[Hospital expenditures for five diseases of high economic impact]. / Gasto hospitalario de cinco patologías de alto impacto económico.

OBJECTIVE: to identify by gender and age group, the hospital expenditures of the diseases that have the major economic impact at Instituto Mexicano del Seguro Social through using the diagnosis related groups (DRG) classification system and by estimating their associated costs. METHODS: DRG system served to estimate hospital expenditures for five diseases: hypertension, type 2 diabetes, chronic renal failure, cervical cancer and HIV/AIDS. DRG allow for better estimation given that consider cost adjustment based on the amount of resources employed in the treatment of different episodes. RESULTS: in the year 2002, 6.7 % of the hospital budget was assigned to the care of these five diseases. 42.6 % of the expenditures were allocated to patients aged 60 years and older and 22.3 % to patients from 50 to 59 years of age. Regarding diabetes mellitus and hypertension, care to patients over the age of 60 reached values of 55 % and 57 % of hospital expenditures respectively. Chronic renal failure and cervical cancer reached 60.5 % and 72.8 % of the expenditures, which were concentrated in patients aged 59 years or less; HIV/AIDS expenditures were distributed among patients from 20 to 50 years of age, the highest percentage (41.7 %) was in the group of 30 to 39 years of age. CONCLUSIONS: It is relevant to develop classification and information tools that consider the type of patients receiving hospital care, that are able to monitor changes due to the demographic and epidemiologic transition processes, and that allow for sensitive outcomes measurement. These tools will help in achieving an adequate financing and planning of health expenditures.

[Premature death and disability profile in the population affiliated to the Mexican Institute of Social Security (IMSS)]. / Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social.

OBJECTIVE: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. MATERIAL AND METHODS: Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. RESULTS: The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. CONCLUSION: The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Muerte prematura y discapacidad en los derechohabientes del Instituto Mexicano del Seguro Social / Premature death and disability profile in the population affiliated to the Mexican Institute of Social Security (IMSS)

OBJETIVO: Realizar estimaciones de la carga de la enfermedad para 129 causas a fin de identificar prioridades de salud en cada una de las delegaciones y presentar datos comparativos entre 1995-2000. MATERIAL Y MÉTODOS: Se analizaron los indicadores años de vida saludables perdidos (AVISA) y esperanza de vida saludable (EVISA) de los años 1995 y 2000 en la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS); en ambos estudios se utilizó la metodología del Estudio Mundial de Carga de Enfermedad. Los datos de 1995 se analizaron en 1997, y los datos de 2000, en 2001. El estudio comparativo se llevó a cabo en 2006 en el IMSS, México. RESULTADOS: La mayor proporción de AVISA perdidos se debió a enfermedades crónicas, si bien la tasa en 2000 es 1.5 veces mayor respecto de 1995. Las prioridades identificadas fueron diabetes mellitus, cardiopatía isquémica y la enfermedad cerebrovascular con pérdidas principalmente por muerte prematura, así como padecimientos asociados con discapacidad con una importante carga de enfermedad, tales como el SIDA o la depresión. Aún se observan rezagos epidemiológicos. CONCLUSION: La población derechohabiente se encuentra aún en fase de transición epidemiológica, lo que favorece una polarización en las condiciones de salud. Es necesario que las políticas de salud se orienten a dar una mejor respuesta y a revertir las tendencias de padecimientos que representan un riesgo institucional para el financiamiento de la atención de los derechohabientes.

OBJECTIVE: To carry out estimations of the burden of disease for 129 causes in order to identify health priorities in the different geographic regions of the country and to present comparative data between 1995 and 2000. MATERIAL AND METHODS: Indicators such as disability-adjusted life years (DALYs) and disability adjusted life expectancy (DALE) were analyzed for the population covered by IMSS in 1995 and 2000; for both years, the methodology proposed by the Burden of Disease Worldwide Study was applied. Data corresponding to 1995 were analyzed in 1997, while data corresponding to 2000 were analyzed in 2001. The comparative study was carried out in 2006 by IMSS, Mexico. RESULTS: The higher proportion of DALYs was due to chronic diseases, although the 2000 rate is 1.5 times higher than that of 1995. Priorities that were identified were diabetes mellitus, ischemic cardiopathy, and cerebrovascular disease, with a loss that is mainly accounted for by premature death, as well as by diseases related to disability with an important burden of disease, such as AIDS or depression. Epidemiological backlogs can still be observed. CONCLUSION: The population covered by IMSS is still in a phase of epidemiologic transition, favoring polarization in health conditions. Health policies need to be directed toward bringing about an improved response and reversing the trend in diseases that represent an institutional risk for the financing of health care.

Esperanza de vida saludable en la población mexicana con seguridad social / Disability adjusted life expectancy in mexican population with social security

Objetivo: Estimar la esperanza de vida saludable para ambos sexos, y por delegación, y aportar algunos aspectos metodológicos para la construcción del indicador. Material y método: Con base en la información de mortalidad correspondiente al año 2000, se realizó el análisis de las defunciones y construcción de la tabla de vida de la población derechohabiente del Instituto Mexicano del Seguro Social (IMSS), con la finalidad de conocer la Esperanza de Vida (EV) de esa población, tanto nacional como por delegaciones, para ello se utilizó el método de Chiang. Posteriormente se realizó modificación a la tabla de vida ajustada por la prevalencia de discapacidad, a través del método de Sullivan, para el cálculo de años de vida libre de discapacidad. Resultados: Se calculó una esperanza de vida en población asegurada que fue de 77.4 años. La esperanza de vida saludable se estimó en promedio para la población derechohabiente en 65.8 años y la esperanza de vida con discapacidad en 10.5 años. Conclusión: La población asegurada muestra un perfil demográfico que aún esta en transición, ya que los estados del centro y sur del país aún muestran rezagos en materia de salud, que impactan en una menor esperanza de vida, y en la esperanza libre de discapacidad, a diferencia de los demás que ya se encuentran en transición avanzada. Esto refleja el perfil de salud y las demandas que el sistema de salud deberá de enfrentar en el futuro. La tabla de vida es una herramienta que puede ayudar a los tomadores de decisiones a apoyar la construcción de escenarios y facilitar las actividades de planeación estratégica.

Objective: Estimate the disability adjusted life years for both sex and state and include the methodology that let it to build the indicator. Material and methods: We shown the build of life table elaborated for the Mexican population with Social Security in order to know the life expectancy (LE). We made the Chiang's Method with information about population and death certificate for the year 2000 after we modified the table of life Sullivan's method. Results: We calculate the life expectancy in social security population in 77.36 years and the life expectancy free of disability around 65.8 years and life expectative with disability in 10.5 years, this reference is a population ageing in transition process. Conclusion: With health profile that will give upper demands to health system. This is a tool that can help to build scene and to give facilities for the strategic administration.