Acceso a medicamentos de alto precio en Brasil: la perspectiva de médicos, farmacéuticos y usuarios / Access to high-cost drugs in Brazil from the perspective of physicians, pharmacists and patients

Objetivo: Explorar las percepciones sobre el acceso a los medicamentos del Componente Especializado de la Asistencia Farmacéutica (CEAF) del Sistema Único de Salud brasileño (que incluye los medicamentos de alto costo), por parte de los actores involucrados en el ámbito asistencial del CEAF. Métodos: Estudio cualitativo descriptivo. Para la recolección de los datos se realizaron un grupo focal con siete usuarios/as y 11 entrevistas semiestructuradas a profesionales de la salud (medicina y farmacia) del estado de Santa Catarina. Resultados: Según los/las participantes, el acceso a medicamentos del CEAF ha mejorado. Se encontraron también dos percepciones sobre los Protocolos Clínicos y Directrices de Tratamiento del CEAF: las exigencias son burocracia que limita el acceso y los requisitos aumentan la demanda de exámenes y especialistas, superando la capacidad de la red de servicios de salud. A partir de estas percepciones se generan vías alternativas de acceso que evidencian una concepción frágil del derecho a la salud, desinformación y dependencia por parte de los usuarios, las cuales pueden tener consecuencias en la salud de las personas y en el sistema de salud. Según los/las participantes, debido a las dificultades en el acceso de los servicios de salud en general, el pleno acceso a los medicamentos aún es un objetivo por alcanzar. Conclusión: De acuerdo con las percepciones encontradas, aunque el acceso a los medicamentos del CEAF ha mejorado, persisten dificultades para garantizar su oportunidad y su integralidad (AU)

Objective: To explore perceptions on access to medication supplied by the Specialized Component of Pharmaceutical Assistance (CEAF) within the Brazilian Unified Health System (which includes high-cost drugs) by the actors involved in the healthcare services of this component. Method: A descriptive, qualitative study was carried out by using a focal group with 7 users and 11 semi-structured interviews with health professionals (physicians and pharmacist) in the state of Santa Catarina. Results: According to the participants, access to medicines had improved. Two main perceptions of the CEAF Clinical Guidelines were identified: the requirements constitute a bureaucracy that limits access, and the requisites increase the demand for tests and specialized healthcare services, exceeding the capacity of the healthcare services network. These assumptions generated the search for other means of access that revealed a lack of information and understanding of the right to health among the users. In addition, according to the participants, because of the difficulties of accessing services as a whole, full access to CEAF medicines is a goal that remains to be achieved. Conclusion: Although access to CEAF medicines has improved, there are still some difficulties in guaranteeing treatment access and comprehensiveness (AU)

Caring for children with complex and continuing health needs.

Advances in medicine and technology mean that more children can survive with complex and continuing health problems. These children have specific needs that healthcare professionals should consider when providing and planning care. This article discusses home care provision, equipment and funding as well as family support needs.

High-tech rural clinics and hospitals in Japan: a comparison to the Japanese average.

CONTEXT: Japanese medical facilities are noted for being heavily equipped with high-tech equipment compared to other industrialised countries. Rural facilities are anecdotally said to be better equipped than facilities in other areas due to egalitarian health resource diffusion policies by public sectors whose goal is to secure fair access to modern medical technologies among the entire population. OBJECTIVES: To show the technology status of rural practice and compare it to the national level. DESIGN: Nationwide postal survey. SETTING, SUBJECTS & INTERVENTIONS: Questionnaires were sent to the directors of 1362 public hospitals and clinics (of the 1723 municipalities defined as 'rural' by four national laws). Information was collected about the technologies they possessed. The data were compared with figures from a national census of all hospitals and clinics. RESULTS: A total of 766 facilities responded (an effective response rate of 56%). Rural facilities showed higher possession rates in most comparable technologies than the national level. It is noted that almost all rural hospitals had gastroscopes and colonoscopes and their possession rates of bronchoscopes and dialysis equipment were twice as high as the national level. The discrepancy in possession rates between rural and national was even more remarkable in clinics than in hospitals. Rural clinics owned twice as many abdominal ultrasonographs, and three times as many gastroscopes, colonoscopes, defibrillators and computed tomography scanners as the national level. CONCLUSIONS: Rural facilities are equipped with more technology than urban ones. Government-led, tax based, technology diffusion in the entire country seems to have attained its goal. What is already known on this subject: As a general tendency in both developing and developed countries, rural medical facilities are technologically less equipped than their urban counterparts. What does this paper add?: In Japan, rural medical facilities are technologically better equipped than urban facilities.

Beneficios tangibles e intangibles de las nuevas tecnologías sanitarias / Tangible and intangible benefits of the new sanitary technologies

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HMO penetration, competition, and risk-adjusted hospital mortality.

OBJECTIVE: HMOs have been shown to have an effect on the care provided directly to their enrollees. They may also influence the care provided to individuals in fee-for-service plans through a spill-over effect. The objective of this study was to investigate the associations among HMO market penetration, HMO and hospital competition, and the quality of care received by Medicare fee-for-service patients measured by risk-adjusted hospital mortality rates. DATA SOURCES: The 1990 data for 1,927 hospitals in 134 metropolitan statistical areas (with five or more hospitals) included Medicare fee-for-service risk-adjusted mortality rates from the Medicare Hospital Information Reports, hospital characteristics from the American Hospital Association annual survey, and HMO market penetration and competition calculated from InterStudy and Group Health Association of America data. STUDY DESIGN: Statistical regression techniques were used to identify the associations between HMO market penetration, competition, and risk-adjusted mortality, controlling for other hospital characteristics and region. PRINCIPAL FINDINGS: Higher HMO market penetration and to a lesser degree increased HMO competition were associated with better mortality outcomes for fee-for-service Medicare enrollees. Competition between hospitals did not exhibit a significant association. CONCLUSIONS: HMOs may have a spill-over effect on quality of care received by individuals enrolled in fee-for-service plans. These findings may be explained by a positive effect on local practice styles or a preferential selection by HMOs for areas with better hospital care.

Make sure your imaging equipment goes the distance.

Today's hospitals have invested a substantial portion of their capital budgets on the purchase of high-tech equipment--diagnostic imaging machinery, clinical laboratory apparatus, biomedical devices--and yet only half have developed strategies for taking care of that equipment as it ages. When do you replace it? When is it obsolete? How do you determine whether it is cost effective? Kenneth Halverson examines the steps to take to develop and implement a successful asset management program that will enable you to keep your high-tech equipment going.