Universal Health Coverage in Rural Ecuador: A Cross-sectional Study of Perceived Emergencies.

INTRODUCTION: In many low- and middle-income countries emergency care is provided anywhere in the health system; however, no studies to date have looked at which providers are chosen by patients with perceived emergencies. Ecuador has universal health coverage that includes emergency care. However, earlier research indicates that patients with emergencies tend to seek private care. Our primary research questions were these: What is the scope of perceived emergencies?; What is their nature?; and What is the related healthcare-seeking behavior? Secondary objectives were to study determinants of healthcare-seeking behavior, compare health expenditure with expenditure from the past ordinary illness, and measure the prevalence of catastrophic health expenditure related to perceived emergencies. METHODS: We conducted a cross-sectional survey of 210 households in a rural region of northwestern Ecuador. The households were sampled with two-stage cluster sampling and represent an estimated 20% of the households in the region. We used two structured, pretested questionnaires. The first questionnaire collected demographic and economic household data, expenditure data on the past ordinary illness, and presented our definition of perceived emergency. The second recorded the number of emergency events, symptoms, further case description, healthcare-seeking behavior, and health expenditure, which was defined as being catastrophic when it exceeded 40% of a household's ability to pay. RESULTS: The response rate was 85% with a total of 74 reported emergency events during the past year (90/1,000 inhabitants). We further analyzed the most recent event in each household (n=54). Private, for-profit providers, including traditional healers, were chosen by 57.4% (95% confidence interval [CI] [44-71%]). Public providers treated one third of the cases. The mean health expenditure per event was $305.30 United States dollars (USD), compared to $135.80 USD for the past ordinary illnesses. Catastrophic health expenditure was found in 24.4% of households. CONCLUSION: Our findings suggest that the provision of free health services may not be sufficient to reach universal health coverage for patients with perceived emergencies. Changes in the organization of public emergency departments and improved financial protection for emergency patients may improve the situation.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia / Análisis de costo-efectividad de la administración postoperatoria de Vitamina D y calcio después de tiroidectomía para la prevención de la hipo calcemia

Objective Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. Methods Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. Results The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. Conclusion Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Objetivos La hipo calcemia es la complicación más frecuente después de tiroidectomía. La administración profiláctica de vitamina D o metabolitos y calcio reduce la incidencia de hipocalcémia sintomática. Se evalúa su costo-efectividad en Colombia. Materiales y métodos Utilizamos la información de un meta-análisis que comparó la administración de vitamina D o metabolitos contra calcio no tratamiento en pacientes llevados a tiroidectomía total y diseñamos un análisis de costo-efectividad basados en un modelos de decisiones con costos locales. Resultados El valor del OR para la comparación entre calcitriol y calcio comparado con no tratamiento o calcio exclusivo fue de 0.32 (95 % IC, 0.13- 0.79) y 0.31 (95 % IC, 0.14-0.70), respectivamente. La estrategia más costo-efectiva fue la administración de vitamina D o metabolitos y calcio, con una relación de costo-efectividad incremental de US $0.05. Conclusiones El tratamiento profiláctico de la hipo calcemia con vitamina D o metabolitos y calcio o calcio exclusivo después de tiroidectomía total es una estrategia costo-efectiva.

Cost-effectiveness analysis regarding postoperative administration of vitamin-D and calcium after thyroidectomy to prevent hypocalcaemia.

OBJECTIVE: Hypocalcaemia is a frequently arising complication following total thyroidectomy. Routine postoperative prophylactic administration of vitamin D or metabolites and calcium reduce the incidence of symptomatic hypocalcaemia; this article reports evaluating its cost-effectiveness in Colombia. METHODS: Meta-analysis was used for comparing the administration of vitamin D or metabolites to oral calcium or no treatment at all in patients following total thyroidectomy and a cost-effectiveness analysis was designed based on a decision-tree model with local costs. RESULTS: The OR value for the comparison between calcitriol and calcium compared to no treatment and to exclusive calcium treatment groups was 0.32 (0.13-0.79 95 %CI) and 0.31 (0.14-0.70 95 %CI), respectively. The most cost-effective strategy was vitamin D or metabolites and calcium administration, having a US $0.05 incremental cost-effectiveness ratio. CONCLUSION: Prophylactic treatment of hypocalcaemia with vitamin D or metabolites + calcium or calcium alone is a cost-effective strategy.

Avian influenza in Mexico.

The outbreak of highly pathogenic avian influenza (HPAI) H5N2 in Mexico in 1994 led to a clear increase in biosecurity measures and improvement of intensive poultry production systems. The control and eradication measures implemented were based on active surveillance, disease detection, depopulation of infected farms and prevention of possible contacts (identified by epidemiological investigations), improvement of biosecurity measures, and restriction of the movement of live birds, poultry products, by-products and infected material. In addition, Mexico introduced a massive vaccination programme, which resulted in the eradication of HPAI in a relatively short time in two affected areas that had a high density of commercial poultry.

[Costs due to asthma medical care in a group of children from northeastern Mexico]. / Costos derivados de la atención médica del asma en un grupo de niños del Noreste de México.

BACKGROUND: In 1998 the economic burden of asthma in the United States was estimated in 12.7 billion dollars. In Mexico the annual direct costs for asthma could be approximately from 32 to 35 million dollars. OBJECTIVE: To estimate the healthcare costs in asthmatic children in the Northeast of Mexico. MATERIAL AND METHODS: A descriptive cross-sectional study was performed. We applied a questionnaire to the parents of 60 asthmatic children. They attended to a conference about asthma and allergy illnesses. In this questionnaire the parents answered some questions that provided us information about expenditures because of the treatment of their children with asthma during the last year. RESULTS: Fifty-six questionnaires were answered correctly. The mean age of children was 10.8 +/- 2.5 years and 64.3% of them were males. The annual costs reported by patient were < or = 225 USD for medical consultation (76.8%) and < or = 134 USD for immunotherapy (81.6%). On the other hand, the costs for emergency department visits and hospitalization were < or = 45 USD and < or = 180 USD by each event respectively. CONCLUSIONS: The costs of asthma treatment in children are considerable and cause a huge impact in the family economy. It is necessary further research in bigger groups and doing comparative studies among different groups will help clarify the extent of the economic burden of asthma in Mexico.

Análisis de costo-utilidad de la perfusión miocárdica en reposo y las troponinas en el tamizaje de pacientes con dolor torácico y electrocardiograma normal o no diagnóstico en urgencias / Cost-effectiveness ratios of the myocardial perfusion imaging at rest in patients with typical or atypical chest pain and normal or non diagnostic electrocardiogram

Objetivo: Determinar la utilidad esperada y la costo-efectividad del uso de la perfusión miocárdica en reposo en pacientes con riesgo bajo e intermedio de presentar infarto agudo del miocardio que consultan a urgencias con dolor típico o atípico y electrocardiograma normal o no diagnóstico. Diseño: Análisis de decisiones, Estudio de utilidad esperada y Análisis económico de costoefectividad. Lugar: Fundación A. Shaio. Bogotá-Colombia. Población: Pacientes mayores de 40 años con dolor típico o atípico que consultan a urgencias con electrocardiograma normal o no diagnóstico. Intervención: Se diseñaron tres modelos de análisis de decisiones que permitieran calcular la utilidad esperada y las razones de costoefectividad de las alternativas derivadas del uso de la perfusión miocárdica de reposo en urgencias y las troponinas para decidir hospitalización guiada o no por estos resultados, en las primeras seis horas de iniciados los síntomas. Mediciones: Se construyeron 3 árboles de decisiones comparando las alternativas de tamizaje derivadas del uso de las troponinas y la perfusión miocárdica para decidir la hospitalización. Las probabilidades de los eventos se obtuvieron de la revisión crítica de la literatura. Las utilidades se midieron mediante la técnica de ordenamiento directo en escala de 0 a 1 valorando las preferencias de los médicos de urgencias y de los pacientes que consultaron a urgencias por dolor torácico agudo y que fueron remitidos a Medicina Nuclear para valoración. Los costos se obtuvieron de la revisión de las facturas de las historias clínicas de 105 pacientes con diagnóstico en urgencias de angina y 116 pacientes quienes ingresaron por urgencias con diagnóstico de infarto en el período de enero a julio de 2001. El desenlace utilizado es la unidad natural "pacientes correctamente clasificados" que permita medir el impacto del diagnóstico incorrecto. Se calcularon las utilidades esperadas y las razones de costoefectividad una vez establecido el cos...

Uso y abuso de la imagenología en emergencias, Nonestre 2001 / Use and abuse of screening in emergencies. 2001

Se realizó un estudio descriptivo y transversal para hacer una caracterización de las indicaciones imagenologicas realizadas de urgencia en el Servicio Provincial de Emergencias del Hospital Provincial Docente Saturnino Lora, que abarcó el periodo comprendido desde el 1ro de enero hasta el 30 de septiembre del 2001. Entre las principales conclusiones tenemos que solo al 16,3 por ciento del total de los pacientes atendidos se les pudieron realizar estudios radiológicos. Dentro de las principales indicaciones las de mayor positividad están las de caderas, seguidas de los tobillos y hombro respectivamente. Los estudios negativos representan un costo de $ 45, 388 54(AU)

It was performed a descriptive and transversal study to make a characterization of the emergency imagenologic indications in the Provincial Service of Emergencies at Saturnino Lora Teaching Provincial Hospital during the period comprised from January 1rst to September 30, 2001. Among the main conclusions we expressed that only 16,3 percent of the total of the patients could had the radiologic studies. Within the main indications the ones of greater positivity were the hips, followed by the ankles and shoulder respectively. The negative studies represented a cost of $ 45, 388 54(EU)