Binational burden of American cutaneous leishmaniasis in Oiapoque, Amapá State, Brazil, bordering French Guiana

Abstract INTRODUCTION: American cutaneous leishmaniasis (ACL) is regarded as a public health problem in the Oiapoque basin, between Brazil and French Guiana. METHODS Data on ACL occurrence/epidemiological profile and etiology were sourced from Brazilian health services and a reference laboratory. Rainfall correlation was also analyzed. RESULTS: Majority of the ACL cases were observed in adult men working as gold miners. ACL incidence peaks appeared to be linked to periods 2 months after the dry season. Migratory flow was found to be a non-negligible complicating factor in epidemiological surveillance. CONCLUSIONS: Binational strategies are required to minimize exposure for high-risk populations.

Informing public policy toward binational health insurance: Empirical evidence from California / Información para las políticas públicas sobre seguros binacionales de salud: evidencia empírica de California

Objective. To estimate reimbursement rate differences between Mexico and US based physicians reimbursed by a binational health insurance (BHI) plan and US payers, respectively; and show the relationship between plan benefit designs and health care utilization in Mexico. Materials and methods. Data include 33 841 and 53 909 HMO enrollees in California from Sistemas Médicos Nacionales (SIMNSA) and Salud con Health Net, respectively. We use descriptive statistical methods. Results. SIMNSA's physician reimbursement rates averaged 50.7% (95% CI: 34.5%-67.0%) of Medi-Cal's, 28.3% (95% CI: 19.6%-37.0%) of Medicare's, and 22% of US private plans'. Each year, 99.4% of SIMNSA enrollees but only 0.1% of Salud con Health Net enrollees obtained care in Mexico. Conclusion. SIMNSA only covers emergency and urgent care in the US, while Salud con Health Net covers comprehensive care with higher patient cost sharing than in Mexico. To realize potential savings, plans need strong incentives to increase utilization in Mexico.

Objetivo. Estimar diferencias en tasas de reembolso y utilización de servicios médicos cubiertos por seguros binacionales de salud (SBS) y aquellos de planes públicos y privados de EUA. Material y métodos. Con métodos estadísticos descriptivos se analizan datos de 33 841 afiliados a Sistemas Médicos Nacionales (SIMNSA) y 53 909 de Salud con Health Net en California. Resultados. Las tasas de reembolso de SIMNSA son en promedio 50.7% (95% IC: 34.5%-67.0%) de aquellas de Medi-Cal, 28.3% (95% IC: 19.6%-37.0%) de Medicare, y 22% de los planes privados de EUA. Cada año, 99.4% de afiliados a SIMNSA, pero sólo 0.1% de Salud con Health Net obtienen atención en México. Conclusión. SIMNSA sólo cubre gastos de emergencia y atención urgente en EUA, mientras que Salud con Health Net cubre servicios de atención integrales. Los planes de SBS pueden lograr ahorros importantes con más incentivos para que la atención ocurra en México.