Healthcare providers' satisfaction with participation in private health insurance scheme in a city in the southern Nigeria

Health insurance coverage in Nigeria is still very low as over 70% of health care expenditure is financed by out-of-pocket payment. Health care providers are critical participants in the private health insurance scheme, therefore, their perception and satisfaction with the scheme is fundamental in ensuring sustainability. This study assessed health providers' satisfaction with private health insurance scheme in Port Harcourt Rivers State.Method: A descriptive cross-sectional study which engaged a two-stage sampling method to recruit 60 participating health facilities and 180 responding health personnel by simple random sampling at each stage. A structured, pretested interviewer-administered questionnaire was used to collect data on the levels of satisfaction with the four major domains of satisfaction viz; billing rate, payment models, HMO administrative processes and claims management. Data was analysedusing of SPSS, version 26. Characteristics of the responding facilities were tabulated and compared. Level of satisfaction was deduced by Likert Scale according to the domains of satisfaction. Regression analysis with p-value was set at less than or equal to 0.05 was used to determine the predictors of satisfaction with participation in health insurance. The level of satisfaction with negotiated billing rates, payment models, HMO administrative processes and claims management were analyseddescriptively, and results were presented as means, standard deviation, frequencies and percentages, in tables, pie and bar charts

Bibliometrics analysis of the General Catalogue of Traditional Chinese Medicine Ancient Books / 国际中医中药杂志

Objective To observe the development of Traditional Chinese Medicine health maintenance books in the past. Method Based on the General Catalogue of Traditional Chinese Medicine Ancient Books, the author did a bibliometrics analysis from the year of the ancient literature of the TCM health preservation, the year and type of the version, the distribution of the second class of the health maintenance, the unique books of ancient books in health maintenance, the collection in the series and Collected Taoist Scriptures and other issues. Results Of the 551 kinds of works of health maintenance embodied in the General Catalogue of Traditional Chinese Medicine Ancient Books, 404 kinds were completed before 1911, including 3 in the Han Dynasty, 1 in the Three Kingdoms Period, 2 in the Eastern Jin Dynasty, 1 in the Northern and Southern Dynasties, and 23 in the Tang Dynasty, 16 in the Song Dynasty, 20 in the Yuan Dynasty, 155 in the Ming Dynasty,and 183 kinds in the Qing Dynasty. The distribution of edition year was 1 in the Yuan Dynasty, 155 in the Ming Dynasty, 182 in the Qing Dynasty, 155 in the Republic of China, and 47 unknown. The versions were mainly wood-block edition, lithograph, stereotype edition, manuscript, and copied manuscript. There were different types of second class, including 309 kinds of general theory of health-maintenance, 157 kinds of Daoyin and Qigong, and 85 kinds of alchemy. There were 224 kinds of unique books, accounting for 40.65％ of the total amount of 551 kinds of books of traditional Chinese medicine, among which 95 kinds were included in the series, and 109 kinds were included in Collected Taoist Scriptures, Quotes of Taoist Canon, Taoist Essence, and Taoist Collection. Conclusions The Health monographs reflect the development of TCM health maintenance level, the ideological culture, and social changes in different historical periods, which is of great value in the history of TCM health maintenance.

Indirect self-destructiveness in individuals with schizophrenia

Objective: To explore the indirect self-destructiveness syndrome in patients with schizophrenia. Methods: Two hundred individuals with paranoid schizophrenia (117 men and 83 women, mean age 37.15 years), all in remission, were examined using the Polish version of the Chronic Self-Destructiveness Scale. Two hundred well-matched healthy individuals served as a control group. Results: The intensity of indirect self-destructiveness was greater in the schizophrenia group than in controls. The intensity of each manifestation was as follows (in decreasing order): helplessness and passiveness in the face of difficulties (A5), personal and social neglects (A3), lack of planfulness (A4), poor health maintenance (A2), transgression and risk (A1). Conclusion: Patients with schizophrenia displayed more behaviors that were indirectly self-destructive than healthy controls; they scored better than healthy controls only on caring for their own health. The patients showed the lowest intensity of behaviors connected with the active form of indirect self-destructiveness, and the highest intensity of behaviors connected with the passive form. These findings may enable delivery of more effective forms of pharmacological and psychosocial help to patients with schizophrenia.

Utilization of basic health units of FHS according to private health insurance / Utilização das unidades básicas de saúde da ESF conforme a cobertura por plano de saúde

ABSTRACT OBJECTIVE To describe the utilization of basic health units according to coverage by discount card or private health insurance. METHODS Household survey in the area covered by Family Health Strategy in Pelotas, state of Rio Grande do Sul, Brazil, from December 2007 to February 2008, with persons of all age groups. The frequency of (medical or non-medical) healthcare seeking at the basic health units in the last six months and the prevalence of basic health unit utilization for the last medical consultation (in case it had been performed up to six months before, for a non-routine reason) were analyzed by Poisson regression adjusted for the sampling design. RESULTS Of the 1,423 persons, 75.6% had no discount card or private health insurance. The average frequency of (medical or non-medical) healthcare seeking was 1.6 times in six months (95%CI 1.3-2.0); this frequency was 55.8% lower (p < 0.001) among privately insured persons compared to those with no discount card or private health insurance. Among the last medical consultations, 35.8% (95%CI 25.4-47.7) had been performed at the basic health units; this prevalence was 36.4% lower (p = 0.003) among persons covered by discount card and 87.7% lower (p = 0.007) among privately insured persons compared to those without both coverages. CONCLUSIONS Private health insurance and, to a lesser degree, discount card coverage, are related to lower utilization of basic health units. This can be used to size the population under the accountability of each Family Health Strategy team, to the extent that community health workers are able to differentiate discount card from PHI during family registration.

RESUMO OBJETIVO Descrever a utilização de unidades básicas de saúde conforme a cobertura por cartão de desconto e plano de saúde. MÉTODOS Inquérito domiciliar na área de abrangência da Estratégia Saúde da Família de Pelotas, RS, entre dezembro de 2007 e fevereiro de 2008, incluindo pessoas de todas as faixas etárias. A frequência de busca por atendimento (médico ou não) nas unidades básicas de saúde nos últimos seis meses e a prevalência do uso das unidades básicas de saúde para a última consulta médica (caso esta tivesse sido realizada até seis meses atrás, e tivesse tido um motivo que não rotina) foram analisadas por regressão de Poisson ajustada para o delineamento amostral. RESULTADOS Das 1.423 pessoas, 75,6% não estavam cobertas por cartão de desconto ou plano de saúde. A frequência média da busca por atendimento (médico ou não) foi de 1,6 vezes em seis meses (IC95% 1,3-2,0); essa frequência foi 55,8% menor (p < 0,001) entre as pessoas cobertas por plano de saúde em comparação às pessoas sem cartão de desconto ou plano de saúde. Dentre as últimas consultas médicas, 35,8% (IC95% 25,4-47,7) tinham sido realizadas nas unidades básicas de saúde; essa prevalência foi 36,4% menor (p = 0,003) entre as pessoas cobertas por cartão de desconto e 87,7% menor (p = 0,007) entre as pessoas cobertas por plano de saúde em comparação às pessoas com ambas as coberturas. CONCLUSÕES A cobertura por plano de saúde e, em menor grau, a cobertura por cartão de desconto associam-se a uma menor utilização das unidades básicas de saúde. Isso pode ser utilizado para dimensionar a população sob a responsabilidade de cada equipe de Estratégia Saúde da Família, na medida em que os agentes comunitários de saúde sejam capazes de diferenciar cartão de desconto e plano de saúde durante o cadastramento das famílias.

Significance of establishing a corpus of English translation for the TCM health preservation / 国际中医中药杂志

This paper discussed and elucidated the significance of establishing a corpus of English translation for the TCM terms of health preservation. To investigate the necessity and feasibility of corpus, we have explored the domestic and international researchs of the data sources and corpora and translation of TCM terms. We also predicted the prospect of application of this corpus.

Research and Development of Health Maintenance Mobile Applications of Traditional Chinese Medicine / 医学信息学杂志

Based on the investigation and analysis of industry dynamics of health maintenance Applications (APP) of Traditional Chinese Medicine (TCM),the paper designs and develops health maintenance APP of TCM,and describes its architecture,operating principle,functions,innovativeness,applicability scope,etc.

Experience of Lifetime Health Maintenance Clinic in a Tertiary Hospital: Patients Satisfaction and Associated Factors

BACKGROUND: Lifetime health maintenance program (LHMP) is designed for individualized disease prevention and health promotion through regular health check-ups and improving risk factors. This study aimed to investigate patients' satisfaction of lifetime health clinic (LHC) in a tertiary hospital and to evaluate associated factors in order to support primary health care strengthening policy. METHODS: We conducted surveys for patients, who visited LHC in a department of family medicine at a tertiary hospital from March 1st 2016 to December 31st 2016. We analyzed proportions and characteristics associated with patients, who were willing to recommend LHC. The relationship between willingness to recommend LHC and associated factors were evaluated by multivariate logistic regression analyses. RESULTS: Among the patients who answered the questionnaires, 83.7% responded that they would recommend LHC to others. Results from multivariate analyses suggested that patients living in provinces (odds ratio [OR] 4.21, 95% confidence interval [CI], 1.36-13.02), patients who were recommend by others to visit LHC (OR 3.99, 95% CI, 1.29-12.35), and those who had a large number of medical service preference items (OR 5.91, 95% CI, 1.48-23.58) were significantly associated with willingness to recommend LHC. CONCLUSIONS: LHC pursues the goal of primary care. Findings highlight the fact that high quality health service should be provided in small and municipal hospitals to improve patients' satisfaction. Furthermore, it is essential to establish family physician networks and health service infrastructure that can reflect various opinions.

Procesos de expansión y límites a la privatización de la atención de la salud en América Latina: más allá de las tipologías / Processes of expansion and limits to privatization of healthcare in Latin America: beyond typologies / Processos de expansão e limites a privatização da atenção à saúde na América Latina: além das tipologias

Resumen: El objetivo fue realizar una revisión bibliográfica sobre los sistemas de salud y estudios comparados en políticas y sistemas de salud para identificar los principales aportes de los mismos en el análisis de la privatización, especialmente, el papel de las organizaciones que comercializan planes y seguros de salud en los sistemas nacionales de salud en países de América Latina. La revisión se centró en analizar la adecuación de perspectivas o propuestas teórico-metodológicas y de sus indicadores para dimensionar la participación del sector privado, y su interacción con los sistemas nacionales de salud. De este modo, buscamos problematizar la adecuación, los límites y las potencialidades de los mismos, en el estudio de los procesos de privatización en los sistemas de salud de países de América Latina. El análisis comparado de algunos elementos específicos, como el análisis de gastos, la capacidad instalada, la población cubierta con planes y seguros privados en los sistema de salud, nos permitió identificar matices, contradicciones existentes en los sistemas, respecto a la relación público-privada, así como cuestionarnos el uso de clasificaciones tradicionales con las que se definieron diversos sistemas de salud en nuestra región. Nuestro desafío fue romper con algunas explicaciones lineales o ausentes de contradicciones sobre los análisis de los sistemas de salud. Desde esa perspectiva, es necesario cuestionar categorías o tipologías que se han desarrollado y utilizado de manera recurrente, con el fin de que se discutan y repiensen para poder avanzar en una comprensión más rigurosa de nuestras realidades, así como estimular nuevos debates y explicaciones.

Abstract: The aim was to conduct a literature review on health systems and comparative studies of health policies and systems to identify the leading contributions to the analysis of privatization, especially the role of health maintenance organizations and health insurance companies in national health systems in Latin America. The review focused on analyzing the adequacy of theoretical and methodological perspectives or proposals and their indicators to measure the private health sector's participation and interaction with national health systems. We thus seek to problematize the adequacy, limits, and potentialities of such perspectives for investigating the privatization processes in Latin American health systems. The comparative analysis of some specific elements such as health expenditures, installed capacity, and population covered by health plans and health insurance allowed us to identify contradictions in the systems regarding public-private relations, as well as to question the use of traditional classifications for defining various health systems in the region. Our challenge was to break with linear, non-contradictory explanations for analyzing health systems. This perspective requires questioning categories and typologies that have been developed and used repeatedly in order to discuss and rethink to move forward with a more rigorous understanding of our realities, as well as to encourage new debates and explanations.

Resumo: O estudo teve como objetivo fazer uma revisão bibliográfica sobre os sistemas de saúde e estudos comparados em políticas e sistemas de saúde para identificar os principais aportes dos mesmos na análise da privatização, especialmente, no papel das organizações que comercializam planos e seguros de saúde nos sistemas nacionais de saúde em países da América Latina. A revisão foi focada em analisar a adequação das perspectivas ou propostas teórico-metodológicas de seus indicadores para dimensionar a participação do sector privado da saúde, e sua interação com os sistemas nacionais de saúde. Deste modo, procuramos problematizar a adequação, os limites e as potencialidades dos mesmos, estudando os processos de privatização nos sistemas de saúde de países da América Latina. As análises comparadas de alguns elementos específicos, como as análises de custos em saúde, a capacidade instalada, a população coberta com planos e seguros de saúde, nos permitiu identificar as vinculações e contradições existentes nos sistemas, ao respeito das relações com o sistema público-privado, além de questionarmos o uso das classificações tradicionais com as quais foram definidos os diferentes sistemas de saúde em nossa região. Nosso desafio foi romper com algumas explicações lineares o carentes de contradições sobre as análises dos sistemas de saúde. Desde essa perspectiva, é necessário questionar as categorias ou tipologias que foram desenvolvidas e usadas de forma recorrente, com o fim de discuti-las e repensa-las a fim de avançar numa compreensão mais rigorosa das nossas realidades, assim como estimular novos debates e explicações sobre esta questão.

Research on Construction Methods of Traditional Chinese Medicine Health Maintenance / 世界科学技术-中医药现代化

This article was aimed to explore the method of traditional Chinese medicine (TCM) health maintenance knowledge base building. TCM health maintenance knowledge classification method was studied under the guidance of TCM health maintenance classification system to construct a special literature database to store TCM health maintenance knowledge. Based on TCM literature resources, TCM health maintenance knowledge service platform was designed and developed for the static display and dynamic query support of TCM health maintenance knowledge. The content of knowledge base will be accessed to the whole society. The results showed that the construction method can be a system arrangement and modern interpretation of TCM health maintenance knowledge, in order to support TCM health maintenance knowledge base and its update and service system. It was concluded that under the guidance of TCM theories, the construction of TCM health maintenance knowledge base will realize the health maintenance knowledge-sharing and service requirement of TCM.

Comparative Study on Traditional Chinese Medicine Constitution Test and Fitness Test of University Students / 中国中医药信息杂志

Objective To compare the differences between TCM constitution test and fitness test of university students from different aspects;To prove that bringing TCM constitution test into fitness test of university students is feasible. Methods Comparative method was used to compare the differences between TCM constitution test and fitness test of university students from the aspects of basic theory, test content, test methods, and interventions. Results There were differences on the aspects of basic theory, test content, test methods, and interventions between TCM constitution teat and fitness test of university students. The test population and test aim were the same. TCM constitution test could comprehensively test physical, psychological, and social adaptability of university students. The individualized program of health maintenance could be given according to TCM constitutions after TCM constitution test. But this test is subjective. The fitness test of university students mainly focus on measuring physical health and the test method is objective. Conclusion TCM constitution test can be brought into current fitness test of university students to test their healthy condition more comprehensively and accurately. The individualized program of health maintenance can be offered after the test to promote health of university students.

Las denuncias de los afiliados de las empresas de medicina prepaga presentadas ante la Subsecretaría de Defensa del Consumidor en Argentina, 2000-2008 / Complaints by private health insurance policy-holders to the Consumer Protection Bureau in Argentina, 2000-2008 / As denúncias de afiliados às empresas de planos e seguros privados de saúde encaminhadas à Subsecretaría de Defensa del Consumidor na Argentina, 2000-2008

El trabajo analiza los problemas de los afiliados a las empresas de medicina prepaga en Argentina cuando las mismas incumplen con la Ley de Defensa del Consumidor. El universo de estudio se conformó por las denuncias de los afiliados durante los años 2000-2008, ante la Subsecretaría de Defensa del Consumidor de la Nación, y por las disposiciones y laudos emitidos por la misma. Un aspecto conclusivo es la recurrencia de los incumplimientos en las prestaciones del Programa Médico Obligatorio y los argumentos expuestos por las empresas, centrados en la responsabilización de los afiliados. Se advierte que la falta de un sistema de información a nivel nacional impide la realización de estudios empíricos que reflejen adecuadamente el problema. La discusión se realiza a partir de estudios sobre los seguros privados de salud en otros países de la región. Sobre ello se observa la importancia de estudiar a las empresas de medicina prepaga, su articulación con el sistema de salud, y los procesos de limitación y negación de la ciudadanía, así como la creciente judicialización de la salud.

This paper analyzes problems experienced by policy-holders of voluntary private health insurance plans in Argentina when insurance companies fail to comply with the Consumer Protection Code. The sample consisted of consumer complaints filed with the Consumer Protection Bureau and rulings by the Bureau from 2000 to 2008. One striking issue was recurrent non-compliance with services included in the Mandatory Medical Program and the companies’ attempts to blame policy-holders. According to the study, the lack of an information system hinders scientific studies to adequately address the problem. Thus, a comparison with studies on health insurance in other Latin American countries highlighted the importance of such research, the relationship to health systems, constraints on use and denial of citizens’ rights to healthcare, and the increasing judicialization of healthcare provision.

O artigo analisa os problemas dos usuários das empresas de planos e seguros privados de saúde na Argentina quando as mesmas não cumprem com a Lei de Defesa do Consumidor. O universo de estudo foram as reclamações dos usuários durante os anos 2000-2008 encaminhadas à Subsecretaría de Defensa del Consumidor, e as disposições e os laudos emitidos pela Subsecretaría. Um aspecto conclusivo é a recorrência do não cumprimento dos serviços do Programa Médico Obrigatório e o argumento das empresas centrado na responsabilização dos usuários. Avalia-se que a falta de um sistema de informação dificulta estudos empíricos que reflitam adequadamente o problema. Assim, com base em estudos sobre empresas de planos e seguros de saúde em outros países da América Latina, observa-se a importância de realizar estudos sobre as mesmas, sua relação com os sistemas de saúde e os processos de limitação e negação da cidadania e da crescente judicialização da saúde.

Economic Burden of Drug Therapy in Hypertension Management in a Private Teaching Hospital in Nigeria.

Background: Information on economic burden of hypertension is needed for relevant decisions and policies due to escalating cost of disease management. Aims: The study assessed economic burden of pharmacotherapy in hypertension management on the National Health Insurance Scheme (NHIS) of Nigeria and the economies of antihypertensives selection. Study Design: Cross-sectional study. Place and Duration of Study: Out-patient-department of a private teaching hospital located in Lagos, Nigeria over four-month duration in 2011. Methodology: Two hundred and fifty case notes of hypertensive patients were randomly selected. These were assessed for costs of pharmacotherapeutic management of hypertension. Patients’ details such as demographic data, drug regimens and funding status were extracted from the case notes. Drugs’ prices were obtained from the hospital billing guide. Data presentation was by using descriptive statistics. Results: Two hundred and eight (83.2%) of the selected case notes met the study criteria. Diuretics were the most economical at an average monthly cost per prescription of NGN858.6 ($5.51) followed by the beta-blockers at NGN1,101.1 ($7.07) while fixed dose combinations were the costliest at NGN10,425.0 ($66.93). Health Maintenance Organizations (HMOs) having 104 (50.0%) of the cohort as enrollees incurred most of the cost at NGN446, 325.0 ($2,865.47) followed by NHIS 75 (36.0%) at NGN321, 354.0 ($2,063.14). An average monthly cost of antihypertensives per patient was highest for private patients NGN4, 314.47 ($27.69) and least for NHIS NGN4, 284.72 ($27.50). The national cost implication using the least average monthly antihypertensive cost per patient of NGN4,284 .72 ($27.50) for NHIS implies an average of NGN51,416.64 ($330.10) per annum for each patient and a whooping sum in excess of NGN1.054 trillion (over $6.76billion) for over 20 million affected hypertensive patients in Nigeria. Conclusion: Cost burden of hypertension management is high, incurred mostly by HMOs and NHIS. Diuretics were the most economical of all prescribed regimens.

Afinación del instrumento para medir entornos de la práctica de Enfermería: "PracticeEnvironmentScale of theNursingWorkIndex PES-NWI" / Refinement of the instrument to measure Nursing practice environments: "PracticeEnvironmentScale of theNursingWorkIndex PES-NWI"

La medición de los Ambientes de Práctica cobra relevancia a medida que los mismos adquieren significado para el desarrollo de la Práctica Profesional de Enfermería. Actualmente en Colombia no se cuenta con un instrumento para la medición de los ambientes que esté totalmente validado para el contexto nacional, situación que motivó la realización de la presente investigación, cuyo contenido explica el desajuste con relación a la validez de constructo que presenta el instrumento para medir entornos de la práctica de Enfermería: "Practice Environment Scale of the Nursing Work Index PES - NWI", creado en Estados Unidos y tomado como referencia en estudios precedentes en Colombia. La investigación metodológica adquirió como punto de partida la estructura general para el diseño y elaboración de instrumentos, enfocada en la evaluación de la teoría subyacente del instrumento "PES - NWI". Los resultados obtenidos permiten visualizar que no se encuentra un desarrollo a profundidad del constructo que se pretende medir, por lo que se realizó una revisión teórica que conduce a la descripción aproximada de un sustento para el instrumento "PES - NWI". Con la investigación se relacionan los ítemes del instrumento con aspectos de la Sociología de las Organizaciones y se genera una nueva propuesta teórica que reformula tanto las dimensiones como la distribución de los ítemes en ellas. En esta investigación diecinueve de treinta y un ítemes son clasificados y organizados en cuatro dimensiones, una menos que en el "PES - NWI" original de Eileen Lake. No obstante se consideran pertinentes nuevas revisiones para el ajuste final del instrumento. (AU)

Measuring Practice Environments become relevant as they acquire meaning for the development of Nursing Practice. Currently in Colombia an instrument that is fully validated for the national context does not exist, situation which led to the completion of this investigation. The content explains the mismatch with respect to construct validity, introducing the instrument to measure Environments Nursing Practice: "Practice Environment Scale of the Nursing Work Index PES - NWI", created in the United States and used as a reference in previous studies in Colombia. Methodological research took as its starting point the general structure for the design and development of tools focused on assessing the underlying theory of the instrument "PES - NWI". The results obtained display that there is not in-depth development of the construct to be measured, so that a theoretical review leading to the approximate description of a livelihood for the "PES - NWI" instrument was made. Through research, the items of the instrument are related to aspects of the Sociology of Organizations, generating a new theoretical proposal which reformulates both the size and the distribution of items in them. In this current research, nineteen thirty-one items were classified and organized into four dimensions, one less than in the "PES - NWI" original Eileen Lake. However new revisions are considered relevant for the final adjustment of the instrument. (AU)

Desempenho cognitivo e fragilidade em idosos clientes de operadora de saude / Desempeno cognitivo y fragilidad en ancianos clientes de operadora de salud / Cognitive performance and frailty in older adults clients of a private health care plan

OBJETIVO Analisar a associação entre a síndrome da fragilidade e desempenho cognitivo em idosos e respectivo efeito da escolaridade e da idade. MÉTODOS Foram analisados dados seccionais da fragilidade de idosos brasileiros da Fase 1 do Estudo FIBRA-RJ, relativos a 737 indivíduos residentes na cidade do Rio de Janeiro, RJ, com 65 anos ou mais, clientes de uma operadora de saúde, avaliados entre janeiro de 2009 e janeiro de 2010. Foram coletadas informações sobre características socioeconômicas e demográficas, condições médicas e capacidade funcional. O desempenho cognitivo foi avaliado através do Mini Exame do Estado Mental. Foram considerados frágeis os indivíduos que apresentaram três ou mais das seguintes características: perda de peso não intencional (≥ 4,5 kg no último ano); sensação de exaustão autorrelatada; baixo nível de força de preensão palmar; baixo nível de atividade física e lentificação da marcha. A associação entre fragilidade e desempenho cognitivo foi avaliada por regressão logística multivariada, com ajuste por condições médicas, atividades da vida diária e variáveis socioeconômicas. Idade e escolaridade foram avaliadas como possíveis modificadoras de efeito dessa associação. RESULTADOS Os idosos frágeis apresentaram maior prevalência de baixo desempenho cognitivo comparados aos idosos não frágeis ou pré-frágeis nas três faixas etárias estudadas (65 a 74; 75 a 84; ≥ 85 anos), p < 0,001. Após ajuste, a associação entre fragilidade e desempenho cognitivo foi encontrada em idosos com 75 anos ou mais, com OR aj = 2,78 (IC95% 1,23;6,27) para 75 a 84 anos e OR aj = 15,62 (IC95% 2,20;110,99) para 85 anos ou mais. A idade se comportou ...

OBJETIVO Analizar la asociación entre el síndrome de la fragilidad y desempeño cognitivo en ancianos y respectivo efecto de la escolaridad y la edad. MÉTODOS Se analizaron datos seccionales de la fragilidad de ancianos brasileños de la Fase 1 del Estudio FIBRA RJ, relativos a 737 individuos residentes de la ciudad de Rio de Janeiro (Brasil), con 65 años o más, clientes de una operadora de salud, enero de 2009 a enero de 2010. Se colectaron informaciones sobre características socioeconómicas y demográficas, condiciones médicas y capacidad funcional. El desempeño cognitivo fue evaluado a través del Mini Examen del Estado Mental. Se consideraron frágiles los individuos que presentaron tres o más de las siguientes características: pérdida de peso no intencional (≥ 4,5 Kg en el último año); sensación de cansancio extremo auto-relatado; bajo nivel de fuerza de prensión palmar; bajo nivel de actividad física y lentitud en la marcha. La asociación entre fragilidad y desempeño cognitivo fue evaluado por regresión logística multivariada, con ajuste por condiciones médicas, actividades de la vida diaria y variables socioeconómicas. La edad y la escolaridad fueron evaluadas como posibles modificadoras del efecto de ésta asociación. RESULTADOS Los ancianos frágiles presentaron mayor prevalencia de bajo desempeño cognitivo en comparación con los ancianos no frágiles o pre-frágiles en los tres grupos etarios estudiados (65 a 74; 75 a 84; ≥ 85 años), p< 0,001. Posterior al ajuste, la asociación entre fragilidad y desempeño cognitivo fue encontrada en ancianos con 75 años o más, con ORaj = 2,78 (IC95% 1,23;6,27) para 75 a 84 años y ORaj = 15,62 (IC95% 2,20;110,99) para 85 años o más. La edad se comportó como modificadora ...

OBJECTIVE To investigate the association between frailty syndrome and cognitive performance in the older adults and the effect of schooling and age on this association. METHODS Data on frailty in older adults from Phase 1 of the FIBRA-RJ Study were analyzed, relating to 737 customers of a private health care provider, aged 65 and over, living in Rio de Janeiro, Southeastern Brazil, between January 2009 and January 2010. Data on socioeconomic and demographic characteristics, medical conditions and functional capacity were collected. Cognitive performance was assessed using the Mini-Mental State Examination (MMSE). Individuals who exhibited three or more of the following features were considered to be frail: unintentional weight loss (≥ 4.5 kg in the last year); feeling self-reported exhaustion, low grip strength, low physical activity level and slowness. The association between frailty and cognitive performance was evaluated using multivariate logistic regression, with adjustment for medical conditions, activities of daily living and socioeconomic variables. We evaluated the age and schooling as possible effect modifiers in this association. RESULTS The frail subjects had a higher prevalence of low cognitive performance, compared to not frail or pre-frail, in the three age groups studied (65-74; 75-84; ≥ 85 years), p < 0.001. After adjustment, the association between frailty and cognitive performance was found among older adults individuals aged 75 and older, with an ORadj= 2.78 (95%CI 1.23;6.27) for those aged 75 to 84 and ORadj= 15.62 (95%CI 2.20;110.99) for 85 and older. The age variable was an effect modifier in the association between frailty and cognitive performance, χ2(5) = 806.97, p < 0.0001; the same was not the case with schooling. CONCLUSIONS Frailty syndrome is associated with cognitive performance in the aging. Age proved to be an effect modifier in this association. The oldest patients showed ...

Perspectiva bioética do modelo de assistência suplementar no Brasil / Bioethics perspective model supplemental assistance in Brazil

Este artigo apresenta os resultados de estudo voltado aos planos e seguros privados de saúde, denominado de assistência suplementar, regulamentados no Brasil há mais de uma década para solucionar conflitos na prestação de serviços. A partir de metodologia qualitativa descreveu-se e analisou-se o modelo de assistência, as questões resolvidas, as que permanecem e as que emergiram nesse período. Resultados mostram que o setor suplementar pouco avançou do modelo baseado na lista de doenças e procedimentos, aprovado como plano referência, aumentando os conflitos relativos à incorporação de tecnologias e ao incremento da demanda e dos custos, diante do envelhecimento populacional. Consolidaram-se políticas na regulamentação que ferem princípios bioéticos do Sistema Único de Saúde, na assistência aos mais vulneráveis, às gestantes e idosos. Falta regulação, por parte do Estado, na adequação da área suplementar com outras políticas públicas, no sentido de aperfeiçoar a qualidade da atenção e ampliar equitativamente a cobertura assistencial.

This paper presents the results of a study about the private health plans and insurance, called supplementaryhealth, which were regulated in Brazil more than a decade ago in order to solve conflicts in the provision ofservices. The model of care, the issues resolved, those that remain and the ones that emerged during this period were described and analyzed, using a qualitative methodology. The results show that the supplementarysector made little progress from the model based on the list of diseases and procedures, approved as a reference plan, increasing conflicts regarding the incorporation of technologies and the increase of the demandand costs, due to the aging of the population. Regulatory policies that hurt the bioethical principles containedin the National Health System were consolidated, mainly regarding the assistance to the most vulnerable,pregnant women and the elderly. Regulation is lacking, by the State, in the adequacy of the supplementaryarea with other public policies, in the sense of perfecting the quality of care and expanding healthcare coverage equitably.

Health Maintenance and Access to Care Among Japanese Living in the U.S. (Pittsburgh, Pennsylvania) / General Medicine

<b>Introduction:</b> Minority ethnic populations have experienced poor health and barriers to accessing care, including Asian American and Pacific Islanders (AAPIs) in the US. Despite some evidence, there is inadequate understanding of the shortcomings of access to care for AAPIs due to substantial variations in health status among AAPI sub-ethnicities. In order to illuminate the access to care issue, we aimed to determine the prevalence of health insurance coverage and health maintenance visits to primary care among one of the major AAPI ethnicities, Japanese in the US city of Pittsburgh, Pennsylvania.<br><b>Methods:</b> Japanese in Pittsburgh registered at an urban primary care clinic where bilingual providers are available were surveyed in terms of health insurance and health maintenance exam. The key results were compared to age- and gender-matched Japanese averages from Japan's national data (Japanese National Health and Nutrition Survey, J-NHANS).<br><b>Results:</b> Of 97 identified for inclusion, all responded (Response rate, 100.0%). The majority of respondents (87.5%) had US-based health insurance. Only 38.5% of men and 17.5% of women visited their primary care physicians for annual health maintenance visits within a year (P < .001 compared to J-NHANS). Only 38.6% of the Japanese women in Pittsburgh who had primary care physicians had annual gynecological exams within a year. The prevalence of annual dental exams within a year was 55.0% and 68.4% in men and women, respectively.<br><b>Conclusions:</b> Despite the high rate of health insurance coverage, Japanese in Pittsburgh had far less health maintenance visits than expected. Improving access to preventive care may help to reduce unnecessary disease.

Idosos com e sem plano de saúde e características socioepidemiológicas associadas / Health insurance coverage of the elderly and socioepidemiological characteristics associated / Ancianos con y sin póliza de salud y características socioepidemiológicas asociadas

OBJETIVO: Analisar fatores epidemiológicos e sociodemográficos associados à saúde de idosos com ou sem plano de saúde. MÉTODOS: Foram realizadas entrevistas com 2.143 pessoas de 60 anos e mais, no município de São Paulo, em 2000 e 2006. A variável dependente, dicotômica, foi ter ou não plano de saúde. As variáveis independentes abrangeram características sociodemográficas e de condição de saúde. Foram descritas as proporções encontradas para as variáveis analisadas e desenvolvido modelo de regressão logística que considerou significantes as variáveis com p < 0,05. RESULTADOS: Houve diferenças, favoráveis aos titulares de planos, para renda e escolaridade. O grupo sem planos privados realizou menos prevenção contra neoplasias e mais contra doenças respiratórias; esperou mais para ter acesso a consultas de saúde; realizou menos exames pós-consulta; referiu menor número de doenças; teve maior proporção de avaliação negativa da própria saúde e relatou mais episódios de queda. Os titulares de planos relataram menor adesão à vacinação e, dentre os que foram internados, 11,1% em 2000 e 17,9% em 2006 tiveram esse procedimento custeado pelo Sistema Único de Saúde. A única doença associada à condição de titular de plano privado foi a osteoporose. CONCLUSÕES: Há diferenças representadas pela renda e pela escolaridade favoráveis aos titulares de planos e seguros privados, as quais estão relacionadas com o uso de serviços e com os determinantes sociais de saúde.

OBJECTIVE: To examine sociodemographic and epidemiological factors associated with private health insurance coverage in the elderly. METHODS: A total of 2,143 individuals aged 60 years or more were interviewed in the city of São Paulo in 2000 and 2006. Having private health insurance was the dichotomous dependent variable. Independent variables included sociodemographic characteristics and self-reported health status. The proportions of the variables studied were described and a logistic regression model considering those variables significant at p < 0.05 was constructed. RESULTS: The elderly with private insurance coverage had significantly higher income and education. The elderly with no private insurance were screened less for cancer and more for respiratory diseases; they waited longer for appointments; they performed less medical tests; they reported fewer conditions and more falls and had a more negative self-rated health. The insured respondents reported lower vaccination rates and, among those hospitalized, 11.1% had their medical costs covered by the Brazilian National Health System (SUS) in 2000 and 17.9% in 2006. Osteoporosis was the single condition associated with private health insurance. CONCLUSIONS: The elderly with private insurance coverage had significantly higher income and education than those with no private coverage, and these differences were associated with service utilization and social determinants of health.

OBJETIVO: Analizar factores epidemiológicos y sociodemográficos asociados a la salud de ancianos con o sin seguro de salud. MÉTODOS: Se realizaron entrevistas con 2.143 personas de 60 años y más, en el municipio de Sao Paulo, en 2000 y 2006. La variable dependiente, dicotómica, fue tener o no póliza de salud. Las variables independientes abarcaron características sociodemográficas y de condición de salud. Se describieron las proporciones encontradas para las variables analizadas y se desarrolló modelo de regresión logística que consideró significantes las variables con p < 0,05. RESULTADOS: Hubo diferencias, favorables a los titulares de pólizas, para renta y escolaridad. El grupo sin seguros privados realizó menos prevención contra neoplasias y más contra enfermedades respiratorias; esperó más para tener acceso a consultas de salud; realizó menos exámenes post-consulta; refirió menor número de enfermedades; tuvo mayor proporción de evaluación negativa de la propia salud y relató más episodios de caídas. Los titulares de pólizas relataron menor adhesión a la vacunación y, entre los que fueron internados, 11,1%, en 2000 y 17,9% en 2006 tuvieron ese procedimiento costeado por el Sistema Único de Salud Brasileño. La única enfermedad asociada a la condición de titular de seguro privado fue la osteoporosis. CONCLUSIONES: Hay diferencias representadas por la renta y por la escolaridad favorables a los titulares de pólizas y seguros privados, y estas están relacionadas con el uso de servicios y con los determinantes sociales de salud.

Avaliação de operadoras de saúde por usuários pelo método Analytic Hierarchy Process / Evaluation of health service providers by consumers through the Analytic Hierarchy Process Method / Evaluación de operadoras de salud por usuarios por el método Analytic Hierarchy Process (AHP)

OBJETIVO: Analisar a qualidade dos serviços oferecidos por empresas operadoras de planos de saúde, segundo a percepção de usuários. MÉTODOS: Estudo transversal com 360 usuários de sete operadoras de planos de saúde da cidade de Curitiba, PR, e região metropolitana em 2008. Foi aplicado questionário sobre as preferências dos usuários em relação a seis atributos (localização dos pontos de atendimento; efetividade da ação dos médicos, clínicas e hospitais; rapidez e amabilidade no atendimento; facilidade na liberação de guias; preço; abrangência da rede credenciada) de cada uma das empresas operadoras. Para a análise das respostas foi utilizado o método Analytic Hierarchy Process (AHP, ou Processo Analítico de Hierarquia), ferramenta de análise de decisão e planejamento de múltiplos critérios. RESULTADOS: O atributo mais valorizado pelos usuários foi "preço". As empresas foram agrupadas em dois conjuntos de preferências em relação aos atributos: dos sete planos de saúde, dois apresentaram menor preferência (entre 23% e 19%) e cinco, maior preferência (em torno de 10%). CONCLUSÕES: Com esse tipo de pesquisa, as empresas operadoras de planos de saúde poderiam reformular suas estruturas, processos, preços e redes credenciadas com o objetivo de melhorar seu posicionamento no mercado.

OBJECTIVE: To assess the quality of services offered by health service providers, according to the perception of consumers. METHODS: A cross-sectional study with 360 consumers from seven health service providers in the metropolitan area of Curitiba, PR, in 2008, was performed. An individual questionnaire measuring the consumers' preferences in relation to six attributes (location of service points; effectiveness of doctors, clinics and hospitals; promptness and kindness when caring for patients and family members; ease of access to the authorization forms for consultations; price; diversity of available doctors, clinics and hospitals) for each one of the analyzed health service providers was carried out. The Analytic Hierarchy Process (AHP), a multiple criteria tool for decision analysis and planning, was used to analyze the responses. RESULTS: The attribute most valued by the consumers was "price". The companies were grouped into two sets, regarding the mentioned attributes: two had lower preference (between 19% and 23%) and five, higher preference (around 10% each). CONCLUSIONS: With this type of research, health service providers could reshape their structures, processes, prices and accredited networks, in order to improve their market strategy.

OBJETIVO: Analizar la calidad de los servicios ofrecidos por empresas operadoras de seguros de salud, según la percepción de usuarios. MÉTODOS: Estudio transversal con 360 usuarios de siete operadoras de seguros de salud de la ciudad de Curitiba, Sur de Brasil, y región metropolitana en 2008. Se aplicó cuestionario sobre las preferencias de los usuarios con relación a seis atributos (localización de los puntos de atención; efectividad de la acción de los médicos, clínicas y hospitales; rapidez y amabilidad en la atención, facilidad en la liberación de documentos de aprobación, precio; alcance de la red acreditada) de cada una de las empresas operadoras. Para el análisis de las respuestas fue utilizado el método Analytic Hierarchy Process (AHP, o Proceso Analítico de Jerarquía), herramienta de análisis de decisión y planificación de múltiples criterios. RESULTADOS: El atributo más valorizado por los usuarios fue "precio". Las empresas fueron agrupadas en dos conjuntos de preferencias con relación a los atributos: de los siete seguros de salud, dos presentaron menor preferencia (entre 23% y 19%) y cinco, mayor preferencia (en torno de 10%). CONCLUSIONES: Con este tipo de investigación, las empresas operadoras de seguros de salud podrían reformular sus estructuras, procesos, precios y redes acreditadas con el objetivo de mejorar su posicionamiento en el mercado.

Estudo dos modelos assistenciais praticados por operadoras de planos privados de saúde / Study of care models practiced by private operators of health plans

Este estudo objetivou identificar a adoção, pelas operadoras, de modelos assistenciais que busquem a integralidade do cuidado, a partir da indução pela Agência Nacional de Saúde Suplementar (ANS). O universo foi composto por operadoras de planos de saúde atuantes no estado de Minas Gerais, nas modalidades autogestão, filantropia, medicina de grupo e cooperativa médica. As empresas foram descritas a partir dos cadastros da ANS. Foi realizada entrevista telefônica assistida por computador - ETAC - para obtenção de dados sobre o acesso dos beneficiários aos serviços, estruturação da rede e implantação de modelos segundo linhas materno-infantil, adulto/idoso, cardiovascular e neoplasias. Foram constatadas 182 empresas em atividade no estado; 108 foram elegíveis para o estudo; 27,1 por cento das operadoras informaram ter implantado programas de cuidado na linha materno-infantil; 22,2 por cento, na linha de cuidado ao adulto/idoso e 9,2 por cento em neoplasias. Inadequadas estruturas internas e o pequeno porte da maioria das operadoras podem explicar, em parte, a dificuldade de implantação e modelos de atenção mais cuidadores. Ressalta-se a ampla margem de inovações ainda existente para a introdução dessas práticas por parte das operadoras.

This study aimed to identify the adoption by private health insurance companies, from the induction by the Agência Nacional de Saúde Suplementar (ANS) of models that foments integrality. The universe were companies in Minas Gerais, in the modalities self-management, philanthropy, group medicine and medical cooperative. The companies were described from ANS official registers. Also, was made a computer-assisted telephone interview - ETAC- which approached: the beneficiaries' access to services, the structuring of the network, and the introducion of care models on maternal and child health, adult/elderly, cardiovascular and cancer. There were found 182 companies in Minas Gerais; 108 were elegible; 27,1 percent reported the deployment of care models on maternal and child health; 22,2 percent on adult/elderly health and 9,25 percent on cancer. Inadequate internal structures and the small size of most companies may somehow explain the difficulty of implementing models of care that foments integrality. We highlight the wide scope for innovations that still exists for the introduction of these practices by the companies.

Risk factors for cesarean section by category of health service / Fatores de risco para cesárea segundo tipo de serviço

OBJECTIVE: To analyze the rate of cesarean section and differences in risk factors by category of health service, either public or private. METHODS: A cross-sectional study was carried out including all pregnant women in labor admitted to hospitals in the city of Rio Grande, Southern Brazil, between January 1 and December 31, 2007. A pre-coded and pre-tested questionnaire was used to collect on social, demographic, obstetric and newborn care information. Two regression models were constructed: one for public users and the other one for private ones. Poisson regression was used in each model in the multivariate analysis. Prevalence rates and 95 percent confidence intervals were calculated for each adjusted factor. RESULTS: The rate of cesarean section was 43 percent and 86 percent among public and private users. Sociodemographic factors and twin births have a more significant impact among public users as well as number of pregnancies (25 percent vs. 13 percent reduction in public and private users, respectively) and previous cesarean section (86 percent vs. 24 percent increase in public and private users, respectively). Prenatal care visits and hospital admissions affected the outcome only in women users of public services. CONCLUSIONS: Cesarean section rates were high in both groups studied, but it was twice as high among women cared in the private sector. Associated factors differ in magnitude by category of service used.

OBJETIVO: Analisar a taxa de cesárea e fatores associados à sua ocorrência segundo serviço de saúde utilizado, público ou privado. MÉTODOS: Foi realizado estudo transversal entre 1º de janeiro e 31 de dezembro de 2007 com todas as gestantes que deram à luz nos hospitais da cidade de Rio Grande, RS. As gestantes foram entrevistadas, utilizando-se um questionário testado e pré-codificado com questões sociodemográficas, obstétricas e relacionadas ao recém-nascido. Foram desenvolvidos dois modelos de predição, um para as gestantes internadas pelo Sistema Único de Saúde (público) e outro para as gestantes internadas em serviços privados. Em cada modelo foi realizada uma análise multivariada utilizando a regressão de Poisson, calculando-se as razões de prevalência e seus respectivos intervalos com 95 por cento de confiança. RESULTADOS: A taxa de cesárea para o grupo público foi 43 por cento enquanto no grupo privado foi 86 por cento. Os fatores sociodemográficos e o parto gemelar foram mais importantes no modelo público, assim como o número gravidezes (redução de 25 por cento vs. 13 por cento no grupo privado) e cesárea prévia (incremento de 86 por cento vs. 24 por cento no privado). Consultas de pré-natal e internações afetaram o desfecho somente no grupo público. CONCLUSÕES: As taxas de cesárea foram elevadas nos dois grupos, sendo o dobro no serviço privado. Os fatores de risco são diferentes em magnitude, segundo o tipo de gestante.