Influência das redes sociais no enfrentamento dos gastos diretos e indiretos com o tratamento da tuberculose / The impact of social network in coping with direct and indirect expenses with the treatment of tuberculosis

Introdução: A tuberculose constitui um problema de saúde pública e causa grande impacto na vida das pessoas, principalmente se viverem em situação de vulnerabilidade social. Objetivos: Identificar as redes sociais primária e secundária da pessoa com tuberculose; identificar a percepção da pessoa com tuberculose sobre o impacto do diagnóstico nos gastos diretos e indiretos para o tratamento da doença e; descrever o tipo de suporte das redes sociais primária e secundária da pessoa com tuberculose. Método: Pesquisa qualitativa fundamentada em um referencial teórico-metodológico de rede social, realizada mediante entrevista semiestruturada com 33 pessoas diagnosticados com tuberculose atendidas em duas unidades básicas de saúde do Rio de Janeiro, RJ, no período de janeiro a março de 2020. Os dados foram analisados com base na técnica de análise de conteúdo temática de Bardin. Resultados: Os resultados demonstraram que os participantes obtiveram impacto financeiro no orçamento familiar, tendo em vista as demandas de transporte alternativo no deslocamento até as unidades de saúde, com alimentação e realização de exames diagnósticos e complementares. Outro fator que contribuiu para esse impacto foi a perda do vínculo empregatício devido às dificuldades provenientes dos sinais e sintomas da doença, à redução das horas de trabalho e à diminuição da renda. Nesse contexto, verificou-se que os participantes contaram com o apoio da rede social primária, composta por familiares, amigos, colegas e vizinhos e manifestaram a expectativa de receber algum tipo de auxílio do programa social governamental ou de transferência de renda. Conclusão: Neste estudo foram destacados aspectos referentes à percepção das pessoas com tuberculose sobre impacto do diagnóstico nos seus gastos durante o tratamento da doença. O apoio de familiares e amigos foi fundamental para a manutenção do orçamento familiar, visto que as dificuldades evidenciadas implicam na falta de conexão com diferentes serviços de saúde e programas de benefícios sociais e governamentais durante a fase de tratamento da tuberculose que poderiam reduzir os riscos de agravamento da doença, bem como a manutenção das despesas e a reorganização do orçamento familiar desses usuários.

Introduction: Tuberculosis constitutes a public health issue, and causes great impact on people's lives, especially if they live in a situation of social vulnerability. Objectives: To identify the primary and secondary social network of the person with tuberculosis; To identify the perception of the person with tuberculosis about the impact of the diagnosis on the direct and indirect expenses for the treatment of the disease; and To describe the type of support of the primary and secondary social network of the person with tuberculosis. Method: This is a qualitative research based on the theoretical and methodological social network, done through a semi-structured poll with 33 persons that were diagnosed with tuberculosis and assisted at two basic healthcare units of Rio de Janeiro, RJ, in the period from January to March 2020. Data was analyzed based on the Bardin's thematic content analysis technique. Results: The results showed that the participants had financial impact on the family budget, given the demands of alternative transportation to the healthcare units, of food and with diagnostic and complementary tests. Another factor that contributed to this impact was the loss of employment due to difficulties arising from the signs and symptoms of the disease, to reduced working hours, and to reduced income. In this context, it was found that participants relied on the support of their primary social network, composed of family, friends, colleagues and neighbors, and expressed the expectation of receiving some type of assistance from a government social program or cash transfer. Conclusion: This study highlighted aspects related to the perception of people with tuberculosis about the impact of diagnosis on their expenses during the treatment of the disease. The support of family and friends was essential for the maintenance of the family budget, since the difficulties evidenced implied a lack of connection with different healthcare services and social and governmental benefit programs during the stage of tuberculosis treatment that could reduce the risks of worsening the disease, as well as the maintenance of expenses and the reorganization of the family budget of these users.

Catastrophic Health Expenditure Status and Trend of Korea in 2015 / 보건행정학회지

Catastrophic healthcare expenditure refers to out-of-pocket spending for healthcare exceeding a certain proportion of a household's income and can lead to subsequent impoverishment. The aim of this study was to investigate the proportion of South Korean households that experienced catastrophic healthcare expenditure between 2006 and 2015 using available data from the Korea Health Panel, National Survey of Tax and Benefit, and Household Income and Expenditure Survey. Frequencies and trend tests were conducted to analyze the proportion of households with catastrophic healthcare expenditure. Subgroup analysis was performed based on income level. The results of the Household Income and Expenditure Survey revealed that around 2.88% of households experienced catastrophic healthcare expenditure in 2015 and that this proportion was highest in the low income group. Results also showed a statistically significant increasing trend in the number of households with catastrophic healthcare expenditure (annual percentage change=0.92%, p-value <0.0001). Therefore, the findings infer a need to strengthen public health care financing and to particularly monitor catastrophic healthcare expenditure in the low income group.

Direct and Indirect Costs of Pediatric Gastroenteritis in Vellore, India.

Objective: To determine costs of pediatric gastroenteritis in out-patient and in-patient facilities. Methods: Cross-sectional survey of children with acute gastroenteritis attending out-patient clinic (n=30) or admitted in the ward (n=30) for management in the Christian Medical College, Vellore, India from July-September 2014 to estimate direct (drugs, tests, consultation/hospitalization) and indirect (travel, food, lost wages) costs associated with the episode. Results: Median direct and indirect costs were Rs 590 and Rs 190 for out-patient management and Rs 7258 and Rs. 610 for hospitalization, constituting 1.1% and 11% of median annual household income, respectively. Conclusions: Escalating healthcare costs need tracking for evaluation of interventions.

Inpatient Expenditure of the Decedent Elderly in Japan.

End-of-life healthcare expenditure has much to do with the Japanese Government’s policies of promoting integrated care in communities and promoting end-of-life care at home or at nursing homes rather than at hospitals. We analyzed healthcare expenditure for decedent elderly during the one year prior to death, focusing on inpatient expenditure and place of death as well as differences between males and females. The share of inpatient expenditure was 78 percent for the decedent elderly as a whole, compared to 45 percent for the whole elderly population. Monthly inpatient expenditure of those decedent elderly who received inpatient care consecutively in the final 4 months, increased gradually as death month approached for each age group. However, a sharp increase was found in only a small portion of this group. Place of death was quite related to the healthcare expenditure during the one year prior to death, and frequency of inpatient care use in the final year is as important as place of death in determining the level of healthcare expenditure.

Impacto da hepatite C sobre o consumo de recursos e custos de pacientescom cirrose hepática no SUS / Impact of hepatitis C on resource use and costs of patients with liver cirrhosis in the Brazilian public healthcare system (SUS)

Objetivo: Avaliar o consumo de recursos relacionado ao tratamento de pacientes cirróticos com o vírus da Hepatite C (HCV) genótipo 1 (G1) e compará-lo ao de pacientes com cirrose não relacionada ao HCV no SUS. Métodos: Foram levantadas no banco de dados do DataSUS as hospitalizações por CID de cirrose entre 2008 e 2012. Dentre estas hospitalizações, foram levantados os pacientes com histórico de tratamento com interferon peguilado, no mesmo período, para identificar pacientescom HCV G1 prévia, como definido pelo Protocolo Clínico e Diretrizes Terapêuticas (PCDT) do SUS. As coortes de pacientes com ou sem HCV prévio (CH+HCV e CH-HCV) foram acompanhadas por 60 meses e comparadas em termos de uso de recursos. Para a avaliação econômica, custos unitários de medicamentos foram analisados a partir do Portal de Compras Governamentais e, para valoração de hospitalizações, a partir do DataSUS. Resultados: Gastos com hospitalização de pacientes cirróticossomaram aproximadamente R$ 108 milhões em 2012, podendo ser observado um aumento de 75% no gasto comparado a 2008. A maioria dos pacientes internados por CH com ou sem HCV estava entre as idades de 45 e 64 anos, sendo a média de idade de 52 anos, e grande parte do gênero masculino. Os gastos médios com hospitalizações por paciente foram de R$ 6.583,00 nos pacientes do grupo CH+HCV versus R$ 3.496,00 nos pacientes do grupo CH-HCV (p < 0,001). Aproximadamente 5% dos pacientes CH-HCV receberam transplante hepático comparado com 7% dospacientes CH+HCV. O custo relacionado ao transplante na população CH+HCV representou 78% do custo total contra 67% dos pacientes CH-HCV, sendo o custo médio atribuído a transplantes nos pacientes CH+HCV 17% superior à população sem HCV. Conclusão: Os custos hospitalares entre os pacientes cirróticos relacionados ou não ao HCV apresentaram uma distribuição diferente entre si e significativa para a perspectiva do SUS.

Objective: Evaluate resource consumption related to the treatment of cirrhotic patients with hepatitis C virus (HCV) genotype 1 (G1) and compare to patients with cirrhosis not related to HCV in the Brazilian public healthcare system (SUS). Methods: Hospitalizations for the diagnosis of cirrhosis were obtained from DatasSUS between 2008 and 2012. Among these hospitalizations, patients with a history of treatment with pegylated interferon in the same period were evaluated, to identify patients with previous HCV G1, as defined by the Clinical Protocol and Therapeutic Guideline (PCDT)from SUS. The cohorts of patients with or without previous HCV (CH+HCV and CH-HCV) were followed for 60 months and compared in terms of resource use. For the economic evaluation, unit costs of medications were analyzed based on the Government Procurement Portal and costs of hospitalization from DataSUS. Results: Hospitalization expenditures of cirrhotic patients totaled approximately R$108 million in 2012, with an increase of 75% in spending compared to 2008. Most patients admitted for CH with or without HCV were between the ages of 45 and 64 years, with a mean age of 52 years and were mostly male. Approximately 5% of patients CH-HCV received liver transplantation compared to 7% of patients CH+HCV. Costs related to transplantation in the CH+HCV populationaccounted for 78% of the total cost compared to 67% among CH-HCV patients, being the average transplantation cost 17% higher in patients CH+HCV when compared to the population without HCV. Conclusion: Hospitalization costs among cirrhotic patients with or without prior treatment of HCV showed a different distribution and differences were significant for the SUS perspective.

Impacts of health care alliance on the visiting rate of NRCMS patients within the county:Case study of Huangzhong county, Qinhai province / 中国卫生政策研究

Objective:After examining the changes in medical expenses and flows of hospitalized patients with-in and outside the county under the New Rural Cooperative Medical Scheme ( NRCMS ) before and after the imple-mentation of health care alliance reform, this paper analyzes the impacts of health care alliance reform on the visiting rate of NRCMS patients within the county and explores their causes and channels. Methods:This paper uses the hos-pitalization data of NRCMS patients in 2013 and 2014 collected from Huangzhong county Qinghai province and inter-views with key informants and analyzes the hospitalization expenses, visiting flows and other indicators of patients. Results:After starting health care alliance reform, the total number of hospitalized patients to seek treatment outside the county decreased by 6 . 38%, the total hospitalization expenses to seek treatment outside the county decreased by 22 . 13%, and the hospitalization expenses per inpatient day to seek treatment within and outside the county increased by 14. 41% and 20. 69% respectively. Conclusions: By improving service capabilities of township health centers and increasing synergies between county-township-village health institutions, the county health care alliance reform has suc-cessfully enhanced the service capabilities of health care systems in the whole county and reasonably helped patients with common diseases to be hospitalized outside the county and frequently hospitalized people to return back to the county.

Funds for Treatment of Hospitalized Patients: Evidence from Bangladesh.

This study was designed to explore sources of funds for health expenditure of patients if they are hospitalized. We have included 379 patients of 3 private and 7 public hospitals to estimate total expenditure. Of them, 229 (60.4%) were from public and 150 (39.6%) from private hospitals. Mean expenditure was Tk 60,613.3 and 8,262.7, and duration of hospital stay was 10.7 and 11.8 days in private and public hospitals respectively. More than half (55%) of the patients from middle class were treated in private hospitals. Of them, 278 (74.0%) were funded by themselves, 48 (12.8%) by loan with interest rate of 100% to 180%, 23 (6.1%) by loan without interest, 17 (4.5%) by losing their fixed asset, and 4 (1.1%) by begging in the street. Most of the patients did bear expenditure by themselves, followed by loan with high interest rate. ‘Distress’ selling of property was also a source. Middle-class patients could be comfortable with expenditure if they were in public hospitals.

A Five Year Retrospective Study of Bed Utilization Trends in a Tertiary Care Teaching Institution.

Healthcare resources need to maintain pace with the increasing population and expectations. A hospital bed is a very important but limited healthcare resource. This 5 year study analyses the trends in the various bed utilization indices, bed utilization being an objective measure of the efficiency of any hospital management system. The study indicates that although the various indices fall within the described optimal, there is yet a lot of reserve on the available resources particularly so far as a hospital bed is concerned. The study emphasizes the role of analysis and assessment of bed utilization indices with a view to improving utilization of this scarce resource.