RESUMO
A field trial was conducted to compare the effects of eight health education and economic incentive interventions on the awareness and acceptance of cataract surgery. Cataract screening and follow-up surgery were offered to more than 19,000 residents age 40 years and older in a probability sample of 90 villages in south India. Eight months after intervention, an evaluation was conducted to identify those in need of surgery who had been operated on. Two principal measures of program effectiveness are examined: awareness of cataract surgery and acceptance of the surgery. The type of intervention had a negligible effect on awareness of cataract surgery. A multiple logistic regression analysis revealed that individuals who were aware of surgery tended to be male, literate, and more affluent than those who were unaware of that option. Interventions that covered the complete costs of surgery had higher surgery acceptance rates. One health education strategy, house-to-house visits by a subject with aphakia, increased acceptance of the procedure more than others. In a multiple logistic regression analysis of acceptance rates, persons accepting surgery tended to be male; other factors were not important in explaining variation in acceptance rates.
Assuntos
Extração de Catarata/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Adulto , Idoso , Extração de Catarata/economia , Extração de Catarata/psicologia , Análise Custo-Benefício , Feminino , Educação em Saúde , Conhecimentos, Atitudes e Prática em Saúde , Visita Domiciliar , Humanos , Índia , Masculino , Meios de Comunicação de Massa , Pessoa de Meia-Idade , Comportamento Social , Fatores Socioeconômicos , Seleção VisualRESUMO
OBJECTIVE: Assessment of productivity, quality and production costs and determination of the efficiency of top grade clinical laboratories in Mexico. METHODS: Ten laboratories were selected from among the total number (52) existing in Mexico City, and the Donabedian model of structure, process and results were applied. Blood count was selected as a tracer. RESULTS: The principal problems found were: inadequate distribution of trained human resources, poor glass material, inadequate analytic process and low productivity. These factors are reflected in the unit costs, which exceed reference laboratory costs by 200%. Only 50% of the laboratories analyzed generate reliable results. Only 20% of the laboratories studied operate efficiently. CONCLUSIONS: To solve the problems identified requires integral strategies at different levels. A specific recomendation for the improvement of quality and productivity is an assessment of the cost/benefit of creating a central laboratory and using the remaining sites exclusively for the collection of samples.
Assuntos
Eficiência Organizacional , Laboratórios/economia , Laboratórios/normas , Biometria , Custos e Análise de Custo , MéxicoRESUMO
The behavior of private sector health care providers will depend critically on the environment within which they operate. A bewildering array of possible regulatory and incentive setting structures exist. Most developing countries have the basic legislation for regulation, but there are frequently difficulties in enforcing such controls. While process aspects of quality of care regulation are often the responsibility of professional organizations, these organizations may have limited incentives to be active in ensuring high quality medical car.e There has been less experience with the use of incentives to encourage appropriate behavior amongst private providers: this appears a promising area for further work. Above all, adequate information is essential both for the enforcement of regulations and the application of incentive mechanisms.