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1.
Ciênc. Saúde Colet ; 24(12): 4579-4586, dez. 2019.
Article in Spanish | LILACS | ID: biblio-1055763

ABSTRACT

Resumen El presente artículo indaga sobre la participación popular en salud en barrios de la periferia de La Plata (Argentina) en un contexto de vaciamiento de las políticas sociales de acuerdo a las normativas neoliberales que rigen con fuerza creciente en el país y en el continente. En este marco de crisis económica que afecta particularmente a la salud pública, los movimientos sociales se organizan para defenderla, al mismo tiempo que resisten el empobrecimiento cotidiano y construyen alternativas de salud popular y colectiva. El trabajo, sostenido en una investigación etnográfica, se propone reconstruir los modos en que los sujetos reconfiguran los modos de pensar la salud y la participación política en la vida cotidiana de los territorios a través de distintas tácticas y estrategias de cuidado y construcción político-comunitarias.


Abstract This article investigates the popular participation in health in neighborhoods of the periphery of La Plata (Argentina) in a context of emptying of social policies according to the neo-liberal regulations that govern with increasing force in the country and in the continent. In this framework of economic crisis that especially affects public health, social movements are organized to defend, while resisting daily impoverishment and building popular and collective health alternatives. The work, sustained in an ethnographic investigation, aims to reconstruct the ways in which the subjects reconfigure the ways of thinking about health and political participation in the daily life of the territories through different tactics and strategies of care and community-political construction.


Subject(s)
Humans , Politics , Social Justice , Residence Characteristics , Public Health , Community Participation/methods , Economic Recession , Argentina , Public Sector/economics , Public Sector/organization & administration , Private Sector/economics , Qualitative Research , Right to Health/trends , Health Promotion/methods , Health Services Accessibility , Insurance, Health/economics , Insurance, Health/organization & administration , Anthropology, Cultural , National Health Programs/organization & administration
2.
Ciênc. Saúde Colet ; 24(7): 2727-2736, jul. 2019. tab
Article in English | LILACS | ID: biblio-1011842

ABSTRACT

Abstract To describe the last place of medical and dental health service used in relation to private health plans, and examine the effect of being registered in the primary healthcare system through the Family Health Strategy (FHS). This was a cross-sectional study using data from Brazil's 2008 National Household Survey. Multinomial logistic regression was performed to analyze how a private health plan and enrollment in the FHS influenced the use of health services. Results showed that individuals with a private health plan tend to use medical and dental services more than individuals without such a plan. However, many individuals with a private health plan used public services or paid out-of-pocket services, mainly for dental care. Among individuals without a private plan, being enrolled in the FHS reduced the use of out-of-pocket private services, regardless of age, income or educational level. Enrollment in the FHS increased the chances of using public services, and the effect of this enrollment is greater among those who have a private plan. Policies to strengthen public primary healthcare and to expand the FHS should be encouraged within the universal health system.


Resumo O objetivo deste estudo foi descrever os locais usados na última visita a serviços médicos e odontológicos no Brasil em relação à posse de plano privados de saúde, e examinar o efeito de estar cadastrado na Estratégia de Saúde da Família (ESF). Este é um estudo transversal que utiliza dados da Pesquisa Nacional de Amostra Domiciliar (PNAD) de 2008 no Brasil. Regressão logística multinomial foi realizada para analisar a influência da posse de plano privado de saúde e o cadastro na ESF no uso do serviço de saúde. Os resultados mostraram que os indivíduos com plano de saúde tendem a usar mais os serviços médico-odontológicos do que indivíduos sem plano privado. Porém, muitos indivíduos com planos usam serviços públicos ou privados com pagamento direto, principalmente para serviços odontológicos. Dentre indivíduos sem plano, estar cadastrado na ESF reduziu as chances de uso de serviços privados com pagamento direto, independente de idade, renda e nível educacional. Estar cadastrado na ESF aumentou o uso de serviços públicos e o efeito foi mais forte dentre indivíduos com planos privados. Políticas para fortalecer a atenção primária à saúde e expandir a ESF devem ser incentivadas.


Subject(s)
Humans , Primary Health Care/statistics & numerical data , Family Health , Dental Health Services/statistics & numerical data , National Health Programs/organization & administration , Primary Health Care/economics , Brazil , Cross-Sectional Studies , Surveys and Questionnaires , Dental Health Services/economics , Health Policy , Insurance, Health/economics , National Health Programs/economics
3.
Ciênc. Saúde Colet ; 24(3): 705-714, mar. 2019. tab
Article in Portuguese | LILACS | ID: biblio-989588

ABSTRACT

Resumo O presente trabalho evidenciou o processo de trabalho do cirurgião-dentista (CD) no setor de saúde suplementar a partir da visão do profissional, sob a luz da Bioética de Intervenção. Foi realizado um estudo observacional-seccional do tipo inquérito circunscrito à região do Distrito Federal. Os dados foram coletados por meio de 108 questionários respondidos por CDs credenciados à duas modalidades de operadora: autogestão e odontologia de grupo, com a finalidade de conhecer a percepção e o grau de satisfação profissional diante do mercado de trabalho odontológico. A insatisfação maior por parte dos profissionais foi relacionada à remuneração dos trabalhos odontológicos pelas operadoras. Para a operadora de autogestão 1, 38,1% dos profissionais responderam que a remuneração era satisfatória, enquanto para a de autogestão 2 e odontologia de grupo, houve 100% de insatisfação. Outro dado encontrado foi que a operadora de odontologia de grupo restringiu os tratamentos selecionados aos pacientes de forma expressiva. Conclui-se que existe a perda de autonomia profissional, desvalorização dos ressarcimentos e precarização do trabalho odontológico na saúde suplementar, demonstrando conflitos éticos nessa relação de trabalho.


Abstract The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Subject(s)
Humans , Attitude of Health Personnel , Dentistry/organization & administration , Dentists/statistics & numerical data , Job Satisfaction , Bioethics , Cross-Sectional Studies , Surveys and Questionnaires , Professional Autonomy , Private Sector/economics , Private Sector/organization & administration , Health Care Sector/economics , Health Care Sector/organization & administration , Dentists/economics , Dentists/psychology , Insurance, Health/economics
4.
Article in English | AIM, AIM | ID: biblio-1264489

ABSTRACT

The high cost and effect of out of pocket payments for health care on households in developing countries have led to the use of community-based health insurance (CBHI) as a viable alternative for health care funding. The overall objective of the study was to assess the perception and determinants of willingness-to-pay (WTP) for a proposed community based health insurance scheme in urban and rural households in Lagos State. The multi-stage sampling technique was used with 960 household heads enrolled in the study. A pre-tested, semi-structured, interviewer administered questionnaire was used to collect data from the respondents. The contingent valuation method was used to elicit household willingness to enrol and pay for a proposed community based health insurance scheme. Data was analysed using Statistical Package for Social Sciences software (SPSS) version 17. This study revealed that 86.3% of the households in the rural LGA and 78.6% of the households in the urban LGA were willing to pay for the proposed community based health insurance scheme (p=<0.001). The households were willing to pay a mean amount of ₦957.56 and ₦754.83/ household/ month in the urban and rural area respectively (p<0.001). The paper concludes by emphasizing the high willingness among households to participate in the proposed hypothetical CHBI scheme. This highlights its prospects of increasing access to quality health care in Lagos especially amongst vulnerable low-income households


Subject(s)
Family Characteristics , Healthcare Financing , Insurance, Health/economics , Lakes , Nigeria , Socioeconomic Factors
5.
Rev. méd. Chile ; 146(6): 737-744, jun. 2018. tab
Article in Spanish | LILACS | ID: biblio-961454

ABSTRACT

Background: People need a financial protection system to face the high costs of health care. Aim: To compare the financial protection between households affiliated to the Chilean public health financing system (FONASA) or to a private health financing system (ISAPRE). To describe the evolution of protection at the national level between 2007 and 2012. Material and Methods: As proposed by the World Bank, impact indicators to measure the equity and efficiency of the insurance systems were generated. Namely, average out-of-pocket expenses by insurance and average out-of-pocket spending as a percentage of expenditure. Also, the evolution of out-of-pocket spending by quintiles and Gini Coefficient were measured as measure of equity. To determine these, Family Budget Surveys for 2007 and 2012 were used. Results: Household out-of-pocket spending increased by 14.12%. When expressed as a percentage of total expenditure, it grew from 5.6% to 6.2%. Household Gini coefficient and per capita out-of-pocket spending decreased and the ratio between the highest and lowest quintile out-of-pocket increased at both analysis levels. Pocket expense in absolute values or expressed as a percentage of total expenses was higher among persons insured in private systems than those affiliated to the public financing service. Conclusions: Out-of-pocket spending increased for all income groups and people insured in the public system had a lower absolute and relative spending than those insured in private systems.


Subject(s)
Humans , Health Expenditures/statistics & numerical data , Healthcare Financing , Financing, Government/economics , Financing, Personal/economics , Insurance, Health/economics , Reference Values , Socioeconomic Factors , Time Factors , Algorithms , Chile , Family Characteristics , Financing, Government/statistics & numerical data , Financing, Personal/statistics & numerical data , Income/statistics & numerical data , Insurance, Health/statistics & numerical data
6.
Ciênc. Saúde Colet ; 23(6): 2035-2042, jun. 2018. tab
Article in Portuguese | LILACS | ID: biblio-952665

ABSTRACT

Resumo Este artigo estimou o gasto tributário em saúde tendo como base os dados oficiais da Receita Federal do Brasil entre 2003 e 2015. O Ministério da Saúde poderá assim avaliar o papel de tais subsídios no contexto do subfinanciamento do Sistema Único de Saúde. Para a análise dos dados, articularam-se dois eixos teóricos: os estudos relacionados à economia política da saúde e às finanças públicas. Vale dizer, ao lado da dimensão empírica do trabalho, se privilegiou a avaliação das políticas de saúde no campo do financiamento setorial. Os resultados apontam que o subsídio associado aos planos de saúde atingiu o montante de R$ 12,5 bilhões em 2015, o que poderia ampliar a alocação de recursos financeiros na atenção primária e nos bens e serviços de média complexidade tecnológica.


Abstract Using official data from Brazil's Internal Revenue Service, this article estimates health-related federal tax expenditures between 2003 and 2015. The Ministry of Health will thus be able to assess the relevance of these subsidies within a context of gross underfunding of Brazil's public health system. The analysis was built around concepts and theories developed in the fields of political economy and public finance, focusing on policies directed at public funding of the health sector. The results show that tax expenditures associated with health insurance plans was R$12.5 billion in 2015. It is suggested that these resources could be put to better use in public primary care and medium-complexity care services.


Subject(s)
Humans , Health Expenditures/trends , Delivery of Health Care/economics , Healthcare Financing , National Health Programs/economics , Politics , Primary Health Care/economics , Public Policy , Taxes/economics , Taxes/trends , Brazil , Delivery of Health Care/organization & administration , Delivery of Health Care/trends , Insurance, Health/economics , Insurance, Health/trends , National Health Programs/organization & administration , National Health Programs/trends
7.
Salud pública Méx ; 60(2): 130-140, mar.-abr. 2018. tab
Article in Spanish | LILACS | ID: biblio-962452

ABSTRACT

Resumen: Objetivos: Determinar el impacto del Seguro Popular (SPS) en los gastos catastróficos y empobrecedores de los hogares y la protección financiera del sistema de salud en México. Material y métodos: Se aplicó el método de pareo por puntaje de propensión sobre la afiliación al SPS y se determinó el efecto atribuible en el gasto en salud. Se hizo uso de la Encuesta Nacional de Ingresos y Gastos de los Hogares (ENIGH) de 2004 a 2012, del Instituto Nacional de Estadística y Geografía. Resultados: El SPS tiene un efecto significativo reductor en la probabilidad de sufrir gastos empobrecedores. En lo que respecta a los gastos catastróficos hubo reducción sin ser significativa entre grupos. Conclusión: Este estudio demuestra el efecto que el SPS, y en particular el aseguramiento en salud, tiene como un instrumento de protección financiera. Para futuros estudios se propone analizar la persistencia del alto porcentaje del gasto de bolsillo aprovechando series de tiempo más largas de la ENIGH.


Abstract: Objective: To determine the impact of Seguro Popular (SPS) on catastrophic and impoverishing household expenditures and on the financial protection of the Mexican health system. Materials and methods: The propensity score matching (PSM) method was applied to the population affiliated to SPS to determine the program's attributable effect on health expenditure. This analysis uses the National Household Income and Expenditure Survey (ENIGH) during 2004-2012, conducted by Mexico's National Institute of Statistics and Geography (INEGI). Results: It was found that SPS has a significant effect on reducing the likelihood that households will incur impoverishing expenditures. A negative effect on catastrophic expenditures was also found, but it was not statistically significant. Conclusion: This paper shows the effect that SPS, in particular health insurance, has as an instrument of financial protection. Future studies using longer periods of ENIGH data should analyze the persistence of high out-of-pocket expenditure.


Subject(s)
Humans , Health Expenditures/statistics & numerical data , Insurance, Health/economics , Poverty , Time Factors , Mexico
8.
Cad. Saúde Pública (Online) ; 34(3): e00058517, 2018. tab, graf
Article in Spanish | LILACS | ID: biblio-889895

ABSTRACT

La coyuntura venezolana está marcada por una profunda crisis socioeconómica que genera interrogantes sobre sus efectos en el sistema de salud. El objetivo de este trabajo fue analizar las tendencias y la situación actual del sistema de salud venezolano, con especial énfasis en la financiación. Teniendo por base el marco de acción de la Organización Mundial de la Salud para el fortalecimiento de los sistemas de salud, fueron estudiados cinco de los seis componentes básicos del sistema, así como los resultados en términos de cobertura y salud de la población. El financiamiento de la salud en Venezuela resultó ser primordialmente privado, con un elevado y creciente componente de gasto de bolsillo que se coloca entre los mayores del mundo. Asimismo, el sector salud mostró una baja prioridad fiscal, con un gasto público reducido y vulnerable ante las oscilaciones de los precios del petróleo. Por otro lado, la prestación y el acceso efectivo a los servicios de salud se ha visto comprometido en años recientes, debido -entre otros factores- a la disminución en la disponibilidad de médicos, particularmente para algunas especialidades; fallas en la dotación y equipos médicos de los centros de salud; escasez de insumos médicos, medicamentos y vacunas, afectando la salud de la población que registra algunos retrocesos. Las características estructurales de la economía y la dinámica coyuntural socioeconómica han impactado en el sistema de salud venezolano, profundizando problemas de vieja data como la fragmentación, segmentación y "privatización" del sistema y provocando el surgimiento de nuevas dificultades como escasez de medicamentos, opacidad en la información, entre otros.


The situation in Venezuela is marked by a profound socioeconomic crisis that raises questions concerning its effects on the health system. The study's aim was to analyze the trends and current situation of the Venezuelan health system, with special emphasis on financing. Based on the World Health Organization's Framework for Action to Strengthen Health Systems, five of the system's six basic components were studied, along with the results in terms of coverage and the population's health. Healthcare financing in Venezuela proved to be primarily private, with a high and growing share of out-of-pocket expenditures, one of the highest in the world. The health sector is also assigned low fiscal priority, with a reduced public budget, vulnerable to fluctuations in oil prices. Meanwhile, health services provision and effective access have been jeopardized in recent years due to the decreased availability of physicians, particularly in some specialties, gaps in provision and medical equipment in health centers, and shortage of medical inputs, medicines, and vaccines, among other factors, affecting the population's health, worsening of several indicators. The economy's structural characteristics and socioeconomic dynamics have impacted the Venezuelan health system, aggravating longstanding problems like the system's fragmentation, segmentation, and "privatization", triggering the emergence of new difficulties like shortage of medicines and lack of accountability, among others.


A conjuntura venezuelana está caracterizada por uma profunda crise socioeconômica que gera interrogantes sobre os seus efeitos no sistema de saúde. O objetivo deste trabalho foi analisar as tendências e a situação atual do sistema de saúde venezuelano, com especial ênfase no financiamento. Tendo por base o marco de ação da Organização Mundial da Saúde para o fortalecimento dos sistemas de saúde, foram estudados cinco dos seis componentes básicos do sistema, assim como os resultados em termos de cobertura e saúde da população. O financiamento da saúde na Venezuela acabou por ser, sobretudo, privado, com um elevado e crescente componente de despesas diretas que fica entre os maiores do mundo. Além disso, o setor da saúde revelou uma baixa prioridade fiscal, com despesas públicas reduzidas e vulneráveis perante as oscilações dos preços do petróleo. Por outro lado, a prestação e o acesso efetivo aos serviços de saúde foram comprometidos nos anos recentes, devido -entre outros fatores- à redução na disponibilização de médicos, particularmente para algumas especialidades; falhas na dotação e equipes médicas dos centros de saúde; carência de material médico, remédios e vacinas, afetando a saúde da população que registra alguns retrocessos. As características estruturais da economia e a dinâmica conjuntural socioeconómica tem atingido o sistema de saúde venezuelano, aprofundando problemas de longa data como a fragmentação, segmentação e "privatização" do sistema, gerando o surgimento de novas dificuldades como a carência de medicamentos, ausência de transparência na informação, entre outros.


Subject(s)
Humans , Health Services/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Insurance, Health/statistics & numerical data , Medication Systems/statistics & numerical data , Venezuela , World Health Organization , Privatization , Government Regulation , Government Programs , Health Services/economics , Health Services Accessibility/economics , Insurance, Health/economics , Medication Systems/economics
9.
Cad. Saúde Pública (Online) ; 33(10): e00141515, oct. 2017. tab, graf
Article in Portuguese | LILACS | ID: biblio-952312

ABSTRACT

Resumo: Este estudo foi desenhado para avaliar a cobertura por plano de saúde e seus motivos em uma população coberta pela Estratégia Saúde da Família. Nesta análise, descrevemos a cobertura por plano de saúde, total e por tipos, e analisamos sua associação com características de saúde e sociodemográficas. Entre os 31,3% (IC95%: 23,8-39,9) de pessoas que relatavam cobertura por "plano de saúde", 57,0% (IC95%: 45,2-68,0) estavam cobertos por cartões de desconto, que não oferecem qualquer tipo de cobertura para assistência médica, apenas descontos em farmácias, clínicas e hospitais. Tanto no caso dos planos de saúde quanto no dos cartões de desconto, os motivos para cobertura mais frequentemente relatados foram "para a segurança" e "para ter melhor atendimento". Ambas as coberturas se associaram à idade (65+ versus 15-24 anos: odds ratio ajustada, ORa = 2,98; IC95%: 1,28-6,90; e ORa = 3,67; IC95%: 2,22-6,07, respectivamente) e ao nível econômico (desvio padrão adicional: ORa = 2,25; IC95%: 1,62-3,14; e ORa = 1,96; IC95%: 1,34-2,97). Além disso, a cobertura por plano de saúde se associou à escolaridade (ORa = 7,59; IC95%: 4,44-13,00) para Ensino Superior completo e ORa = 3,74 (IC95%: 1,61-8,68) para Ensino Médio completo, em comparação a menos do que o Ensino Fundamental completo. Por outro lado, nem a cobertura por plano de saúde nem a por cartão de desconto se mostraram associadas ao estado de saúde ou ao número de doenças diagnosticadas. Em conclusão, estudos que pretendam avaliar a cobertura por saúde suplementar deveriam ser planejados de forma a poderem distinguir entre cartões de desconto e planos de saúde formais.


Abstract: This study was designed to assess the reasons for health insurance coverage in a population covered by the Family Health Strategy in Brazil. We describe overall health insurance coverage and according to types, and analyze its association with health-related and socio-demographic characteristics. Among the 31.3% of persons (95%CI: 23.8-39.9) who reported "health insurance" coverage, 57.0% (95%CI: 45.2-68.0) were covered only by discount cards, which do not offer any kind of coverage for medical care, but only discounts in pharmacies, clinics, and hospitals. Both for health insurance and discount cards, the most frequently cited reasons for such coverage were "to be on the safe side" and "to receive better care". Both types of coverage were associated statistically with age (+65 vs. 15-24 years: adjusted odds ratios, aOR = 2.98, 95%CI: 1.28-6.90; and aOR = 3.67; 95%CI: 2.22-6.07, respectively) and socioeconomic status (additional standard deviation: aOR = 2.25, 95%CI: 1.62-3.14; and aOR = 1.96, 95%CI: 1.34-2.97). In addition, health insurance coverage was associated with schooling (aOR = 7.59, 95%CI: 4.44-13.00) for complete University Education and aOR = 3.74 (95%CI: 1.61-8.68) for complete Secondary Education, compared to less than complete Primary Education. Meanwhile, neither health insurance nor discount card was associated with health status or number of diagnosed diseases. In conclusion, studies that aim to assess private health insurance should be planned to distinguish between discount cards and formal health insurance.


Resumen: Este estudio se diseñó para evaluar la cobertura por seguro de salud y sus causas en una población cubierta por la Estrategia Salud de la Familia. En este análisis, describimos la cobertura por seguro de salud, total y por tipos, y analizamos su asociación con características de salud y sociodemográficas. Dentro del 31,3% (IC95%: 23,8-39,9) de personas que informaban contar con una cobertura por "seguro de salud" un 57,0% (IC95%: 45,2-68,0) estaban cubiertas por tarjetas de descuento, que no ofrecen cualquier tipo de cobertura para la asistencia médica, solamente descuentos en farmacias, clínicas y hospitales. Tanto en el caso de los seguros de salud, como en el de las tarjetas de descuento, los motivos de cobertura más frecuentemente relatados fueron "por seguridad" y "para tener una mejor atención". Ambas coberturas se asociaron a la edad (65+ versus 15-24 años: odds ratio ajustada, ORa = 2,98; IC95%: 1,28-6,90; y ORa = 3,67; IC95%: 2,22-6,07, respectivamente), y al nivel económico (desvío patrón adicional: ORa = 2,25; IC95%: 1,62-3,14; y ORa = 1,96; IC95%: 1,34-2,97). Además, la cobertura por seguro de salud se asoció a la escolaridad (ORa = 7,59; IC95%: 4,44-13,00) para la Enseñanza Superior completa y ORa = 3,74 (IC95%: 1,61-8,68) para el Nivel Medio completo, en comparación con los menores índices por la Enseñanza Fundamental completa. Por otro lado, ni la cobertura por seguro de salud, ni la por tarjeta de descuento, se mostraron asociadas al estado de salud o al número de enfermedades diagnosticadas. En conclusión, los estudios que pretendan evaluar la cobertura de seguro de salud privado se deberían planear de tal forma que puedan distinguir entre tarjetas de descuento y seguros de salud formales.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Young Adult , Medically Uninsured/statistics & numerical data , Health Services Accessibility/statistics & numerical data , Insurance, Health/statistics & numerical data , Socioeconomic Factors , Brazil , Family Health , Health Expenditures/statistics & numerical data , Health Services Accessibility/economics , Insurance, Health/economics , Middle Aged , National Health Programs
10.
Ciênc. saúde coletiva ; 22(5): 1631-1640, maio 2017. tab
Article in Spanish | LILACS | ID: biblio-839958

ABSTRACT

Resumen El Informe Mundial de Salud 2010 de la OMS delineó un marco conceptual para analizar los componentes de la Cobertura Universal de Salud, sugiriendo tres dimensiones: cobertura del servicio, cobertura financiera y cobertura de la población. A partir de ese marco, se analizan los gastos relacionados a la salud en los hogares argentinos en el año 2012/13. Para el análisis se utilizó como fuente de datos la Encuesta Nacional de Gastos de Hogares 2012/13. Se construyeron indicadores de gasto en salud de los hogares siguiendo la propuesta de Sherri (2012) y se definieron modelos multivariados para identificar determinantes del gasto de los hogares. Los resultados evidencian que la situación de gasto catastrófico en compromete al 2,3% de los hogares del país, mientras que el empobrecimiento debido al gasto en salud se encontró en el 1,7% de los hogares.


Abstract The 2010 World Health Report of WHO established a conceptual framework for the analysis of the components of Universal Health Coverage; three dimensions were suggested: services coverage, financial coverage, and population coverage. Within this framework, health-related spending of argentine households for the year 2012-2013 are analyzed. The analysis was performed on data retrieved from the National Survey of Household Expenditure 2012-2013. Household healthcare expenditure indicators were built following Sherri’s proposal (2012) and multivariate models were defined to identify determiners of household spending. Results indicate that catastrophic spending situations affect 2.3% of the country households, whereas impoverishment resulting from spending on healthcare was detected in 1.7% of them.


Subject(s)
Humans , Health Expenditures/statistics & numerical data , Insurance, Health/economics , Universal Health Insurance/economics , Argentina , Catastrophic Illness/economics , Family Characteristics , Surveys and Questionnaires
11.
Rio de Janeiro; s.n; 2017. 131 f p. il.
Thesis in Portuguese | LILACS | ID: biblio-905081

ABSTRACT

A cesariana é o procedimento cirúrgico mais realizado no mundo e no Brasil, alcançou índices preocupantes tanto no setor público, quanto no setor privado. Este problema de saúde pública é constantemente discutido desde a década 1960, se tornando, consequentemente, um importante tema de publicação na grande imprensa brasileira. Diversas ações foram realizadas pelas autoridades responsáveis pelas políticas de atenção ao parto para o desestimulo deste procedimento, no entanto, nenhuma delas obteve o resultado esperado, levando os diversos atores a opiniões diferentes sobre os motivos causadores deste problema. Nesta perspectiva, o objetivo geral deste trabalho foi compreender o desenvolvimento e a influência dos interesses de mercado nos altos índices de cesariana no Brasil. Os objetivos específicos é analisar o desenvolvimento da atenção ao parto no Brasil, com ênfase no período compreendido entre 1960 e 1990, quando se deu o grande crescimento da proporção de cesarianas; e analisar a transformação da cesariana numa mercadoria e os interesses privados envolvidos nos serviços a ela relativos. Para atingir o objetivo, foi realizada uma pesquisa documental utilizando, como principal fonte, as publicações sobre cesariana encontradas nos acervos dos jornais O Globo e Folha de São Paulo. Um estudo, neste aspecto, faz uma narrativa histórica do processo de mercantilização da cesariana no país, baseadas principalmente em matérias publicadas pela mídia e uma síntese dos elementos históricos que propiciaram uma transformação da cesariana, que inicialmente era um ato familiar, humano e natural, para um produto de mercado altamente lucrativo


Subject(s)
Humans , Female , Brazil , Cesarean Section/economics , Commodification , Insurance, Health/economics , Obstetrics/economics , Parturition , Mass Media , Public Health
13.
Cad. Saúde Pública (Online) ; 32(supl.2): e00154015, 2016. tab
Article in English | LILACS | ID: lil-798197

ABSTRACT

Abstract: The concentration and internationalization of health plan companies in Brazil gave them a clearly financial face. Based on the need to understand the health care industry's capital accumulation patterns, the current study examines health plan companies' expansion strategies through the classification of their supply and demand characteristics by recent historical periods and an analysis of recent shareholding trends in one of the leading corporations in the Brazilian health care industry. The 1960s to 2000s witnessed changes in the scale of demands for health plans and adherence by companies to long-term accumulation strategies. Beginning in the early 21st century, changes in the shareholding structures of the largest Brazilian company, consistent with the financialization of its accumulation regime, resulted in the rapid multiplication of its capital. Deepening segmentation of the health care system in a context marked by the downturn in the national economy challenges the preservation of public subsidies for private health plans.


Resumen: La concentración e internacionalización de empresas de planes de salud en Brasil les han conferido un carácter financiero. Considerando la necesidad de comprender los padrones de acumulación de ese sector, el trabajo examina estrategias de expansión de las empresas de planes de salud, mediante la periodización de atributos de oferta y demanda y el examen de la trayectoria patrimonial reciente de uno de los grandes grupos del sector. Entre los años 1960 y 2000, se produjeron alteraciones en la escala de las demandas por parte de planes de salud y una adhesión de las empresas a estrategias de acumulación a largo plazo. A partir del siglo XXI, las alteraciones en las estructuras societarias de la mayor empresa brasileña, compatibles con el régimen de acumulación de carácter financiero, resultaron en la multiplicación de su capital en un corto intervalo de tiempo. La profundización de la segmentación del sistema de salud, en un contexto marcado por la desaceleración de la economía, cuestiona la preservación de los subsidios públicos para los planes privados.


Resumo: A concentração e internacionalização de empresas de planos de saúde no Brasil conferiram-lhes feição financeira. Considerando a necessidade de compreender os padrões de acumulação desse setor, o trabalho examina estratégias de expansão das empresas de planos de saúde por meio da periodização de atributos da oferta e demanda e exame da trajetória patrimonial recente de um dos grandes grupos do setor. Entre os anos 1960 e 2000, ocorreram alterações na escala das demandas por planos de saúde e adesão das empresas a estratégias de acumulação de longo prazo. A partir do século XXI, as alterações nas estruturas societárias da maior empresa brasileira, compatíveis com o regime de acumulação financeirizada, resultaram na multiplicação de seu capital em um curto intervalo de tempo. O aprofundamento da segmentação do sistema de saúde, em um contexto marcado pela desaceleração da economia, questiona a preservação dos subsídios públicos para os planos privados.


Subject(s)
Humans , Prepaid Health Plans/economics , Delivery of Health Care/economics , Internationality , Economic Competition , Financing, Government/trends , Insurance, Health/economics , Brazil , Prepaid Health Plans/trends
14.
Rev. gaúch. enferm ; 37(1): e52287, 2016. tab
Article in Portuguese | LILACS, BDENF | ID: biblio-960706

ABSTRACT

RESUMO Objetivos Identificar desigualdades socioeconômicas e regionais na cobertura de exames citopatológicos do colo do útero no Rio Grande do Sul. Métodos Estudo ecológico utilizou dados dos sistemas de informação em saúde de 2011-2012 para estimar coberturas anuais de exames para todas as mulheres residentes e para as não beneficiárias de planos privados de saúde. Desigualdades na cobertura foram estimadas conforme o Índice de Vulnerabilidade Social Municipal, macrorregiões e regiões de saúde. Resultados A prevalência de mulheres não beneficiarias de planos privados de saúde variou de 38,1% a 94,2% entre regiões de saúde. A cobertura estadual foi 17,3% para todas as residentes e 23,8% para as não beneficiárias de planos privados. As maiores coberturas ocorreram nos municípios em maior vulnerabilidade social e nas regiões com maior prevalência de planos privados. Conclusões A prevalência de planos privados de saúde deve ser considerada em estudos da cobertura de serviços pelo Sistema Único de Saúde.


RESUMEN Objetivos Identificar desigualdades socioeconómicas y regionales en la cobertura de exámenes citopatológicos del cuello uterino en Rio Grande do Sul. Métodos Estudio ecológico utilizó datos de los sistemas de información en salud de 2011-2012 para estimar coberturas anuales de exámenes para la totalidad de mujeres residentes y para no beneficiarias de planes privados de salud. Se estimaron las desigualdades según el Índice de Vulnerabilidad Social Municipal, las macroregiones y las regiones de salud. Resultados La prevalencia de mujeres no beneficiarias de planes privados de salud tuvo una variación de 38.1% a 94.2% entre las regiones de salud. La cobertura del estado fue de 17.3% para la totalidad de residentes y el 23.8% para no beneficiarias de planes privados. Las mayores coberturas sucedieron en los municipios de mayor vulnerabilidad social y regiones con mayor prevalencia de planes privados. Conclusiones La prevalencia de los planes privados de salud debe ser considerada en los estudios de cobertura de servicios del Sistema Único de Salud (SUS).


ABSTRACT Objectives To identify socioeconomic and regional inequalities of pap smear coverage in the state of Rio Grande do Sul. Methods An ecological study based on data of the 2011-2012 national health information system to estimate the annual coverage of pap smears for the overall female population of the state and for women without private health insurance. We estimated annual pap smear coverage according to the Municipal Social Vulnerability Index and health macro-regions and regions of the state. Results The percentage of women without private health insurance ranged from 38.1% to 94.2% in the health regions. Pap smear coverage was 17.3% for the overall female population and 23.8% for women without private health insurance. Pap smear coverage was higher in more socially vulnerable municipalities and regions with a higher percentage of women with private health insurance. Conclusions The prevalence of private health insurance should be considered in studies that address the coverage of the Brazilian Unified Health System (SUS).


Subject(s)
Humans , Female , Adult , Healthcare Disparities/statistics & numerical data , Early Detection of Cancer/statistics & numerical data , Papanicolaou Test/statistics & numerical data , Rural Population , Urban Population , Brazil/epidemiology , Poverty Areas , Uterine Cervical Neoplasms/prevention & control , Uterine Cervical Neoplasms/epidemiology , Insurance Coverage , Vulnerable Populations , Early Detection of Cancer/economics , Papanicolaou Test/economics , Social Determinants of Health , Insurance, Health/economics
15.
Article in English | WPRIM | ID: wpr-56497

ABSTRACT

OBJECTIVES: The purposes of this study were to examine the status of children and adolescents with regard to enrollment in private medical insurance (PMI) and to investigate its influence on their utilization of medical services. METHODS: The present study assessed 2973 subjects younger than 19 years of age who participated in five consecutive Korea Health Panel surveys from 2009 to 2012. RESULTS: At the initial assessment, less than 20% of the study population had not enrolled in any PMI program, but this proportion decreased over time. Additionally, the number of subjects with more than two policies increased, the proportions of holders of indemnity-type only ('I'-only) and of fixed amount+indemnity-type ('F+I') increased, whereas the proportion of holders with fixed amount-type only ('F'-only) decreased. Compared with subjects without private insurance, PMI policyholders were more likely to use outpatient and emergency services, and the number of policies was proportionately related to inpatient service utilization. Regarding out-patient care, subjects with 'F'-only PMI used these services more often than did uninsured subjects (odds ratio [OR], 1.69), whereas subjects with 'I'-only PMI or 'F+I' PMI utilized a broad range of inpatient, outpatient, and emergency services relative to uninsured subjects (ORs for 'I'-only: 1.39, 1.63, and 1.38, respectively; ORs for 'F+I': 1.67, 2.09, and 1.37, respectively). CONCLUSIONS: The findings suggest public policy approaches to standardizing PMI contracts, reform in calculation of premiums in PMI, re-examination regarding indemnity insurance products, and mutual control mechanisms to mediate between national health insurance services and private insurers are required.


Subject(s)
Adolescent , Ambulatory Care/statistics & numerical data , Child , Child, Preschool , Female , Health Surveys , Humans , Income , Infant , Infant, Newborn , Insurance, Health/economics , Male , Medically Uninsured , Odds Ratio , Republic of Korea
16.
Cad. saúde pública ; 31(11): 2331-2341, Nov. 2015. tab
Article in Portuguese | LILACS | ID: lil-772083

ABSTRACT

Resumo O objetivo deste estudo foi avaliar a influência do excesso de peso e da obesidade sobre os gastos em saúde nos domicílios brasileiros. Dados da Pesquisa de Orçamentos Familiares de 2008-2009 foram utilizados para estimar os gastos familiares privados em saúde, que compreendem os gastos por desembolso direto, incluindo a aquisição de medicamentos e o pagamento por serviços de assistência à saúde, e avaliar o estado nutricional dos moradores dos 55.970 domicílios. Os gastos mensais em saúde e seus componentes foram analisados segundo o número de indivíduos com excesso de peso e obesidade nos domicílios (nenhum, um, dois ou três, ou mais indivíduos). A presença e o aumento do número de indivíduos com excesso de peso e obesidade resultaram em maiores gastos em saúde, com destaque para as despesas com medicamentos e planos de saúde. Tais resultados foram mantidos após ajuste (renda, região, área, presença de idosos e número de moradores nos domicílios). O excesso de peso e a obesidade influenciaram positivamente os gastos privados em saúde das famílias brasileiras.


Abstract The objective of this study was to evaluate the influence of excess weight and obesity on health spending in Brazilian households. Data from the Household Budget Survey 2008-2009 were used to estimate monetary health spending, corresponding to out-of-pocket spending, including purchase of medicines and payment for healthcare services, and to evaluate the nutritional status of the 55,970 household residents. Monthly spending on health and its components were analyzed according to the number of excess weight and obese individuals in households (none, one, two, or three or more individuals). The presence and increasing number of excess weight and obese individuals has resulted in greater spending on health, especially on medicines and health insurance. The results were maintained after adjusting for income, region, area, and presence of elderly and number of residents in the household. Excess weight and obesity had a direct impact on out-of-pocket health spending by Brazilian families.


Resumen El objetivo del estudio fue evaluar la influencia del exceso de peso y obesidad en el gasto en salud en los hogares brasileños. Se utilizaron los datos de la Encuesta de Presupuestos Familiares de 2008-2009 para estimar los gastos en salud, que contiene los gastos con la compra de medicinas y el gasto con los servicios de atención médica privada. También se evaluó el estado nutricional de las personas de los 55.970 hogares. El gasto mensual privado por persona en salud y sus componentes fueron analizados de acuerdo con la cantidad en número de personas con exceso de peso y obesidad en los hogares estratificados en cuatro categorías (ninguna, una, dos y tres o más personas). La presencia y el aumento en el número de individuos con exceso de peso y obesidad en los hogares resultaron en un mayor gasto en salud, especialmente el gasto en medicinas y seguros de salud privados. Estos resultados se mantuvieron después de realizar el ajuste pertinente. El exceso de peso y la obesidad influenciaron positivamente el gasto en salud de las familias brasileñas.


Subject(s)
Adolescent , Adult , Aged , Child , Child, Preschool , Humans , Young Adult , Health Expenditures/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Obesity/epidemiology , Overweight/epidemiology , Body Mass Index , Brazil/epidemiology , Family Characteristics , Income , Insurance, Health/economics , National Health Programs
17.
Arq. bras. cardiol ; 104(6): 433-442, 06/2015. tab, graf
Article in English | LILACS | ID: lil-750702

ABSTRACT

Background: Heart failure (HF) is one of the leading causes of hospitalization in adults in Brazil. However, most of the available data is limited to unicenter registries. The BREATHE registry is the first to include a large sample of hospitalized patients with decompensated HF from different regions in Brazil. Objective: Describe the clinical characteristics, treatment and prognosis of hospitalized patients admitted with acute HF. Methods: Observational registry study with longitudinal follow-up. The eligibility criteria included patients older than 18 years with a definitive diagnosis of HF, admitted to public or private hospitals. Assessed outcomes included the causes of decompensation, use of medications, care quality indicators, hemodynamic profile and intrahospital events. Results: A total of 1,263 patients (64±16 years, 60% women) were included from 51 centers from different regions in Brazil. The most common comorbidities were hypertension (70.8%), dyslipidemia (36.7%) and diabetes (34%). Around 40% of the patients had normal left ventricular systolic function and most were admitted with a wet-warm clinical-hemodynamic profile. Vasodilators and intravenous inotropes were used in less than 15% of the studied cohort. Care quality indicators based on hospital discharge recommendations were reached in less than 65% of the patients. Intrahospital mortality affected 12.6% of all patients included. Conclusion: The BREATHE study demonstrated the high intrahospital mortality of patients admitted with acute HF in Brazil, in addition to the low rate of prescription of drugs based on evidence. .


Fundamento: A insuficiência cardíaca (IC) é uma das principais causas de hospitalização em adultos no Brasil, no entanto a maioria dos dados disponíveis é limitada a registros unicêntricos. O registro BREATHE é o primeiro a incluir uma ampla amostra de pacientes hospitalizados com IC descompensada de diferentes regiões do Brasil. Objetivo: Descrever as características clínicas, tratamento e prognóstico intra-hospitalar de pacientes admitidos com IC aguda. Métodos: Estudo observacional tipo registro, com seguimento longitudinal. Os critérios de elegibilidade incluíram pacientes acima de 18 anos com diagnóstico definitivo de IC, admitidos em hospitais públicos ou privados. Os desfechos avaliados incluíram causas de descompensação, uso de medicações, indicadores de qualidade assistencial, perfil hemodinâmico e eventos intra-hospitalares. Resultados: O total de 1.263 pacientes (64 ± 16 anos, 60% mulheres) foi incluído a partir de 51 centros de diferentes regiões do Brasil. As comorbidades mais comuns foram hipertensão arterial (70,8%), dislipidemia (36,7%) e diabetes (34%). Em torno de 40% dos pacientes apresentavam função sistólica do ventrículo esquerdo normal e a maioria foi admitida com perfil clínico-hemodinâmico quente-úmido. Vasodilatadores e inotrópicos endovenosos foram administrados a menos de 15% da amostra estudada. Indicadores de qualidade assistencial baseados nas orientações de alta hospitalar foram atingidos em menos de 65% dos pacientes. A mortalidade intra-hospitalar afetou 12,6% do total dos pacientes incluídos. Conclusão: O estudo BREATHE demonstrou a alta mortalidade intra-hospitalar dos pacientes admitidos com IC aguda no Brasil, somada à baixa taxa de prescrição de medicamentos baseados em evidências. .


Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Antipsychotic Agents/therapeutic use , Anxiety Disorders/drug therapy , Bipolar Disorder , Schizophrenia , Antipsychotic Agents/economics , Anxiety Disorders/epidemiology , Bipolar Disorder/drug therapy , Bipolar Disorder/economics , Bipolar Disorder/epidemiology , Cost-Benefit Analysis , Drug Prescriptions/statistics & numerical data , Health Care Costs , Insurance, Health/economics , Medicaid/economics , Prevalence , Schizophrenia/drug therapy , Schizophrenia/economics , Schizophrenia/epidemiology , United States/epidemiology
18.
Ciênc. saúde coletiva ; 20(5): 1425-1434, 05/2015. tab, graf
Article in Portuguese | LILACS | ID: lil-747195

ABSTRACT

As despesas com planos de saúde correspondem a uma parcela importante dos gastos privados com saúde no Brasil. Este estudo teve como objetivo descrever a evolução dos gastos com planos de saúde das famílias brasileiras, segundo sua renda. Foram utilizados dados das Pesquisas de Orçamentos Familiares (POF) de 2002-2003 e 2008-2009. Para a comparação dos valores dos gastos entre as POF, foi feita correção mediante o Índice de Preços ao Consumidor Amplo (IPCA). A proporção de famílias que tiveram gastos com planos de saúde permaneceu estável, nas duas POF estudadas (2002-2003 e 2008-2009), em torno de 24%. Todavia, o valor do gasto das famílias com planos de saúde aumentou. Entre aquelas que tiveram gasto com planos de saúde, o valor médio elevou-se de R$ 154,35 para R$ 183,97. O gasto médio com planos de saúde foi maior à medida que aumentava a renda das famílias, assim como as parcelas da renda e da despesa comprometidas com esses gastos. O gasto com planos de saúde está concentrado entre as famílias com maior renda. Para estas, os planos de saúde foram o principal componente do gasto total com saúde.


Spending on health insurance represents an important share of private expenditure on health in Brazil. The study aimed to describe the evolution of spending on private health insurance plans of Brazilian families, according to their income. Data from the Family Budget Surveys (POF) 2002-2003 and 2008-2009 were used. To compare the spending figures among the surveys, the Consumer Price Index (IPCA) was applied. The proportion of families with private health insurance expenses remained stable in both surveys (2002-2003 and 2008-2009), around 24%. However, the household spending on health insurance plans increased. Among those families who spent money oh health insurance plans, the average spending increased from R$154.35 to R$183.97. The average spending on health insurance plans was greater with increasing household income, as well as portions of the family income and total expenditure committed to these expenses. Spending on health insurance is concentrated among higher-income families, for which it was the main component of total health expenditure.


Subject(s)
Humans , Budgets , Family , Health Expenditures , Insurance, Health/economics , Private Sector/economics , Brazil , Income , Surveys and Questionnaires , Time Factors
19.
Article in English | IMSEAR | ID: sea-163463

ABSTRACT

The cost of medical care is skyrocketing daily which is unaffordable for the common man.The number of corporate hospitals in the country is increasing; small hospitals and nursing homes which were catering to the middle class people are almost on the verge of vanishing. There is also mushrooming and competition seen among health insurance providers. The common man without insurance coverage finds it very difficult to afford the high cost of healthcare.The doctor’s approach towards the insured patient changes automatically and he quickly responds in a different way.Millions of people fearing such a type of approach by the doctors and the heavy bills of hospitals have ended up taking the insurance coverage. Rising above commercial considerations, doctors should be more cautious and judicious in managing patients irrespective of their insurance coverage. Awareness must be created among the general public about aggressive management.


Subject(s)
Fees and Charges , Humans , India , Insurance, Health/economics , Insurance, Health/methods , Insurance, Health/statistics & numerical data
20.
Article in English | WPRIM | ID: wpr-198107

ABSTRACT

Health financing has been considered as an important building block of a health system and has a key role in promoting universal health coverage in the Vietnam. This paper aims to describe the pattern of health expenditure, including total health expenditure and composition of health expenditure, over the last two decades in Vietnam. The paper mainly uses the data from Vietnam National Health Account and Vietnam Living Standards Survey. We also included data from other relevant published literature, reports and statistics about health care expenditure in Vietnam. The per capita health expenditure in Vietnam increased from US$ 14 in 1995 to US$ 86 in 2012. The total health expenditure as a share of GDP also rose from 5.2% in 1995 to 6.9% in 2012. Public health expenditure as percentage of government expenditure rose from 7.4% in 1995 to nearly 10% in 2012. The coverage of health insurance went up from 10% in 1995 to 68.5% in 2012. However, health financing in Vietnam was depending on private expenditures (57.4% in 2012). As a result, the proportion of households with catastrophic expenditure in 2012 was 4.2%. The rate of impoverishment in 2012 was 2.5%. To ensure equity and efficient goal of health system, policy actions for containing the health care out-of-pocket payments and their poverty impacts are urgently needed in Vietnam.


Subject(s)
Developing Countries/economics , Financing, Government/economics , Health Expenditures/statistics & numerical data , Healthcare Financing , Insurance, Health/economics , Vietnam/epidemiology
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