Racionamiento, inflación e inequidad sanitaria en Venezuela: caso de las enfermedades cardiovasculares / Rationing, inflation and health inequity in Venezuela: case of cardiovascular diseases

los modelos público-sanitarios de caráctermonopólico como el venezolano, suelen asociarse a tendencias al racionamiento de los bienes y servicios que proveen a sus usuarios, así como a la merma de la calidad de estos. Por otro lado, la provisión de dichos bienes y servicios por la vía de mecanismos de mercado, tiene ante sí, el inconveniente que supone el ambiente inflacionario de su economía, cuyo impacto en los precios limita el acceso del paciente a su consumo. El caso de la enfermedad cardiovascular ofrece algunas claves para la comprensión de este fenómeno en el medio venezolano.

Public-health models of a monopolistic nature, suchas the Venezuelan, bring with them trends in the rationing ofthe goods and services they provide to their users, as well as inthe reduction of their quality. On the other hand, the provisionof these goods and services by means of market mechanisms hasbefore it, in our environment, the enormous impediment posedby the inflationary environment of its economy, whose impacton prices limits the patient's access to consumption. The case of cardiovascular disease offers some keys to understanding thisphenomenon in the Venezuelan environment.

Taylor's rule, political cycle, and Latin America-An analysis of time series in search of responsibility for monetary stabilization.

The decades before 1990 were dramatic for Latin American economies. However, from 1990 onwards, a set of policies followed by the various states in the region acheived economic stabilization with real income recovery. The attribution of this success has been disputed by politicians, economists and officials from international economic support institutions. This work will analyze the responsibility for this success in 4 economies in the region (Brazil, Colombia, Mexico and Peru). Through the combined analysis of ARDL, Markov states and structural breaks, we highlight different sources of responsibility in different periods. Additionally, detailing the states of each regime, we verify the duration of the regimes related to inflation rates and to interest rates in the region. We identify specific governments as associated with moments of economic stabilization in the region, so the hypothesis of the political cycle cannot be rejected for the set of results achieved. As policy implication, we claim that Taylor rules are endogenous to Political Budget Cycles and so stabilization plans are restricted to political tenures.

Interest on reserves, helicopter money and new monetary policy.

We build a nonlinear dynamic model with currency, demand deposits and bank reserves. Monetary base is controlled by central bank, while money supply is determined by the interactions between central bank, commercial banks and public. In economic crises when banks cut loans, monetary policy following a Taylor rule is not efficient. Negative interest on reserves or forward guidance is effective, but deflation is still likely to be persistent. If central bank simultaneously targets both interest rate and money supply by a Taylor rule and a Friedman's k-percent rule, inflation and output are stabilized. An interest rate rule policy is just a subset of a more general monetary policy framework in which central bank can move interest rate and money supply in every direction.

The effects of carbon emissions, rainfall, temperature, inflation, population, and unemployment on economic growth in Saudi Arabia: An ARDL investigation.

OBJECTIVE: While macroeconomic and environmental events affect the overall economic performance of nations, there has not been much research on the effects of important macroeconomic and environmental variables and how these can influence progress. Saudi Arabia's economy relies heavily on its vast reserves of petroleum, natural gas, iron ore, gold, and copper, but its economic growth trajectory has been uneven since the 1990s. This study examines the effects of carbon emissions, rainfall, temperature, inflation, population, and unemployment on economic growth in Saudi Arabia. METHODS: Annual time series dataset covering the period 1990-2019 has been extracted from the World Bank and General Authority of Meteorology and Environmental Protection, Saudi Arabia. The Autoregressive Distributed Lag (ARDL) approach to cointegration has served to investigate the long-run relationships among the variables. Several time-series diagnostic tests have been conducted on the long-term ARDL model to check its robustness. RESULTS: Saudi Arabia can still achieve higher economic growth without effectively addressing its unemployment problem as both the variables are found to be highly significantly but positively cointegrated in the long-run ARDL model. While the variable of carbon emissions demonstrated a negative effect on the nation's economic growth, the variables of rainfall and temperate were to some extent cointegrated into the nation's economic growth in negative and positive ways, respectively. Like most other nations the short-run effects of inflation and population on economic growth do vary, but their long-term effects on the same are found to be positive. CONCLUSIONS: Saudi Arabia can achieve both higher economic growth and lower carbon emissions simultaneously even without effectively addressing the unemployment problem. The nation should utilize modern scientific technologies to annual rainfall losses and to reduce annual temperature in some parts of the country in order to achieve higher economic growth.

The Impact of Inflation on the Medical and Hospital Money Transfers of the Neurosurgical Procedures of the Brazilian Unified Healthcare System from 2008 to 2017

Introduction There are more than 1,500 hospital procedures included in the Brazilian Unified Healthcare System's (SUS, in the Portuguese acronym) table, which is the reference for service payment provided by establishments serving the public health network, and they are stagnant. The underfinancing of procedures is so dramatic that in some cases the amounts paid by the SUS are even lower than the taxes generated by the costs of the same procedures in Brazilian private hospitals. This article aims to compare the evolution of the compensation of neurosurgical procedures by calculating the percentile of the lag in the values transferred to both neurosurgeons and hospitals, according to the SUS table, establishing the ideal and real values according to the current inflation, in a retrospective 9-year comparison. Methodology This is an observational, comparative, retrospective study, based on the values of medical and hospital money transfers of 25 neurosurgical procedures in 2008, which were corrected according to the 2017 National Consumer Price Index (IPCA, in the Portuguese acronym). Results Through this study, from 2008 to 2017, the transfers of medical fees regarding neurosurgical techniques are almost completely outdated. As examples, we can mention: the external/subgaleal ventricular shunt, with a deficit of 43.6%; the electrode implant for brain stimulation, with - 41.67%; and decompressive craniotomy, with - 32.21% in relation to the corrected value. Only 4 of the 25 neurosurgeries present a value above that predicted by the IPCA, one of them being cerebral aneurysm embolization larger than 1.5 cm with a narrow neck (þ 8.0%). Regarding the money transfers to hospitals, all procedures are 43.6% lower than expected, since there was no readjustment in the amounts paid to the institutions in the analyzed period. For example, in 2008, for the transposition of the cubital nerve, R$ 267.30 were transferred, and the same amount was maintained in 2017; and, for the surgical treatment of compressive syndrome in osteofibrous tunnel at carpal level (R$ 145.18), the amount also remained fixed throughout these 9 years. Conclusion Because they did not follow the evolution of the economy, in 80% of the surgeries, the neurosurgeons did not have their economic demands met regarding the procedures performed through SUS. And the data became even more alarming when the money transfers to hospitals were evaluated, since there was no evolution in the money transfers for any of the neurosurgeries evaluated.

Association Between the Percentage of US Drug Sales Subject to Inflation Penalties and the Extent of Drug Price Increases.

Importance: Policy makers have proposed levying penalties for drug price increases that are higher than the rate of inflation for drugs covered in the US Medicare program, but research is lacking regarding the ways in which manufacturers might respond to those penalties. An understanding of manufacturers' responses to existing inflation penalties could inform such policy discussions. Objective: To estimate the association of existing inflation penalties in the US 340B Drug Pricing Program with manufacturer pricing behavior in the Medicare Part D program and associated changes in Medicare pharmacy expenditures. Design, Setting, and Participants: This study included a pooled cross-sectional time-series analysis of price changes for Medicare Part D drugs used annually by more than 5000 beneficiaries between January 1, 2013, and December 31, 2017. The percentage of Medicare Part D sales subject to inflation penalties in the 340B program was used to perform a regression analysis to estimate the association of inflation penalties with annual drug price changes. The 340B program requires manufacturers to sell their drugs at a lower price to safety-net health care organizations; this lower price includes a base discount and an additional discount equal to the amount of any price increase that is higher than the rate of inflation. Sales to these 340B-eligible health care organizations represent the market share of a drug subject to inflation penalties. Health care organization-level claims data were obtained from the Medicare Provider Utilization and Payment Data-Part D Prescriber database, and organizations were matched to the Office of Pharmacy Affairs Information System of the Health Resources and Services Administration to identify those organizations that were eligible for the 340B program. Price change and drug use data were obtained from the Medicare Part D Drug Spending Dashboard. Name-brand drugs were included in the analysis if they did not have generic competition and were used by more than 5000 individuals with Medicare Part D in 1 calendar year. Data analysis was conducted from January 1 to February 28, 2020. Main Outcomes and Measure: Annual price change was the primary outcome measure; spending changes associated with lower price increases were also estimated. Sales percentage subject to inflation penalties was the primary independent variable, and formulary classification was a control variable. Results: Of 2148 brand-name drugs included in the database, 606 drugs were used by more than 5000 beneficiaries annually, with a mean sales percentage subject to inflation penalties of 12.1%. A higher sales percentage subject to inflation penalties was associated with lower annual price increases (between-effects coefficient, -0.114; 95% CI, -0.205 to -0.023; P = .01; fixed-effects coefficient, -0.380; 95% CI, -0.466 to -0.294; P < .001). Lower price increases owing to inflation penalties were estimated to be associated with a reduction in Medicare Part D pharmacy expenditures of $7.1 billion between 2013 and 2017. Conclusions and Relevance: In this cross-sectional study, increases in the percentage of drug sales subject to inflation penalties were associated with lower annual price increases. Broader application of inflation penalties may help to reduce drug price increases and decrease overall drug spending.

How the banking system is creating a two-way inflation in an economy.

Here we argue that due to the difference between real GDP growth rate and nominal deposit rate, a demand pull inflation is induced into the economy. On the other hand, due to the difference between real GDP growth rate and nominal lending rate, a cost push inflation is created. We compare the performance of our model to the Fisherian one by using Toda and Yamamoto approach of testing Granger Causality in the context of non-stationary data. We then use ARDL Bounds Testing approach to cross-check the results obtained from T-Y approach.

Consumer Numeracy and Insurance Design Decisions: An Examination of Inflation Protection Take-Up Among Private Long-Term Care Insurance Policy Holders.

Given the rising cost of long-term care (LTC) services, the selection of a private long-term care insurance (LTCi) policy with inflation protection has critical implications for the ability of this coverage to protect against potentially catastrophic LTC expenses. This study examines the effect of consumers' numeric abilities on the decision to add inflation protection to private LTCi policies. Over 40% of current LTCi policies lack inflation protection. Higher scores on a three-question numeracy scale are associated with increases in the probability of choosing inflation protection at the time of policy purchase, with households answering all three questions correctly being 12 percentage points more likely to have this benefit type relative to those with a numeracy score of 0 (p = .002). Market reforms that simplify the task of evaluating LTCi plans and assessing the value of indexed benefits may be needed to ensure that LTCi policy purchasers are selecting adequate protection against future LTC costs.

Asymmetrical effects of real exchange rate on the money demand in Saudi Arabia: A non-linear ARDL approach.

This present research investigates the money demand function of Saudi Arabia using a long period 1968-2016. In addition, the asymmetrical effects of real exchange rate changes have also been explored in the estimated money demand function. Our empirical results suggest that income and inflation have positive and negative effects on money demand respectively. Further, a real appreciation of US dollar has a positive effect but a real depreciation has a negative effect on the money demand. Furthermore, income and price homogeneity hypotheses do not hold for the estimated elasticities. Moreover, the estimated model is found stable with the theoretically expected effects of money demand's determinants. Therefore, we are suggesting money supply as a monetary policy instrument to the economy of Saudi Arabia.

Adjusting Health Expenditures for Inflation: A Review of Measures for Health Services Research in the United States.

OBJECTIVE: To provide guidance on selecting the most appropriate price index for adjusting health expenditures or costs for inflation. DATA SOURCES: Major price index series produced by federal statistical agencies. STUDY DESIGN: We compare the key characteristics of each index and develop suggestions on specific indexes to use in many common situations and general guidance in others. DATA COLLECTION/EXTRACTION METHODS: Price series and methodological documentation were downloaded from federal websites and supplemented with literature scans. PRINCIPAL FINDINGS: The gross domestic product implicit price deflator or the overall Personal Consumption Expenditures (PCE) index is preferable to the Consumer Price Index (CPI-U) to adjust for general inflation, in most cases. The Personal Health Care (PHC) index or the PCE health-by-function index is generally preferred to adjust total medical expenditures for inflation. The CPI medical care index is preferred for the adjustment of consumer out-of-pocket expenditures for inflation. A new, experimental disease-specific Medical Care Expenditure Index is now available to adjust payments for disease treatment episodes. CONCLUSIONS: There is no single gold standard for adjusting health expenditures for inflation. Our discussion of best practices can help researchers select the index best suited to their study.

Effects of food price shocks on child malnutrition: The Mozambican experience 2008/2009.

A propitiously timed household survey carried out in Mozambique over the period 2008/2009 permits us to study the relationship between shifts in food prices and child nutrition status in a low income setting. We focus on weight-for-height and weight-for-age in different survey quarters characterized by very different food price inflation rates. Using propensity score matching techniques, we find that these nutrition measures, which are sensitive in the short run, improve significantly in the fourth quarter of the survey, when the inflation rate for basic food products is low, compared to the first semester or three quarters, when food price inflation was generally high. The prevalence of underweight, in particular, falls by about 40 percent. We conclude that the best available evidence points to food penury, driven by the food and fuel price crisis combined with a short agricultural production year, as substantially increasing malnutrition amongst under-five children in Mozambique.

New BLS Data on Staff Nurse Compensation and Inflation-Adjusted Wages.

The wages of hospital staff RNs are a measure of the economic well-being of nurses across the board. The good news is the estimated average annual compensation for hospital RNs is now $107,307, consisting of $72,862 in wages and $34,445 in fringe benefits. The bad news is inflation has taken away virtually all of those increases. How long will it take the hospital industry to respond to the economic recovery, the decline of unemployment, and increased insurance coverage of the general population? Managing the transition will require greater attention to maintaining the equilibrium of hospital nurse wages.

Intergenerational enrollment and expenditure changes in Medicaid: trends from 1991 to 2005.

BACKGROUND: From its inception, Medicaid was aimed at providing insurance coverage for low income children, elderly, and disabled. Since this time, children have become a smaller proportion of the US population and Medicaid has expanded to additional eligibility groups. We sought to evaluate relative growth in spending in the Medicaid program between children and adults from 1991-2005. We hypothesize that this shifting demographic will result in fewer resources being allocated to children in the Medicaid program. METHODS: We utilized retrospective enrollment and expenditure data for children, adults and the elderly from 1991 to 2005 for both Medicaid and Children's Health Insurance Program Medicaid expansion programs. Data were obtained from the Centers for Medicare and Medicaid Services using their Medicaid Statistical Information System. RESULTS: From 1991 to 2005, the number of enrollees increased by 83% to 58.7 million. This includes increases of 33% for children, 100% for adults and 50% for the elderly. Concurrently, total expenditures nationwide rose 150% to $273 billion. Expenditures for children increased from $23.4 to $65.7 billion, adults from $46.2 to $123.6 billion, and elderly from $39.2 to $71.3 billion. From 1999 to 2005, Medicaid spending on long-term care increased by 31% to $84.3 billion. Expenditures on the disabled grew by 61% to $119 billion. In total, the disabled account for 43% and long-term care 31%, of the total Medicaid budget. CONCLUSION: Our study did not find an absolute decrease in the overall resources being directed toward children. However, increased spending on adults on a per-capita and absolute basis, particularly disabled adults, is responsible for much of the growth in spending over the past 15 years. Medicaid expenditures have grown faster than inflation and overall national health expenditures. A national strategy is needed to ensure adequate coverage for Medicaid recipients while dealing with the ongoing constraints of state and federal budgets.

The past and future evolution of the dental workforce team.

This article looks at changes in the number and mix of providers in the dental workforce over the past sixty years. First, enrollment trends in dental education programs are investigated. These educational programs feed directly into the dental workforce. Then, the changes in the dental workforce are examined. The focus of this investigation is the composition of the dental workforce and how the components of the workforce have changed over time. The forces that are responsible for these changes in the workforce are explored next. Finally, the possibility for workforce changes in the future is considered.