Caracterización de los recobros realizados por la Secretaría Seccional de Salud y Protección Social de Antioquia al Fondo de Solidaridad y Garantía por atenciones No pos. 2010-2013 / Characterization of reimbursements claimed by the Departmental Health and Social Protection Secretariat of Antioquia and submitted to the Solidarity and Guarantee Fund for non-POS interventions. 2010-2013 / Caracterização dos pedidos de ressarcimento realizados pela Secretaria Seccional de Saúde e Proteção Social de Antioquia ao Fundo de Solidariedade e Garantia por atendimentos Não-POS 2010/2013

Resumen Objetivo: Caracterizar los recobros realizados por la Secretaría Seccional de Salud y Protección Social de Antioquia (ssspsa) al Fondo de Solidaridad y Garantía, por atenciones No pos entre 2010-2013. Metodología: Se realizó un estudio descriptivo retrospectivo, según información oficial suministrada por la ssspsa, teniendo en cuenta el total de facturas recobradas (894), por $7 815 241 869. Resultados: 1) las facturas recobradas disminuyeron del 56 al 9 %, con variación negativa de -84 %; los valores recobrados disminuyeron del 51 al 15 %, con variación negativa del -71 %, y los pacientes implicados tuvieron una variación negativa de -79 %; 2) las facturas avaladas pasaron de 81 a 3 %, con variación negativa de -96 %; los valores, del 56,9 al 15 %, con una variación negativa de -79 %, y los pacientes con valores avalados, con variación negativa de -95 %. La glosa fue del 60 %, y solo se reconoció el 5 % de las respuestas. Predominaron recobros y avales para medicamentos, con el 67,5 y 61 % respectivamente. Estuvieron comprometidas 17 instituciones y 399 pacientes, con promedio de 2,2 facturas / paciente. Conclusión: Disminuyeron las solicitudes de recobro y los avales, y predominaron los medicamentos como evento recobrado y avalado. El alto porcentaje de glosa y la baja recuperación por las respuestas a las mismas, hacen el proceso ineficiente e inefectivo, lo que retarda los pagos a las instituciones prestadoras de salud y aumenta el riesgo de crisis hospitalaria, con consecuencias negativas para la salud y la salud pública de la población.

Abstract Objective: To characterize reimbursements claimed by the Departmental Health and Social Protection Secretariat of Antioquia (SSSPSA) and submitted to the Solidarity and Guarantee Fund for non-POS interventions [services not covered by the Compulsory Health Plan] between 2010 and 2013. Methodology: A retrospective descriptive study was performed based on official information provided by the SSSPSA considering the total of reimbursed claims (894) corresponding to 7,815,241,869 COP. Results: 1) Reimbursed claims decreased from 56 to 9%, with a negative variance of -84 %; reimbursed items decreased from 51 to 15%, with a negative variance of -71 %, and patients involved had a negative variance of -79 %; 2) accepted claims decreased from 81 to 3% with a negative variance of -96 %, values decreased from 56.9 to 15 %, with a negative variance of -79 %, and patients with accepted items exhibited a negative variance of -95 %. The percentage of rejected claims was 60% and only 5% of justifications were accepted. Reimbursements and approvals for medications prevailed at 67.5 and 61 % respectively. 17 institutions and 399 patients were involved with an average of 2.2 claims/patient. Conclusion: Medical claims and approvals decreased, and medications as approved and reimbursed events prevailed. The high percentage of rejected claims and the low reimbursement rates of the medical claims make the billing process inefficient and ineffective. They also delay payments to health care facilities and increase the risk of health crisis with negative consequences for the health of population.

Resumo Objetivo: Caracterizar os ressarcimentos realizados pela Secretaria Seccional de Saúde e Proteção Social de Antioquia (SSSPSA) ao Fundo de Solidariedade e Garantia, pelos atendimentos Não-POS (Plano Obrigatório de Saúde) entre 2010/2013. Metodologia: Foi realizado um estudo descritivo retrospectivo, de acordo com a informação oficial concedida pela SSSPSA, considerando o total de faturas ressarcidas (894), pelo valor de $7.815.241.869 pesos colombianos. Resultados: 1) As faturas ressarcidas diminuíram de 56 a 9%, com variação negativa de -84%; os valores ressarcidos diminuíram de 51 a 15%, com variação negativa de -71% e os pacientes envolvidos tiveram uma variação negativa de -79%; 2) As faturas avaliadas passaram de 81 a 3% com variação negativa de -96%; os valores de 56,9 a 15% com uma variação negativa de -79% e os pacientes com valores avaliados, com variação negativa de -95%. As explicações adicionais foram de 60% e apenas 5% das respostas foram consideradas. Predominaram os ressarcimentos e garantias para medicamentos com 67,5% e 61% respectivamente. No processo, envolveram-se 17 instituições e 399 pacientes, com uma média de 2,2 faturas por paciente. Conclusão: Foram reduzidos os pedidos de ressarcimento e garantias, predominando os medicamentos como evento ressarcido e garantido. A alta porcentagem de explicações adicionais e a baixa recuperação pelas respostas às mesmas fazem com que o processo seja ineficiente e ambíguo, o que atrasa os pagamentos às instituições prestadoras de serviços de saúde e aumenta os riscos de crise hospitalar, com consequências negativas para a saúde e para o sistema de saúde pública em geral.

Mortalidad materna en el departamento de Cauca, un estudio en el régimen subsidiado / Maternal mortality in the state of Cauca: a study in the subsidized system / Mortalidade materna no departamento do Cauca, um estudo no regime subsidiado

Resumen Objetivo: Describir algunas características epidemiológicas y del registro de las muertes maternas presentadas en la población afiliada a una empresa prestadora de servicios de salud del régimen subsidiado, en el departamento de Cauca (Colombia). Metodología: Estudio descriptivo, retrospectivo. Se realizó análisis univariado para la caracterización de las muertes, mapeo para la ubicación espacial y presentación gráfica sobre el número de casos por año. Se incluyó análisis bivariado con U de Mann-Whitney y Kruskal-Wallis. Se evaluó la concordancia en los registros mediante el estadístico Kappa. Resultados: Se presentaron 34 muertes maternas entre los años 2009 y 2014, con una razón de mortalidad materna de 193, 141, 231, 67 y 110 muertes por cada 100 000 nacidos vivos, para el periodo 2010-2014. Los casos ocurrieron en mujeres que en su mayoría residían en área rural dispersa (67,6 %), tenían nivel educativo bajo (63,3 %), eran amas de casa (73,5 %) y no asistieron o asistieron tardíamente al control prenatal (67,7 %). Se identificó pobre concordancia entre los documentos institucionales y los reportes al Sistema de Vigilancia en Salud Pública colombiano (K= -0,0282, p= 0,8116). Conclusiones : Las muertes maternas presentadas en la entidad en el periodo de estudio y que tuvieron un perfil enmarcando en condiciones de riesgo, en su mayoría eran prevenibles. A pesar de que la entidad utilizó una estrategia para identificar demoras o retrasos en tres aspectos de cada caso de mortalidad materna, se requiere que dicha evaluación se cumpla para todos los eventos, acompañada de registros completos que faciliten los procesos de seguimiento.

Abstract Objective: To describe epidemiological characteristics, as well as maternal deaths registration characteristics in the population registered in a subsidized healthcare service provider in the state of Cauca (Colombia). Methodology: Descriptive, retrospective study. Univariate analysis was performed for the characterization of deaths, a mapping of their spatial location, and a graphical presentation of the number of deaths per year. Bivariate analysis with the Mann-Whitney U test and the Kruskal-Wallis test was also implemented. The concordance in records was assessed using Cohen's Kappa coefficient. Results: There were 34 maternal deaths between 2009 and 2014, with a rate of maternal mortality of 193, 141, 231, 67 and 110 deaths per 100,000 live births for the period from 2010 to 2014. The incidents occurred in women who mostly resided in scattered rural areas (67.6 %), had a low level of education (63.3 %), were housewives (73.5 %) and did not attend antenatal care or did it lately (67.7 %). Poor concordance was identified between institutional documents and reports to the Colombian Public Health Surveillance System (K = -0.0282, p = 0.8116). Conclusions: The maternal deaths compiled from the entity information system during the study and which had a profile linked to risky conditions were, in most cases, preventable. Although the entity used a strategy to identify delays in three aspects of each maternal mortality case, this assessment is to be completed for all events, accompanied by complete records to facilitate follow-up processes.

Resumo Objetivo: Descrever algumas características epidemiológicas e o cadastro de óbitos maternos apresentados na população afiliada a uma empresa prestadora de serviços de saúde do regime subsidiado "SISBEN", no departamento do Cauca (Colômbia). Metodologia: Estudo descritivo, retrospectivo. Foi realizada uma análise univariada para caracterização dos óbitos, mapeamento para localização espacial e apresentação gráfica do número de casos por ano. A análise bivariada com Mann-Whitney U e Kruskal-Wallis foi incluída. A concordância nos cadastros foi avaliada pela estatística Kappa. Resultados: Houve 34 óbitos maternos entre 2009 e 2014, com uma taxa de mortalidade materna de 193, 141, 231, 67 e 110 óbitos por 100.000 nascidos vivos, no período 2010-2014. Os casos ocorreram em mulheres que residem principalmente em área rural dispersa (67,6%), com baixa escolaridade (63,3%), eram donas de casa (73,5%) e não compareciam ou compareciam tardiamente ao controle pré-natal (67,7%). Foi identificada ínfima concordância entre documentos institucionais e relatórios para o Sistema de Vigilância em Saúde Pública da Colômbia (K = -0,0282, p = 0,8116). Conclusões: Os óbitos maternos apresentados na entidade durante o período do estudo e com perfil emoldurado em condições de risco eram principalmente evitáveis. Embora a entidade tenha utilizado uma estratégia para identificar atrasos ou atrasos em três aspectos de cada caso de mortalidade materna, é necessário que essa avaliação seja realizada para todos os eventos, acompanhada de cadastros completos que facilitem os processos de acompanhamento.

Concentración del gasto sanitario en una aseguradora colombiana del régimen subsidiado, 2014 / Concentration of Health Spending in a Subsidized-scheme Colombian Insurance Company, 2014

Resumen Objetivo: Estimar la concentración del gasto sanitario según grupos de patologías y tipos de servicios en una aseguradora subsidiada que afilia personas pobres (estratos socioeconómicos 1 y 2) al Sistema de Salud de Colombia en 2014. Métodos: Se analizó el gasto sanitario en 1 666 477 afiliados, por grupos de patología y tipos de servicios, en el año 2014. Para la descripción de la concentración del gasto se utilizó el coeficiente de Gini y la curva de Lorenz. Resultados: El gasto sanitario de la aseguradora fue de usd 418 millones. De este, el 81 % se aplicó a servicios contenidos en el Plan Obligatorio de Salud (pos). Los grupos de patologías que concentraron el 43,4 % del gasto sanitario fueron cardiovascular (14,3 %), cáncer (7,8 %), enfermedades respiratorias (7,3 %), enfermedades urinarias (7 %) y traumatismos (6,9 %). Los servicios diagnósticos, curativos y de rehabilitación representaron el 77,8 % del gasto sanitario. La hospitalización fue el grupo de servicio que más impactó el costo (47 %), y las consultas, el más utilizado. Las curvas de Lorenz demostraron que el 70 % del gasto en salud se concentra en aproximadamente el 20 % de los afiliados, generando un coeficiente de Gini de 0,58. Conclusión: El diagnóstico y el tratamiento de las enfermedades crónicas no transmisibles concentran una alta proporción del gasto sanitario, lo cual genera una competencia de recursos para servicios preventivos y de promoción de la salud.

Abstract Objective: to estimate the concentration of health spending depending on pathology groups and types of services in a subsidized insurance company which enrolled low-income people (social economic strata 1 and 2) in the Colombian Healthcare System in 2014. Methodology: Health spending was analyzed in 1 666 477 members, set up by pathologies and types of services during 2014. To describe the concentration of health spending, researchers used the Gini coefficient and the Lorenz curve. Results: the health spending of the insurance company was US$418 million. Out of this, 81 % was used in service contained in the mandatory Health Plan (in Spanish, Plan Obligatorio de Salud -POS). The pathology groups that concentrated 43.4% of health spending were cardiovascular (14.3%), cancer (7.8%), respiratory diseases (7.3%), urinary diseases (7%) and trauma (6.9%). Diagnostic, healing and rehabilitation services represented 77.8% of health spending. Hospitalization was the service group with the highest impact on costs (47%), and consultations, the most used. The Lorenz curves showed that 70% of the health spending is concentrated in approximately 20% the Affiliated people, resulting in a 0.58 Gini coefficient. Conclusion: Diagnostic and treatment of chronic non-transmittable diseases concentrate a vast part of health spending, which produces a competition of resources for preventive services and healthcare promotion.

Factores de riesgo para la infección del sitio quirúrgico posapendicectomía. Estudio de casos y controles / Risk factors for surgical-site infection in the atlantic state, colombia. A case-control study

Resumen Objetivo: Evaluar la influencia de los determinantes sociodemográficos, clínicos y del servicio de salud sobre el riesgo de infección del sitio quirúrgico en pacientes apendicectomizados, en los hospitales del Atlántico, Colombia. Materiales y métodos: Estudio de casos y controles retrospectivo. Se revisaron los registros quirúrgicos de pacientes apendicectomizados entre 2009 y 2013. Muestra: 80 casos y 272 controles. Factores estudiados: sociodemográficos (edad, género, régimen de afiliación al sistema de salud); clínicos (antecedentes patológicos, hospitalizaciones previas, grado del apéndice); servicios (tiempos de espera, técnica quirúrgica, duración del procedimiento, profilaxis antibiótica, tiempo de estancia hospitalaria). Análisis: bivariable y multivariable. Se calcularon las razones de momios (OR), intervalos de confianza al 95 %, y pruebas de significancia estadística. Resultados: Luego del análisis multivariado, los factores de riesgo independientes fueron: edad mayor de 54 años (OR = 5,37); afiliación al régimen subsidiado del sistema general de seguridad social en salud (OR = 3,49) y el grado histopatológico del apéndice II, que incluye inflamación focal, ulceraciones del epitelio y microabscesos aislados en folículos linfáticos, (OR = 1,98). Conclusión: Este estudio aporta nueva evidencia de la multicausalidad de la infección nosocomial en pacientes sometidos a apendicectomía. Se destaca el rol de la desigualdad en salud como factor de riesgo importante, lo cual merece especial atención.

Abstract Objective: To evaluate sociodemographic, clinical and health-service-related determinants associated to surgical site infections in patients undergoing appendectomy in third level Hospitals, located in the Colombian Northern Region, from 2009 to 2013. Methods: Retrospective data was collected of hospital records from participating hospitals; 80 cases and 272 controls were compared regarding socio-demographic (age, gender, regime of affiliation to the social-security health system), clinical (comorbidity, prior hospitalization, degree of appendix), and healthcare-related variables (diagnostic time, preoperative time, operation duration, prophylaxis with antibiotics and hospital-stay length). Both bivariate and multivariate analysis were conducted. Odds Ratios, 95% confidence intervals were estimated; Besides, both X2-Test and T Student Tests were used to evaluate statistical significance. Results: Socio-demographic (age, affiliation to the subsidized-health-system), clinical (metabolic disease) and health-care related factors such as preoperative waiting time showed to be associated to surgical site infections, in the bivariate analysis. In the final regression model only age above 54 (OR= 5,37); subsidized affiliation to the social security system (3,49) and histopathological grade of appendix, which included focal inflammation, epithelial ulcers, and isolated micro-abscesses in lymphatic's follicles showed to be independent risk factors (OR= 1,98). Conclusion: This study adds new evidence on the multifactorial origin of post-surgery nosocomial infections and spotlights health inequality as a major risk factor that needs to be addressed.

A comparison of medication adherence between subsidized and self-paying patients in Malaysia

@#Background: Limited efforts have been made to evaluate medication adherence among subsidized and self-paying patients. Objective: To investigate medication adherence among patients with and without medication subsidies and to identify factors that may influence patients’ adherence to medication. Setting: Government healthcare institutions in Kuala Lumpur, Selangor, and Negeri Sembilan and private healthcare institutions in Selangor and Negeri Sembilan, Malaysia. Methods: This cross-sectional study sampled patients with and without medication subsidies (self-paying patients). Only one of the patient’s medications was re-packed into Medication Event Monitoring Systems (MEMS) bottles, which were returned after four weeks. Adherence was defined as the dose regimen being executed as prescribed on 80% or more of the days. The factors that may influence patients’ adherence were modelled using binary logistic regression. Main outcome measure: Percentage of medication adherence. Results: A total of 97 patients, 50 subsidized and 47 self-paying, were included in the study. Medication adherence was observed in 50% of the subsidized patients and 63.8% of the self-paying patients (χ²=1.887, df=1, p=0.219). None of the evaluated variables had a significant influence on patients’ medication adherence, with the exception of attending drug counselling. Patients who attended drug counselling were found to be 3.3 times more likely to adhere to medication than those who did not (adjusted odds ratio of 3.29, 95% CI was 1.42 to7.62, p = 0.006). Conclusion: There is no significant difference in terms of medication adherence between subsidized and self-paying patients. Future studies may wish to consider evaluating modifiable risk factors in the examination of non-adherence among subsidized and self-paying patients in Malaysia.

Medición y comparación del nivel de equilibrio en alumnos (as) de 1º y 2º básico por tipo de establecimiento educacional y por sexo / Measurement and comparison of the equilibrium level of 1st and 2nd grade students, by type of educational establishment and sex

El presente estudio determinó si existe diferencia en el nivel de equilibrio en alumnos (as) de 1º y 2º básico por tipo de establecimiento y por sexo. Para esto, la muestra estuvo constituida por 316 alumnos (as), de los cuales 145 son mujeres y 171 son hombres, y 110 alumnos (as) representan a establecimien-tos municipales y 206 alumnos (as) representan a establecimientos particulares subvencionados de la comuna de La Granja. Los resultados muestran que existen diferencias en el equilibrio estático donde se ven favorecidos los establecimientos municipales, y por sexo las mujeres presentan un mejor nivel de equilibrio estático que los hombres. En equilibrio dinámico los establecimientos municipales presentan ventajas sobre los particulares subvencionados, y por sexo los varones presentan una leve ventaja sobre las mujeres. Es pertinente realizar una nueva investigación para comprobar si mediante un plan de ejercicios mejorará el nivel de equilibrio estático y dinámico de los alumnos (as) de 1º y 2º básico por tipo de establecimiento y por sexo.

The present study determined whether there was a difference in the equilibrium level of 6 to 7 year old students, depending on their educational establishment and their sex. The sample was made up of 316 students, of which 145 are women, 171 are men, and 110 students represent municipal establishments and 206 students represent private/subsidized establishments in the commune of La Granja, Chile. Results show that there are differences between static equilibrium by type of educational establishment, where municipal establishments fared better; In terms of sex, females demonstrated to have a better level of static equilibrium than males. In dynamic equilibrium, municipal establishments showed an advantage over private/subsidized ones, and as for sex, males fared slightly better than females. It is pertinent to carry out new research in order to verify if using an exercise plan actually improves the level of static and dynamic equilibrium in 6 to 7 year olds, depending on their educational establishment and sex.

Eficiencia de las entidades del régimen subsidiado en Colombia por medio de análisis envolvente de datos / Efficiency of the subsidized regime entities in Colombia by means of data envelopment analysis

En este trabajo de investigación se realiza un análisis de la eficiencia técnica de las entidades que hacen parte del régimen subsidiado en Colombia durante el año 2010. Se utilizó la metodología no paramétrica Data Envelopment Analysis (DEA), específicamente el modelo CCR-O enfocado a salidas para evaluar la eficiencia del sector; como fuente de información utilizada se tomó la Superintendencia de Salud. De 26 entidades estudiadas, 15 presentaron eficiencia baja, 2 presentaron una eficiencia intermedia, 3 presentaron una eficiencia superior y 6 entidades mostraron ser eficientes, estas fueron: Capresoca EPS, Caja de previsión social de comunicaciones Caprecom, Caja de compensación familiar del Chocó Comfachocó, Caja de compensación familiar de Nariño, Caja de compensación familiar de Córdoba Comfaco y Caja de compensación familiar de Huila Comfamiliar Huila. Con el trabajo de investigación se pudo concluir que el 23,08% del total de DMU's evaluadas presentaron una eficiencia óptima. La eficiencia media de la población estudiada fue de 65,85%

In this research, an analysis of the technical efficiency of the entities that are part of the subsidized regime in Colombia during 2010 was made. The nonparametric Data Envelopment Analysis (DEA) approach was used, specifically the CCR-O model, which focuses on outputs to evaluate the efficiency of the sector. The Superintendence of Health was taken as a source of used information. From the 26 organizations studied, 15 presented low efficiency, 2 presented medium efficiency, 3 presented high efficiency, and 6 entities proved to be fully efficient. These entities were: Capresoca EPS, fund of welfare communications Caprecom, benefit society in Choco Comfachoco, benefit society in Nariño, benefit society in Cordoba Comfaco and benefit society in Huila Comfamiliar Huila. It could be concluded that 23.08% of DMU's evaluated showed optimum efficiency. The average efficiency of the study population was 65.85%.

Legalization of Government Subsidized Student Loan / 中华医学教育探索杂志

Government Subsidized Student Loan is a policy adopted by the government,which aims to help the poor students to go to college.However,the result turns out that the policy doesn't achieve the expectant target for many reasons.This paper analyses the reasons and introduces three methods for promoting the healthy development of the Government Subsidized Student Loan.They are: establishing the personal credit system for college students,ensuring the remedy right of loan and designing reasonable procedure of Government Subsidized Student Loan.

Estado de las empresas solidarias de salud en el departamento de Antioquia: 1993-1996 / The state of Antioquia’s Solidary Health Companies: 1993-1996

Se describieron los procesos vividos por 13 de las Empresas Solidarias de Salud ( E.S.S.) de Antioquia durante el período de 1.993 a 1996, con énfasis en: Identificación de la población objeto, fases de conformación (Gestión Sanitaria y Gestión Empresarial), determinación de la demanda, estructura administrativa y organizacional, servicios de salud y situación económica. Todas cumplieron el diseño del Ministerio de Salud para conformarse y vienen prestando servicios a sus beneficiarios. Han mostrado importantes logros en Participación Comunitaria y en la estructuración del Régimen Subsidiado en Salud. Presentan limitaciones administrativas y organizacionales, carencias en sistemas de información y desactualización en sus estados contables. Las E.S.S. son altenativa en Participación Comunitaria y autogestión de los municipios de Colombia en la Administración del Subsidio a la Demanda en Salud para la población más pobre y vulnerable, con particular énfasis en promoción y prevención buscando una nueva cultura de la salud...

The processes lived by 13 of the Solidarity Health Companies (E:S:S:) of Antioquia During the 1993-1996 period were described with emphasis on: identification of the population object, conformation phases (Sanitary Effort, Entrepereunial Effort), determination of demand, administrative and orgazational structure, health services and economic situation. All companies fulfilled the Health Ministry design to be certified and come lending services to their beneficiary. Also have shown important achlevements in Community Participation and in the setup of the Regime Subsididized in Health. These companies present administrative and organizational limitations and lack of information systems. Their countabble states are outdated. The E:S:S companies are alternative in Community Participation and auto effort of the municipallities of Colombia. This is a applied by the Subsidy Administrastion of Health Demand for the poorest and vulnerable population. They have a particular emphasis in promotion and prevention to seek a new culture of health.