Access to private health insurance in the metropolitan region of Manaus, AM, Brazil, in 2015: a cross-sectional population-based study. / Acesso a planos de saúde na região metropolitana de Manaus em 2015: estudo transversal de base populacional.

OBJECTIVE: to analyze the frequency and factors associated with coverage by health insurance in the metropolitan region of Manaus, AM, Brazil. METHOD: a cross-sectional population-based study was conducted in 2015, with data collected through household interviews; prevalence ratios (PR) and confidence intervals (95%CI) were calculated using Poisson regression with robust variance adjusted for sex and age. RESULTS: we interviewed 4,001 individuals; 13% (95%CI - 12.0;14.1%) had health insurance; greater insurance coverage was observed among military personnel (PR=3.18 - 95%CI 1.64;6.15), private sector employees (PR=1.91 - 95%CI 1.46;2.52) and public sector employees (PR=1.75 - 95%CI 1.23;2.49); health insurance was lower among poorer people (PR=0.21 - 95%CI 0.13;0.33), and those with less schooling (PR=0.66 - 95%CI 0.46;0.99). CONCLUSION: frequency of health insurance was low and was associated with better purchasing power, schooling, and employment.

Acesso a planos de saúde na região metropolitana de Manaus em 2015: estudo transversal de base populacional / Acceso a planes de salud en la región metropolitana de Manaus, AM, Brasil, en 2015: estudio transversal de base poblacional / Access to private health insurance in the metropolitan region of Manaus, AM, Brazil, in 2015: a cross-sectional population-based study

Objetivo: analisar a frequência e fatores associados à cobertura por planos privados de saúde na região metropolitana de Manaus, AM, Brasil. Métodos: estudo transversal de base populacional realizado em 2015, por meio de entrevista domiciliar; as razões de prevalência (RP) e intervalos de confiança (IC95%) foram calculadas pela regressão de Poisson, com variância robusta ajustada por sexo e faixa etária. Resultados: foram entrevistados 4.001 indivíduos, dos quais 13% (IC95% 12,0 a 14,1%) tinham plano de saúde; maior cobertura por planos foi observada entre militares (RP=3,18 - IC95% 1,64;6,15), empregados dos setores privado (RP=1,91 - IC95% 1,46;2,52) e público (RP=1,75 - IC95% 1,23;2,49); a cobertura por planos de saúde foi menor entre pessoas mais pobres (RP=0,21 - IC95% 0,13;0,33) e de menor escolaridade (RP=0,66 - IC95% 0,46;0,99). Conclusão: a frequência de planos de saúde foi baixa e associou-se a melhor poder aquisitivo, escolaridade e situação de trabalho.

Objetivo: analizar la frecuencia y los factores asociados a la cobertura por planes de salud en la región metropolitana de Manaus, AM, Brasil. Métodos: estudio transversal de base poblacional por entrevista domiciliar. Las razones de prevalencia (RP) e intervalo de confianza (IC95%) fueron calculadas por regresión de Poisson con varianza robusta, ajustadas por sexo y edad. Resultados: se entrevistaron 4.001 individuos; 13% (IC95%: 12,0 a 14,1%) tenían plan de salud; la mayor cobertura por planes fue observada entre militares (RP=3,18 - IC95% 1,64;6,15), empleados del sector privado (RP=1,91 - IC95% 1,46;2,52) y del sector público (RP=1,75 - IC95% 1,23;2,49); la cobertura fue menor en personas más pobres (RP=0,21 - IC95% 0,13;0,33) y de menor escolaridad (RP=0,66 - IC95% 0,46;0,99). Conclusión: la frecuencia de planes de salud fue baja y se asoció con mejor poder adquisitivo, escolaridad y situación de trabajo.

Objective: to analyze the frequency and factors associated with coverage by health insurance in the metropolitan region of Manaus, AM, Brazil. Method: a cross-sectional population-based study was conducted in 2015, with data collected through household interviews; prevalence ratios (PR) and confidence intervals (95%CI) were calculated using Poisson regression with robust variance adjusted for sex and age. Results: we interviewed 4,001 individuals; 13% (95%CI - 12.0;14.1%) had health insurance; greater insurance coverage was observed among military personnel (PR=3.18 - 95%CI 1.64;6.15), private sector employees (PR=1.91 - 95%CI 1.46;2.52) and public sector employees (PR=1.75 - 95%CI 1.23;2.49); health insurance was lower among poorer people (PR=0.21 - 95%CI 0.13;0.33), and those with less schooling (PR=0.66 - 95%CI 0.46;0.99). Conclusion: frequency of health insurance was low and was associated with better purchasing power, schooling, and employment.

Artificial urinary sphincter for urinary incontinence after radical prostatectomy: a historical cohort from 2004 to 2015.

This study aimed to retrospectively evaluate a cohort of patients with prostate cancer and persistent urinary incontinence after radical prostatectomy. From January 2004 to December 2015, eighty-six individuals were identified to have received an AUS implant, provided by a private nonprofit HMO operating in Belo Horizonte, Brazil. On total, there were 91 AUS implants, with a median interval between radical prostatectomy and AUS implant of 3.6 years (IQR 1.9 to 5.5). The rate of AUS cumulative survival, after a median follow-up of 4.1 years (IQR 1.7-7.2 years), was 44% (n=40). The median survival of AUS implants was 2.9 years (IQR 0.5-7.9 years). Thirty-seven AUS implants (40.7%) resulted in grade III surgical complications. There were 5 deaths at 2.1, 4.7, 5.7, 5.7 and 6.5 years of follow-up, but none due to causes directly associated to the AUS implant. Persistent severe incontinence was documented in 14 (15.3%) additional patients. From the 51 AUS implants which resulted in grade III surgical complications or persistent severe incontinence, 24 (47.1%) underwent surgical revisions. Explantation of the sphincter or its components was observed in 6 cases (25.0%). Mechanical failure, described as fluid loss and/or inability to recycle the AUS device, was observed in 4 devices (16.7%). In conclusion, although AUS implants are recommended as the gold-standard treatment of severe urinary incontinence after prostatectomy, the observed high rates of malfunction and grade III adverse events are a matter of concern warranting further assessment on the safety and efficacy of these devices.

Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization / Dez anos de cirurgia bariátrica no Brasil: mortalidade intra-hopitalar em pacientes atendidos pelo sistema único de saúde ou por operadora da saúde suplementar

BACKGROUND: Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. AIM: To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. METHODS: Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. RESULTS: Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. CONCLUSION: Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients. .

RACIONAL: A cirurgia bariátrica é uma opção de perda de peso sustentada para o indivíduo obeso mórbido. No Brasil coexistem o Sistema Único de Saúde, de cobertura universal do qual dependem 150 milhões de brasileiros e a saúde suplementar, de caráter predominantemente privado, com 50 milhões de beneficiários. OBJETIVO: Comparar acesso, mortalidade intra-hospitalar, tempo de permanência e custos para pacientes submetidos à cirurgia bariátrica, assistidos por um ou outro sistema. MÉTODOS: Foi utilizado o sistema TabNet do DATASUS e IBGE para pacientes SUS e banco de dados de uma operadora da região sudeste do Brasil para a saúde suplementar. RESULTADOS: Entre 2001 e 2010 foram 24.342 e 4.356 operações pelo SUS e operadora, respectivamente. Taxas operatórias realizadas em 2010 foram de 5,3 e 91/100.000 indivíduos no SUS e na operadora na saúde suplementar respectivamente. A taxa de mortalidade intra-hospitalar no SUS, considerando todo o Brasil, foi de 0,55%, na região sudeste 0,44%, e na operadora 0,30%. Os custos das operações no SUS e na saúde suplementar tendem à equiparação ao longo dos anos. CONCLUSÃO: Apesar da diferença no acesso e de características que podem comprometer o resultado da cirurgia bariátrica, os pacientes atendidos no SUS da região sudeste tiveram taxa de mortalidade intra-hospitalar semelhante aos da saúde suplementar. .

Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization.

BACKGROUND: Bariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries. AIM: To compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system. METHODS: Data from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients. RESULTS: Between 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years. CONCLUSION: Despite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients.

Costs and usage of healthcare services before and after open bariatric surgery.

CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.

Costs and usage of healthcare services before and after open bariatric surgery / Custos e utilização de serviços de saúde antes e após a cirurgia bariátrica por laparotomia

CONTEXT AND OBJECTIVE: Morbidly obese individuals are major consumers of healthcare services, with high associated costs. Bariatric surgery is an alternative for improving these individuals' comorbidities. There are no studies comparing costs before and after bariatric surgery in Brazil. The aim here was to analyze results relating to healthcare usage and direct costs among morbidly obese patients undergoing bariatric surgery. DESIGN AND SETTING: Historical cohort study on patients receiving healthcare through a private health plan in Belo Horizonte, Minas Gerais. METHODS: All healthcare services and their associated costs were included in the analysis: hospitalization, hospital stay, elective outpatient consultations, emergency service usage and examinations. The analyses were treated as total when including the whole years before and after surgery, or partial when excluding the three-month periods adjacent to the operation. RESULTS: For 382 obese patients who underwent open bariatric operations, there were 53 hospitalizations one year before and 95 one year after surgery (P = 0.013). Gastrointestinal complications were the main indications for post-procedure hospitalizations. The partial average cost almost doubled after the operation (US$ 391.96 versus US$ 678.31). In subgroup analysis, the costs from patients with gastrointestinal complications were almost four times greater after bariatric surgery. Even in the subgroup without complications, the partial average cost remained significantly higher. CONCLUSION: Although bariatric surgery is the only path towards sustained weight loss for morbidly obese patients, the direct costs over the first year after the procedure are greater. Further studies, with longer follow-up, might elucidate whether long-term reversal of this trend would occur.

CONTEXTO E OBJETIVO: Indivíduos obesos mórbidos são grandes consumidores de serviços de saúde, com altos custos associados. A cirurgia bariátrica é uma alternativa para melhorar suas comorbidades. Não existem estudos comparando custos antes e após a cirurgia bariátrica no Brasil. O objetivo deste estudo foi analisar os resultados assistenciais e gastos diretos de pacientes obesos mórbidos submetidos à cirurgia bariátrica. TIPO DE ESTUDO E LOCAL: Coorte histórica de pacientes assistidos por um plano de saúde na cidade de Belo Horizonte, Minas Gerais. MÉTODOS: Foram incluídos na análise todos os serviços de saúde e seus custos associados: hospitalizações, permanência hospitalar, consultas eletivas e de emergência e exames. A análise foi tratada como total quando incluía todo o ano anterior e posterior à cirurgia, e parcial quando excluía os trimestres adjacentes à cirurgia. RESULTADOS: Para 382 pacientes obesos operados, houve 53 internações um ano antes e 95 um ano após a cirurgia (P = 0,013). As principais indicações para internação pós-procedimento foram complicações relacionadas ao trato gastrointestinal. O custo parcial médio quase dobrou no período pós-operatório (US$ 391,96 versus US$ 678,31). Em análise de subgrupo, pacientes com complicações do trato gastrointestinal apresentaram custos quase quatro vezes maiores no período pós-bariátrica, e mesmo no subgrupo sem estas complicações, o custo parcial médio permaneceu significativamente maior. CONCLUSÃO: Embora a cirurgia bariátrica seja o único caminho para perda de peso sustentada nos pacientes obesos mórbidos, os custos diretos até um ano pós-procedimento são maiores. Novos estudos, com maior tempo de acompanhamento, poderão verificar se essa tendência se reverte no longo prazo.

Mortality and hospital stay after bariatric surgery in 2,167 patients: influence of the surgeon expertise.

BACKGROUND: Postoperative mortality is a rare event after bariatric surgery. The main goal of this study was to calculate the 30-day mortality rate postbariatric "open" surgery and the length of hospital stay of patients assisted by a health maintenance organization in Brazil. We also investigate their association with sex, age, BMI, preexisting comorbidities, and volume of procedures performed by surgeons. METHODS: A total of 2,167 patients who underwent RYGB between 01/2004 and 12/2007 were analyzed. The deaths and hospital stay were identified in the healthcare transactional database and the morbidity data in the preoperative medical audit records. Factors contributing to adverse outcomes were determined by multiple logistic regression analysis. RESULTS: The overall mortality rate was 0.64%, with a decreasing trend over the years. The median hospital stay was 3.1 days. In the multivariate analysis, both mortality and longer hospital stay were positively and significantly associated with age > 50 years, BMI > 50 kg/m(2), and surgeon volume of less than 20 bariatric surgeries/year. Presence of hypertension also increased the risk of longer hospital stay. Multivariate analysis showed that the 30-day mortality was six times higher in patients operated by professionals who performed less surgeries/year and longer hospital stay, four times more frequent. CONCLUSIONS: The 30-day mortality post-RYGB is similar to the rates found in developed countries and much lower than the rates found for patients assisted by the public health system in Brazil. In addition to age and clinical factors, the results suggest that mortality and longer hospital stay are strong and inversely related to surgeon's experience.