La prestación farmacéutica de las mutualidades de funcionarios españoles: ¿buena, bonita y barata? / Pharmaceutical benefit in Spanish civil servant mutual benefit associations: a square deal?

Objetivos. Comparar indicadores de la prestación farmacéutica en mutualismo y Sistema Nacional de Salud (SNS). Material y métodos. Se muestran cifras de recetas y gasto facturados por farmacias a las Mutualidades y SNS en el año 2003, a nivel estatal y autonómico. Se calculan ratios MUFACE/SNS de: a) copagos, gastos y recetas, por persona ("activa" y "pensionista") y por tramo (subvención general y adicional por Aportación Reducida) y b) envases consumidos y precios por grupos terapéuticos. Resultados. El mutualismo financia más del 6,7% de las recetas públicas dispensadas en Ceuta-Melilla, Madrid, Andalucía, Castilla-León, Murcia o Extremadura, pero apenas llega al 2% en Cataluña y País Vasco, superando en presupuesto farmacéutico a muchas Comunidades Autónomas. En MUFACE, el 58,4% de las recetas se destinan a mutualistas en "activo", cuyo gasto per cápita multiplica por 1,43 al del SNS mientras que el copago lo hace por 1,14, por sobreprescripción (ratio de 1,32) y mayor gasto por receta (1,09). Dicho exceso de gasto no afecta al tramo de Aportación Reducida (0,83) sino al de subvención general (1,59), donde supone 42,08 millones euros. El gasto por "pensionista" es la mitad del SNS, por la menor demanda de recetas (0,61) y pese al mayor precio de éstas (1,02), y multiplica por 3,34 al del mutualista "activo" mientras que el copago lo hace por 3,20 recaudando 27,53 millones euros. Los ratios por grupo muestran menor consumo mutualista per cápita de envases cardiovasculares (0,57), sangre (0,66), metabolismo(0,68), nervioso(0,74), "efectos"(0,46) y "genéricos" (0,40) y mayor consumo de antiinfecciosos (1,18), genitourinarios(1,17) y "fórmulas magistrales"(2,14), con precios más altos en envases nerviosos (1,05), dermatológicos (1,14), musculares (1,18), "fórmulas" (1,72) y genéricos (1,08). Conclusiones. Las recetas mutualistas no sustituyen a las del SNS, sobre todo en consumo "pensionista", conllevando sobremedicación de necesidad cuestionable en "activos", por lo que su prescripción debería encomendarse al SNS

Objectives. Compares indicators of pharmaceutical benefit at civil servant Mutuals with the Spanish National Health System (SNHS). Material and methodology. Figures from prescriptions and other expenses invoiced by pharmacies to Mutuals and the SNHS are compared at both national as regional level. Also calculated are the ratios MUFACE/SNHS of: a) co-payments, expenditures and prescriptions per person ("in active" and "pensioner") and stretch (general subsidies and aditional for Reduced Contribution) and b) packaging used and prices per therapeutical group Results. The Mutuals finances over 6.7% of public prescriptions dispensed in Ceuta-Melilla, Madrid, Andalucia, Castilla-Leon, Murcia or Extremadura and 2% in Catalonia and Basque Country, and your pharmaceutical budget is higher than that of many regional service. At MUFACE, 58.4% of these prescriptions are for "in active" and their per capita cost multiplies that of the SNHS by 1.43, while their co-payment does so by 1.14, by over prescribing (1.32) and greater cost per prescription (1,09).This excess is not produced by the Reduced Contribution (0.83) but by general subsidy(1.59) and means 42.08 million euros. Cost per "pensioner" is half that of the SNHS due to a lower demand for prescriptions(0.61) and in spite of a higher price (1.02), multiplies by 3,34 that of those mutualists "in active" while co-payments do so by 3.20 collecting 27.53 million euros. Ratios per therapeutical group show that mutualists use less packaging cardiovascular (0.57), blood (0.66), metabolism (0.68), nervous (0.74), "medical devices" (0.46) or generics (0.40) and more antinfectives(1.18), genito-urinary(1.17) and "pharmaceutical compounding"(2.14). packaging with a higher price include: nervous(1.05), dermatological(1.14), skeletal(1.18), "compounding" (1.72) and generics(1.08). Conclusions. Mutualist prescriptions do not substitute those of the SNHS, especially in "pensionists", causing over prescription of questionable need "in active". SNHS should be responsable for these prescriptions

Oferta e produçao de serviços de saúde no Brasil na década de 80: um estudo exploratório

Este trabalho consiste numa reflexao analítica sobre a universalizaçao dos serviços de assistência médico-hospitalar no Brasil na década de 80, processo que se dá através de uma reestratificaçao do perfil das clientelas e da expansao de empresas médicas. Tomo como caso paradigmático da promoçao da oferta e da produçao de atividades assistenciais pelas empresas de medicina suplementar, a AMIL. O estudo constitui uma tentativa de avançar no conhecimento sobre o fenômeno, a partir da bibliografia nacional disponível, da análise de documentos oficiais do IBGE, do INAMPS e dos dados obtidos na AMIL, na década de 80, além de entrevistas com alguns profissionais médicos ocupando cargo de chefia nessa Instituiçao de medicina suplementar

The need for occupational health nurses in nonindustrial settings. Results of a national survey.

A survey was done to determine the current and future demand for occupational health nurses in the nonindustrial settings of multi-specialty group medical practices and HMOs in the U.S. The results regarding future demand indicate a growth rate for the number of positions for occupational health nurses in these settings at greater than 300% in the coming decade. The present low number of graduates from occupational health nursing education programs make it unlikely that this demand can be met, a situation which will have serious adverses consequences for the health of the American work force.

Competition in health care markets and the development of alternative forms of service delivery.

This paper examines whether alternative forms of health care delivery locate in highly competitive health service markets. The analysis uses cross-sectional Florida data on the penetration of HMOs, ambulatory surgery centers, urgent care centers, hospices and home health programs in local markets characterized by varying levels of competitiveness among hospitals and among physicians. The results show generally that the development of these newer forms of service delivery are not systematically linked to inter-hospital competition but are influenced by physician supply and insurance demand. The potential contribution of such development to cost-containment efforts is thus questioned.

The growth of alternative delivery systems and the implications for hospitals.

The blending of the health care service and insurance industries into health service plans is reflected in the rapid emergence of alternative delivery systems. Detailed here is the growth and potential future of HMOs and PPOs. Also explored is how this phenomenon will affect hospital operations.