund population-based services while PhilHealth, with the assistance of Health Maintenance Organizations (HMO) for premium holders, should fund individual-based services. Health programs with grey areas (i.e. with both individual- and population-based service) need further technical discussions. It is imperative to have clear-cut specific guidelines on the managerial and financial roles of the provincial health board and the scope of financing service delivery. Conclusion. Delineating the roles of DOH, PhilHealth, and HMOs in financing health services is not without risks. The utilization of the special health fund at the provincial level should be carefully implemented and monitored to minimize inefficiencies and fraud.


Subject(s)
Healthcare Financing , Universal Health Insurance , Insurance, Health
15.
Article in Korean | WPRIM | ID: wpr-811302

ABSTRACT

Due to technological advances and the establishment of evidence-based medicine, radiological examinations are playing a crucial role in modern medicine, as a result of which they have been steadily increasing, and the rate of increase has intensified in the 2000s. Although this is a global phenomenon, the increase of radiological examinations in Korea is also high due to the introduction of the National Health Insurance Coverage Expansion Policy, so-called Moon Jae-in Care, for ultrasonography and magnetic resonance imaging. For accurate and rapid diagnosis of diseases, it is necessary for doctors to order appropriate radiological studies. However, the increase in radiological examination has created many problems, such as increased medical costs, decreased diagnostic accuracy due to radiologist burnout, and increased patient exposure to radiation. To reduce unnecessary imaging studies, a number of measures could be deployed including the development of clinical guidelines to select appropriate radiological examinations for each clinical situation.


Subject(s)
Diagnosis , Evidence-Based Medicine , History, Modern 1601- , Humans , Insurance, Health , Korea , Magnetic Resonance Imaging , Moon , National Health Programs , Ultrasonography
16.
Article in English | WPRIM | ID: wpr-810957

ABSTRACT

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.


Subject(s)
Abdomen , Budgets , Chest Pain , Critical Care , Dyspnea , Emergencies , Heart , Heart Arrest , Insurance Coverage , Insurance , Insurance, Health , Korea , Medical Records , National Health Programs , Patient Care , Point-of-Care Systems , Prescriptions , Shock , Thorax , Ultrasonography
17.
Article in English | WPRIM | ID: wpr-810956

ABSTRACT

BACKGROUND: The big data provided by Health Insurance Review and Assessment (HIRA) contains data from nearly all Korean populations enrolled in the National Health Insurance Service. We aimed to identify the incidence of facial fractures and its trends in Korea using this big data from HIRA.METHODS: We used the Korean Standard Classification of Disease and Cause of Death 6, 7 for diagnosis codes. A total of 582,318 patients were included in the final analysis. All statistical analyses were performed using SAS software and SPSS software.RESULTS: The incidence of facial fractures consistently declined, from 107,695 cases in 2011 to 87,306 cases in 2016. The incidence of facial fractures was the highest in June 2011 (n = 26,423) and lowest in January 2014 (n = 10,282). Nasal bone fractures were the most common, followed by orbit and frontal sinus fractures. The percentage of nasal bone fractures declined, whereas those of orbital fractures increased from 2011 to 2016 (P < 0.001). Among orbital fractures, inferior wall fractures were the most common, followed by medial wall fractures. Among mandibular fractures, angle fractures were the most common, followed by condylar process and symphysis fractures. Although it was difficult to predict the most common type of zygomatic and maxilla fractures, their incidence consistently declined since 2011.CONCLUSION: We observed trends in facial fractures in Korea using big data including information for nearly all nations in Korea. Therefore, it is possible to predict the incidence of facial fractures. This study is meaningful in that it is the first study that investigated the incidence of facial fractures by specific type.


Subject(s)
Cause of Death , Classification , Diagnosis , Facial Bones , Fractures, Bone , Frontal Sinus , Humans , Incidence , Insurance, Health , Korea , Mandibular Fractures , Maxilla , Nasal Bone , National Health Programs , Orbit , Orbital Fractures
18.
Article in Korean | WPRIM | ID: wpr-820821

ABSTRACT

OBJECTIVES: This study aimed to estimate the financial budget of fluoride application in the National Health Insurance.METHODS: The amount of fluoride application was calculated by using the sealant rate (utilization rate 1), dental examination rate (utilization rate 2), and the average rate of these two (utilization rate 3) in children and adolescents. For the next five years, 100% of the existing fees were applied to estimate the financial budget.RESULTS: The total budget for children and adolescents was estimated to be 22.0 billion won minimum and 83.5 billion won maximum in the first year, and 104.8 billion won minimum and 398.5 billion won maximum up to the next five years. Moreover, in high risk groups, the total budget was estimated to be 4.2 billion won minimum and 16.1 billion won maximum in the first year, and 18.6 billion won minimum and 70.8 billion won maximum up to the next five years.CONCLUSIONS: The financial budget of fluoride application coverage for children and adolescents was similar or lower than that of the current dental sealants. It needs to implement promptly with the reason of financial saving over the long-term point of view. Based on this evidence, it is affordable and necessary to begin to promote oral health for children and adolescents.


Subject(s)
Adolescent , Budgets , Child , Fees and Charges , Fluorides , Humans , Insurance, Health , National Health Programs , Oral Health , Pit and Fissure Sealants
20.
Article in English | WPRIM | ID: wpr-786209

ABSTRACT

BACKGROUND AND OBJECTIVES: We aim to explore the additional discriminative accuracy of a deep learning (DL) algorithm using repeated-measures data for identifying people at high risk for cardiovascular disease (CVD), compared to Cox hazard regression.METHODS: Two CVD prediction models were developed from National Health Insurance Service-Health Screening Cohort (NHIS-HEALS): a Cox regression model and a DL model. Performance of each model was assessed in the internal and 2 external validation cohorts in Koreans (National Health Insurance Service-National Sample Cohort; NHIS-NSC) and in Europeans (Rotterdam Study). A total of 412,030 adults in the NHIS-HEALS; 178,875 adults in the NHIS-NSC; and the 4,296 adults in Rotterdam Study were included.RESULTS: Mean ages was 52 years (46% women) and there were 25,777 events (6.3%) in NHIS-HEALS during the follow-up. In internal validation, the DL approach demonstrated a C-statistic of 0.896 (95% confidence interval, 0.886–0.907) in men and 0.921 (0.908–0.934) in women and improved reclassification compared with Cox regression (net reclassification index [NRI], 24.8% in men, 29.0% in women). In external validation with NHIS-NSC, DL demonstrated a C-statistic of 0.868 (0.860–0.876) in men and 0.889 (0.876–0.898) in women, and improved reclassification compared with Cox regression (NRI, 24.9% in men, 26.2% in women). In external validation applied to the Rotterdam Study, DL demonstrated a C-statistic of 0.860 (0.824–0.897) in men and 0.867 (0.830–0.903) in women, and improved reclassification compared with Cox regression (NRI, 36.9% in men, 31.8% in women).CONCLUSIONS: A DL algorithm exhibited greater discriminative accuracy than Cox model approaches.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02931500


Subject(s)
Adult , Artificial Intelligence , Cardiovascular Diseases , Cohort Studies , Female , Follow-Up Studies , Humans , Insurance, Health , Learning , Male , Mass Screening , National Health Programs
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