Pancreatitis aguda: costos en un hospital universitario en Chile / Acute pancreatitis: costs in a university hospital in Chile

Background: Acute pancreatitis (AP) is a common disease. There is no information available on the costs of treatment in Chile. Aim: To obtain information on the cost of hospitalization for AP and identify the factors that influence the account, to analyze health insurance coverage and the economic charge for the patient. Patients and Method: Retrospective and descriptive study. Patients treated at the Hospital Clínico Universidad de Chile with diagnosis of AP between May 1, 2014 and April 30, 2016 were included. The clinical records were reviewed after the patient's discharge. Demographic characteristics, clinical evolution, the account issued, the insurance payment and patient's copayment were registered. Results: In the period studied, 176 patients (90 women) were discharged with diagnosis of AP. The dominant etiology was biliary in 61%. According to the Atlanta 2013 classification, 78.4% of the cases were mild, 10.2% moderate, and 11.4% severe. 3 patients (1.7%) died. The median cost in Chilean pesos was $ 2,537,918 (1,383,151-3,897,673) (p25-75). The total sum of the accounts of 176 patients was $ 885,261,241, with an average of $ 5,029,893. The average coverage of the health system (FONASA or ISAPRE) was $ 4,293,113, leaving a copayment of $ 801,661. The final cost was related to the severity of the disease, the length of hospitalization and the need for a high-complexity bed. Discussion: Hospitalization costs for PA are high. It is advisable to rationalize the critical care bed indication.

Introducción: La pancreatitis aguda (PA) es una patología frecuente. No hay información disponible del costo de su tratamiento en Chile. Objetivo: Obtener información del costo de hospitalización por PA, identificar los factores que influyen en la cuenta, estudiar la cobertura por seguros de salud y el cargo económico para el paciente. Pacientes y Métodos: Estudio retrospectivo, descriptivo. Se incluyeron pacientes tratados en el Hospital Clínico Universidad de Chile con diagnóstico de PA entre 01 de mayo de 2014 y 30 de abril de 2016. Las fichas clínicas fueron revisadas después del alta del paciente, se registraron sus características demográficas, evolución clínica, la cuenta emitida, el pago del seguro y el copago del paciente. Resultados: En el periodo estudiado 176 pacientes (90 mujeres) fueron dados de alta con diagnóstico de PA. La etiología dominante fue biliar en 61% . Según la clasificación de Atlanta 2013, 78,4% de los casos fueron leves, 10,2% moderados y 11,4% severos. Fallecieron 3 pacientes (1,7%). La mediana de costos fue de $2.537.918 (1.383.151-3.897.673) (p25-75). La suma total de las cuentas de 176 pacientes fue de $ 885.261.241, con un promedio de $ 5.029.893. La cobertura promedio del sistema de salud (FONASA o ISAPRE) fue de $ 4.293.113 dejando un copago de $ 801.661. El costo final se correlacionó con la severidad de la enfermedad, la duración de la hospitalización y la necesidad de cama de alta complejidad. Discusión: Los costos de hospitalización por PA son elevados. Es recomendable racionalizar la indicación de cama crítica.

Conocimientos sobre salud ocupacional en tenientes del ejército del Perú / Occupational health knowledge in lieutenants of the Peruvian army

Introducción: La salud ocupacional es una actividad multidisciplinaria que promueve y protege la salud de los trabajadores. El conocimiento de las condiciones de riesgo previene los accidentes y enfermedades ocupacionales. Objetivo: Determinar el nivel de conocimientos en salud ocupacional en tenientes del Ejército del Perú. Métodos: Estudio observacional y transversal. Participaron 86 tenientes de una promoción de la Escuela de Infantería. Se realizó el Cuestionario de conocimientos en salud ocupacional. Se aplicó estadística descriptiva para las características generales y para la asociación con los conocimientos, la prueba ji cuadrado. Resultados: La edad promedio fue 28,4 años (DE=1,26; Mín.26, Máx.32), 51,16 por ciento presentaron nivel bajo de conocimientos; trabajadores que no recordaban haber recibido capacitaciones en salud ocupacional y que sufrieron accidente de trabajo tuvieron nivel bajo de conocimientos, 80 por ciento (p = 0,049) y 73,68 por ciento (p = 0,026) respectivamente. La pregunta con mayores aciertos fue sobre el examen de salud ocupacional anual con un 75,58 por ciento, y la de menor conocimiento, sobre la cobertura del seguro complementario de riesgos con un 25,58 por ciento. Conclusiones: El nivel de conocimiento predominante sobre salud ocupacional en tenientes del ejército del Perú, fue bajo, con mayores porcentajes en los que no recuerdan capacitación en salud ocupacional y los que tuvieron algún accidente laboral(AU)

Introduction: Occupational health is a multidisciplinary activity that promotes and protects the health of workers. Knowledge of risk conditions prevents occupational accidents and diseases. Objective: To determine the level of occupational health knowledge in lieutenants of the Peruvian Army. Methods: Observational and cross-sectional study. 86 lieutenants of a promotion of the Infantry School participated. The Occupational Health Knowledge Questionnaire was applied. Descriptive statistics were applied for the general characteristics and the Chi-square test for the association with knowledge. Results: Mean age 28,4 years (SD = 1,26; Min. 26, Max. 32), 51,16 percent presented a poor level of knowledge; workers who did not remember having received training in Occupational Health and who suffered a work accident, 80 percent (p = 0,049) and 73,68 percent (p = 0,026) they had a bad level respectively. The question with the highest correct answers was about the annual occupational health examination with 75,58 percent, and the one with the least knowledge about the complementary risk insurance coverage with 25,58 percent. Conclusions: The predominant level of knowledge about occupational health in lieutenants in the Peruvian army was poor, with higher percentages in those who did not remember training in occupational health and those who had an occupational accident(AU)

Cobertura de plano de saúde no Brasil: análise dos dados da Pesquisa Nacional de Saúde 2013 e 2019 / Health insurance coverage in Brazil: analyzing data from the National Health Survey, 2013 and 2019

Resumo Este artigo objetivou descrever a cobertura de plano de saúde no Brasil. Foram analisados dados das edições de 2013 e 2019 da Pesquisa Nacional de Saúde. A cobertura de plano de saúde médico ou odontológico foi analisada segundo características sociodemográficas, econômicas, de trabalho, situação censitária e Unidade da Federação. A cobertura de plano de saúde médico ou odontológico foi 27,9% (IC95%: 27,1-28,8) para 2013 e 28,5% (IC95%: 27,8-29,2) para 2019. Os resultados mostram que a cobertura continua concentrada nos grandes centros urbanos, nas regiões Sudeste e Sul, entre aqueles com melhor nível socioeconômico e aqueles que possuem algum vínculo de trabalho formal. Em 2019, dentre os trabalhadores formalizados, somente 30,7% relatou que o pagamento da mensalidade é feito diretamente a operadora, sendo 72,7% dentre os trabalhadores informais. Cerca de 92% dos planos de saúde médico cobrem internação e dentre as mulheres com plano de saúde, quase 20% delas não possuem cobertura para o parto. Apenas 11,7% das mulheres com idade entre 15 e 44 anos possuem cobertura para o parto através do plano de saúde. Os resultados mostram que a cobertura por plano de saúde mantém-se bastante desigual, reforçando a importância do Sistema Único de Saúde para a população brasileira.

Abstract This paper aimed to describe health insurance coverage in Brazil. Data from the 2013 and 2019 editions of the National Health Survey (PNS) were analyzed. The medical or dental health insurance coverage was analyzed according to demographic and socioeconomic characteristics, work status, urban/rural area, and Federation Unit. Coverage of medical or dental health insurance was 27.9% (95% CI: 27.1-28.8) for 2013 and 28.5% (95% CI: 27.8-29.2) for 2019. The results show coverage is still concentrated in large urban centers, in the Southeast and South, among those with better socioeconomic status and some formal employment. In 2019, only 30.7% of formal workers reported the monthly payment is made directly to the providers, while 72.7% of informal workers reported this information. About 92% of medical health insurance covers hospitalization, and almost 20% of women with health insurance are not covered for labor. Only 11.7% of women aged between 15 and 44 are covered for childbirth by health insurance. The results show the health insurance coverage is still quite unequal, reinforcing the Unified Health System (SUS) importance for the Brazilian population.

Analysis of Health Service Utilization and its Influencing Factors among Patients with Pneumoconiosis in China / 生物医学与环境科学（英文）

Pneumoconiosis, an interstitial lung disease that occurs from breathing in certain kinds of damaging dust particles, is a major occupational disease in China. Patients diagnosed with occupational pneumoconiosis can avail of free medical treatment, whereas patients without a diagnosis of occupational diseases cannot not claim free medical treatment in most provinces from the government before 2019. This study aimed to analyze the priority of medical facility selection and its influencing factors among patients with pneumoconiosis. A total of 1,037 patients with pneumoconiosis from nine provinces in China were investigated. The health service institutions most frequently selected by the patients were county-level hospitals (37.5%). The main reason for the choice was these hospitals' close distance to the patients' homes (47.3%). The factors for the choice of health care institutions were living in the eastern region (

Clinical Guidance for Point-of-Care Ultrasound in the Emergency and Critical Care Areas after Implementing Insurance Coverage in Korea

Point-of-care ultrasound (POCUS) is a useful tool that is widely used in the emergency and intensive care areas. In Korea, insurance coverage of ultrasound examination has been gradually expanding in accordance with measures to enhance Korean National Insurance Coverage since 2017 to 2021, and which will continue until 2021. Full coverage of health insurance for POCUS in the emergency and critical care areas was implemented in July 2019. The National Health Insurance Act classified POCUS as a single or multiple-targeted ultrasound examination (STU vs. MTU). STU scans are conducted of one organ at a time, while MTU includes scanning of multiple organs simultaneously to determine each clinical situation. POCUS can be performed even if a diagnostic ultrasound examination is conducted, based on the physician's decision. However, the Health Insurance Review and Assessment Service plans to monitor the prescription status of whether the POCUS and diagnostic ultrasound examinations are prescribed simultaneously and repeatedly. Additionally, MTU is allowed only in cases of trauma, cardiac arrest, shock, chest pain, and dyspnea and should be performed by a qualified physician. Although physicians should scan all parts of the chest, heart, and abdomen when they prescribe MTU, they are not required to record all findings in the medical record. Therefore, appropriate prescription, application, and recording of POCUS are needed to enhance the quality of patient care and avoid unnecessary cut of medical budget spending. The present article provides background and clinical guidance for POCUS based on the implementation of full health insurance coverage for POCUS that began in July 2019 in Korea.

Reduction in inequalities in health insurance coverage and healthcare utilization among older adults in the Philippines after mandatory national health insurance coverage: trend analysis for 2003-2017

BACKGROUND@#Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities.@*METHODS@#A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis.@*RESULTS@#NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare.@*CONCLUSION@#The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.

Analysis of Prognosis according to Type of Health Insurance in Five Major Gastrointestinal Cancer Patients in Public Hospitals: Single-institution Retrospective Study / 대한소화기학회지

BACKGROUND/AIMS: Public hospitals were established to provide high quality medical services to low socioeconomic status patients. This study examined the effects of public hospitals on the treatment and prognosis of patients with five-major gastrointestinal (GI) cancers (stomach cancer, colon cancer, liver cancer, bile duct cancer, and pancreatic cancer).METHODS: Among the 1,268 patients treated at Seoul National University Boramae Medical Center from January 2010 to December 2017, 164 (13%) were in the medicare group. The data were analyzed to identify and compare the clinical manifestations, treatment modality, and clinical outcomes between the groups.RESULTS: No statistically significant differences in the clinical data (age, sex), treatment method, and five-year survival rate were observed between the health insurance group and medicare group in the five major GI cancer patients. On the other hand, some medicare group patients tended more comorbidities and fewer treatment options than health insurance patients.CONCLUSIONS: Public hospitals have a positive effect on the treatment and prognosis in medicare group patients with the five-major GI cancers.

Prácticas autoreferidas para controlar la hipertensión y la diabetes mellitus en adultos mayores de Campinas, Brasil, en tres períodos / Self-care management practices for arterial hypertension and diabetes mellitus among elderly people in Campinas, Brazil, in three periods

RESUMEN El objetivo fue estimar la prevalencia de las prácticas autoreferidas para controlar la hipertensión y la diabetes, con y sin medicamentos, en adultos mayores de Campinas, Brasil, en tres períodos. Se analizaron los datos de las encuestas de salud realizadas en tres períodos: 2001-2002, 2008-2009 y 2014-2015. La prevalencia de hipertensión, de diabetes, del uso de medicación continua y las prácticas comportamentales aumentaron durante el período analizado, con una caída significativa en el uso no regular de medicamentos y las consultas médicas de rutina en individuos sin plan de salud privado. Los resultados evidenciaron avances en las prácticas relacionadas con la dieta en aquellas personas sin plan de salud y en quienes declararon contar con plan de salud, destacando mejoras en el tratamiento con medicamentos y la práctica de actividad física. La adherencia al uso de medicamentos y a prácticas comportamentales para controlar las morbilidades se mostró consistente en el período evaluado. Estos indicadores refuerzan la necesidad de mantener y ampliar las políticas dirigidas a la educación sanitaria y la asistencia farmacéutica en el país.

ABSTRACT The objective of this study was to estimate the prevalence of self-care management practices - both with and without medication - in elderly hypertensive and diabetic patients in Campinas, Brazil, in three periods. Data from health surveys conducted in three periods 2001-2002, 2008-2009 and 2014-2015 were analyzed. The prevalence of hypertension, diabetes, the continuous use of medication, and all behavioral practices showed an overall increase in the period analyzed, with a significant drop in both the non-regular use of medications and routine doctor visits on the part of individuals without a private health plan. The results evidenced advances in diet-related practices among individuals without health plans as well as those who reported having healthcare coverage, highlighting improvements in drug treatment and physical activity. Adherence to medication and health behaviors for the management of morbidities was shown to be consistent in the period evaluated. These indicators reinforce the need to maintain and expand policies directed at health education and pharmaceutical assistance in the country.

Private health insurance coverage-related lawsuits / Acciones judiciales relacionadas con la cobertura de prestaciones en la salud complementaria / Ações judiciais relacionadas às coberturas assistenciais na saúde suplementar

ABSTRACT Objectives: to analyze lawsuits brought by beneficiaries of health insurance operators. Methods: this was a cross-sectional descriptive study carried out in a large-capacity private health insurance operator using data collected by the company from 2012 to 2015. Results: ninety-six lawsuits were brought by 86 beneficiaries regarding medical procedures (38.5%), treatments (26.1%), examinations (14.6%), medications (9.4%), home care (6.2%), and other types of hospitalization (5.2%). The procedures with the highest number of lawsuits were percutaneous rhizotomy; chemotherapy; treatment-related positron-emission tomography scans; and for medications relative to antineoplastic and Hepatitis C treatment. Conclusions: the lawsuits were filed because of the operators' refusal to comply with items not established in contracts or not regulated and authorized by the Brazilian National Regulatory Agency for Private Health Insurance and Plans, refusals considered unfounded.

RESUMEN Objetivos: analizar las acciones judiciales iniciadas por beneficiarios de planes de salud de prepago. Métodos: estudio descriptivo, transversal, desarrollado en importante operadora de planes de salud de prepago, utilizando datos recopilados por la empresa entre 2015 y 2015. Resultados: fueron impulsadas 96 acciones judiciales por parte de 86 beneficiarios, referentes a procedimientos médicos (38,5%), tratamientos (26,1%), estudios (14,6%), medicación (9,4%), Home Care (6,2%) y 5,2% por otros tipos de internación. La mayoría de acciones por procedimientos correspondió a rizotomía percutánea; en tratamientos, a quimioterapia; en estudios, a tomografía por emisión de positrones; en medicamentos, a antineoplásicos y para tratar la hepatitis C. Conclusiones: motivaron las acciones judiciales interpuestas la negativa de la operadora de planes de salud a cubrir prestaciones no incluidas en el alcance del plan contratado por el beneficiario, así como asuntos no reglados y autorizados por la Agencia Nacional de Salud Complementaria, considerándose, en consecuencia, improcedentes.

RESUMO Objetivos: analisar as ações judiciais demandadas por beneficiários de uma operadora de plano de saúde. Métodos: estudo descritivo de corte transversal desenvolvido em uma operadora de plano privado de saúde de grande porte, utilizando dados compilados pela empresa no período de 2012 a 2015. Resultados: foram movidas 96 ações judiciais por 86 beneficiários, referentes a procedimentos médicos (38,5%), tratamentos (26,1%), exames (14,6%), medicamentos (9,4%), Home Care (6,2%) e 5,2% a outros tipos de internações. O maior número de ações dentre os procedimentos foi rizotomia percutânea; para tratamentos, a quimioterapia; exames solicitados de tomografia por emissão de pósitrons; para medicamentos, os antineoplásicos e para tratamento de Hepatite C. Conclusões: a razão para as demandas judiciais impetradas foi a negativa da operadora em atender os itens não pertencentes ao escopo do que foi contratado pelo beneficiário ou itens não regulamentados e autorizados pela Agência Nacional de Saúde Suplementar, portanto sendo consideradas improcedentes.

Historia y metodología de las primeras guías chilenas de fibrosis pulmonar idiopática 2019 / History and methodology of the first Chilean idiopathic pulmonary fibrosis guidelines, 2019

Desde 2017 los miembros de la Comisión de Enfermedades Pulmonares Intersticiales Difusas de la Sociedad Chilena de Enfermedades Respiratorias hemos trabajado en la elaboración de las primeras guías de fibrosis pulmonar idiopática (FPI) del país, necesidad evidente para fomentar el diagnóstico precoz y adecuado de la enfermedad y establecer una base para posible incorporación de su cuidado en cobertura de seguros de salud especiales. Se elaboraron 5 preguntas de revisión de evidencia y el resto se trabajó en formato de preguntas de contexto. Un grupo de metodólogos graduaron la evidencia siguiendo la metodología GRADE.

Since 2017, the members of the Commission of Diffuse Interstitial Lung Diseases of the Chilean Society of Respiratory Diseases have worked in the development of the first guidelines of idiopathic pulmonary fibrosis (IPF) in the country, an obvious need to encourage early and adequate diagnosis of the disease and establish a basis for possible incorporation of IPF patients care into special health insurance coverage. Five evidence review questions were prepared and the remainder were worked out in context question format. A group of methodologists graduated the evidence following the GRADE methodology.

Cobertura de aseguramiento en salud: el caso peruano desde la Ley de Aseguramiento Universal / Health insurance coverage: the peruvian case since the universal insurance act

RESUMEN Objetivo. Describir la evolución de la cobertura de aseguramiento en salud (CAS) en Perú para el periodo 2009-2017 y evaluar los principales factores demográficos, sociales y económicos asociados. Materiales y métodos. Realizamos un análisis secundario de la Encuesta Nacional de Hogares. Para cada año estimamos la CAS global, del Seguro Integral de Salud (SIS) y del Seguro Social en Salud (EsSalud), y realizamos pruebas de tendencias anuales. Para los años 2009 (Ley de Aseguramiento Universal en Salud), 2013 (reforma del sector salud) y 2017, construimos una variable politómica del tipo de aseguramiento (SIS/EsSalud/No asegurado) y estimamos razones relativas de prevalencia (RRP) con intervalos de confianza (IC) al 95% mediante modelos logísticos multinomiales para muestras complejas. Resultados. Observamos un incremento en la CAS global (2009: 60,5%; 2013: 65,5%; 2017: 76,4%), en el SIS (2009: 34%; 2013: 35,4%; 2017: 47%) y en EsSalud (2009: 22,8%; 2013: 26,4%; 2017: 26,3%). Observamos que ser mujer aumentó la posibilidad de afiliación al SIS (RRP=2009: 1,64 y 2017: 1,53), mientras que tener entre 18 y 39 años, residir Lima Metropolitana y ser no pobre redujeron esa posibilidad (RRP=2009: 0,16 y 2017: 0,31; 2009: 0,17 y 2017: 0,37; 2009: 0,51 y 2017: 0,53; respectivamente). Por su parte, ser mujer, tener más de 65 años, ser del ámbito urbano, residir en Lima Metropolitana y ser no pobre aumentó la probabilidad de estar afiliados a EsSalud (RRP=2013: 1,12 y 2017: 1,24; 2013: 1,32 y 2017: 1,34; 2009: 2,18 y 2017: 2,08; 2009: 2,14 y 2017: 2,54; 2009: 3,57 y 2017: 2,53; respectivamente). Conclusiones. La CAS ha incrementado durante el periodo 2009-2017. No obstante, las características de la población asegurada difieren de acuerdo con el tipo de seguro.

ABSTRACT Objective. To describe the trends in health insurance coverage (HIC) in Peru during the period 2009-2017 and evaluate associations with demographic, social and economic factors. Materials and Methods. We carried out a secondary data-analysis from the Peruvian National Household Survey. For each year, we estimated the global HIC, for the Integral Health Insurance (SIS) and the Social Security system (EsSalud). In addition, we performed a trend analysis. For 2009 (Universal Health Insurance Act), 2013 (health care reform act) and 2017, we used a polytomous variable for the insurance type (SIS/EsSalud/Non-affiliated). We performed logistic multinomial regressions to estimate relative prevalence ratios (RPR) and their 95% CI with correction for complex sampling. Results. We observed an increasing trend in the global HIC (2009:60.5%; 2013:65.5%; 2017:76.4%), SIS coverage (2009:34%; 2013:35.4%; 2017:47%) and EsSalud coverage (2009:22.8%; 2013:26.4%; 2017:26.3%). Multinomial logistic regressions showed that being a woman increased the likelihood to be affiliated to the SIS (RPR= 2009:1.64 and 2017:1.53), while people between 18 and 39 years old, living in Lima Metropolitan area under non-poverty conditions reduced the likelihood to be affiliated to the SIS (RPR= 2009:0.16 and 2017:0.31; 2009:0.17 and 2017:0.37; 2009:0.51 and 2017:0.53; respectively). Furthermore, being a woman, 65 years old or over, living in urban Lima, and under non-poverty conditions increased the likelihood of being affiliated with the EsSalud (RPR= 2013:1.12 and 2017:1.24; 2013:1.32 and 2017:1.34; 2009:2.18 and 2017:2.08; 2009:2.14 and 2017:2.54; 2009:3.57 and 2017:2.53; respectively). Conclusions. HIC has increased during the period 2009-2017. However, the characteristics of those affiliated are different between the various types of health insurance.

Planos privados de saúde e a saúde dos trabalhadores do Brasil / Private health plans and the health of workers in Brazil

Resumo O presente estudo objetivou comparar as mudanças nos padrões de cobertura por planos privados de saúde entre servidores públicos, militares e demais trabalhadores no Brasil e verificar se a vinculação a planos de saúde repercute nas respectivas prevalências autorreferidas de Hipertensão Arterial Sistêmica (HAS) e Diabetes Mellitus (DM) no país. Para isso, foram utilizados os trabalhadores do setor público (federal, estadual, municipal ou militar) e, outros trabalhadores, com ≥ 18 anos de idade incluídos na Pesquisa Nacional de Amostra de Domicílios dos anos de 1998, 2003, 2008 e na Pesquisa Nacional de Saúde de 2013. Observou-se que ao longo dos anos de estudo, os servidores públicos civis e militares do Brasil apresentaram elevada e crescente proporção de adesão aos planos privados de saúde em relação aos demais trabalhadores. As prevalências de HAS e DM sempre foram maiores e cresceram entre os servidores com planos de saúde do que entre os sem planos. O status diferenciado aos servidores públicos e militares, no que se refere ao duplo acesso aos serviços públicos e privados de saúde, refletiu-se nas crescentes prevalências autorreferidas de HAS e DM, aumentando as iniquidades em saúde diante de um sistema público constituído de modo universal e equânime.

Abstract The scope of this paper was to compare the changes in coverage patterns by health insurance plans among public servants, the military and other employees in Brazil and verify if the purchase of such health plans is reflected in the respective self-reported prevalence of Systemic Arterial Hypertension (SAH) and Diabetes Mellitus (DM) in the country. For this purpose, workers in the public sector (federal, state, municipal or military) and other workers aged ≥18 who were included in the 1998, 2003 and 2008 campaigns of the National Household Sample Survey (PNAD) and in the 2013 National Survey were studied. Over the years of the study, it was observed that Brazil's public service employees, both civilian and military, have presented a high and increasing proportion of health insurance purchase compared to other workers. The prevalence of SAH and DM has always been higher among employees with health insurance. The special status of public servants and the military as regards the double access to both public and private healthcare systems is reflected in the increasing self-reported prevalence of SAH and DM, increasing health inequities in a public health system that was constituted in a universal and equitable way.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012 / Comportamiento en cuidado preventivo de salud entre adultos pobres mayores en México: impacto del Seguro Popular, 2000-2012

Abstract: Objective: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Resumen: Objetivo: Determinar el efecto del Seguro Popular (SP) en la utilización de la atención preventiva entre beneficiarios de SP de bajos ingresos y ancianos sin seguro en México. Material y métodos: Estimación de pseudopanel de variables instrumentales de efectos fijos (FE-IV) en tres rondas de la Encuesta Nacional de Salud y Nutrición de México (2000, 2006 y 2012). Resultados: El SP no tiene un efecto significativo en el uso de los servicios preventivos, incluida la detección de diabetes, hipertensión, cáncer de mama y cáncer de cuello uterino en adultos de 50 años o más. Conclusiones: Aún existen desigualdades en el acceso a la asistencia médica en México. El gobierno mexicano debe seguir trabajando para extender la cobertura del seguro de salud a la población más vulnerable. Se necesitan esfuerzos adicionales para aumentar la cobertura de atención médica y apoyar la atención preventiva para reducir las disparidades persistentes.

Review of Worldwide Regulations and Management Systems for Medical Foods

Enteral nutrition (EN) formulas are foods that are used to improve the nutritional status of patients and these foods' safety and quality must be ensured. Therefore, EN formulas in other countries are managed differently from that of general foods. We investigated the direction of development of the relevant laws regulations and guidelines pertaining to EN formulas and we compared these laws regulations and guidelines from different countries, including Korea. The United States and Europe manage EN formulas as foods, but they are managed differently compared to general foods because of separate laws or programs pertaining to EN foods. In addition, the use of the formulas does not necessarily require a prescription, but when used by prescription, then medical insurance covers them. In Japan, there are two types of EN formulas, food and drug, and there are differences for their management and insurance coverage. In the case of Korea, EN formulas are classified as food and drug, and different management and insurance are applied in each case, which inhibits their systematic management and industrial development. Integration of a management system and establishment of a legal foundation is necessary for the systematic management and development of EN formula in Korea.

A Scoping Review of Components of Physician-induced Demand for Designing a Conceptual Framework / 예방의학회지

OBJECTIVES: The current study presents a new conceptual framework for physician-induced demand that comprises several influential components and their interactions. METHODS: This framework was developed on the basis of the conceptual model proposed by Labelle. To identify the components that influenced induced demand and their interactions, a scoping review was conducted (from January 1980 to January 2017). Additionally, an expert panel was formed to formulate and expand the framework. RESULTS: The developed framework comprises 2 main sets of components. First, the supply side includes 9 components: physicians’ incentive for pecuniary profit or meeting their target income, physicians’ current income, the physician/population ratio, service price (tariff), payment method, consultation time, type of employment of physicians, observable characteristics of the physician, and type and size of the hospital. Second, the demand side includes 3 components: patients’ observable characteristics, patients’ non-clinical characteristics, and insurance coverage. CONCLUSIONS: A conceptual framework that can clearly describe interactions between the components that influence induced demand is a critical step in providing a scientific basis for understanding physicians’ behavior, particularly in the field of health economics.

The socioeconomic impact of Korean dental health insurance policy on the elderly: a nationwide cohort study in South Korea

PURPOSE: The purpose of this retrospective study was to investigate the relationships of types of dental insurance coverage in Korea with sociodemographic characteristics and the prevalence of systemic and oral diseases, as well as to evaluate the socioeconomic impact of Korean dental insurance policies. METHODS: Sample cohort data from 2006 to 2015 were obtained from the National Health Insurance Service. Patients were divided into 2 groups. The exposed group comprised patients who received insurance benefits for complete dentures, removable partial dentures, and implant care, while the control group comprised patients who did not receive these benefits. The type of insurance coverage and the prevalence of systemic and oral diseases were compared between the 2 groups. RESULTS: Patients who received benefits in the form of complete dentures, removable partial dentures, and implants had similar sociodemographic characteristics in terms of sex, age, income quintile, and type of insurance coverage to the control group. The prevalence of hypertension, anemia, renal disease, rheumatoid arthritis, osteoporosis, asthma, and cerebral infarction was higher in the exposed group than in the control group (P<0.05). The prevalence of periodontal diseases and dental caries was also higher in the exposed group. CONCLUSIONS: Korean dental health insurance policy has been beneficial for the medical expenses of low-income and elderly people suffering from a cost burden due to systemic diseases. However, since there is a tendency to avoid invasive interventions in older patients due to the high risk of systemic diseases, insurance coverage of dentures may be more helpful from a socioeconomic perspective than coverage of dental implant treatments.

Racial Differences in Hospital Stays among Patients Undergoing Craniotomy for Tumour Resection at a Single Academic Hospital

BACKGROUND: Racial differences in American patients undergoing brain tumour surgery remain poorly characterized within urban medical centres. Our objective was to assess racial differences in operative brain tumour patients at a single academic hospital in Los Angeles, California. METHODS: We reviewed medical records of adult patients undergoing craniotomy for tumour resection from March 2013 to January 2017 at UCLA Medical Centre. Patients were categorized as Asian, Hispanic, Black, or White. Racial cohorts were matched on demographic variables for comparisons. Our primary outcome was post-operative length of stay (LOS). Secondary outcomes included hospital mortality and discharge disposition. RESULTS: In this study, 462 patients identified as Asian (15.1%), Hispanic (8.7%), Black (3.9%), or White (72.3%). After cohort matching, non-White patients had elevated risk of prolonged LOS [odds ratio (OR)=2.62 (1.44, 4.76)]. No differences were observed in hospital mortality or non-routine discharge. Longer LOS was positively correlated with non-routine discharge [r(pb) (458)=0.41, p<0.001]. Black patients with government insurance had average LOS 2.84 days shorter than Black patients with private insurance (p=0.04). Among Hispanics, government insurance was associated with non-routine discharge [OR=4.93 (1.03, 24.00)]. CONCLUSION: Racial differences manifested as extended LOS for non-White patients, with comparable rates of hospital mortality and non-routine discharge across races. Prolonged LOS loosely reflected complicated clinical course with greater risk of adverse discharge disposition. Private insurance coverage predicted markedly lower risk of non-routine discharge for Hispanic patients, and LOS of three additional days among Black patients. Further research is needed to elucidate the basis of these differences.

Guidelines for Cardiovascular Magnetic Resonance Imaging from the Korean Society of Cardiovascular Imaging—Part 2: Interpretation of Cine, Flow, and Angiography Data

Cardiovascular magnetic resonance imaging (CMR) is expected to be increasingly used in Korea due to technological advances and the expanded national insurance coverage of CMR assessments. For improved patient care, proper acquisition of CMR images as well as their accurate interpretation by well-trained personnel are equally important. In response to the increased demand for CMR, the Korean Society of Cardiovascular Imaging (KOSCI) has issued interpretation guidelines in conjunction with the Korean Society of Radiology. KOSCI has also created a formal Committee on CMR guidelines to create updated practices. The members of this committee review previously published interpretation guidelines and discuss the patterns of CMR use in Korea.

Poor People and Poor Health: Examining the Mediating Effect of Unmet Healthcare Needs in Korea / 예방의학회지

OBJECTIVES: The purpose of this study was to estimate the mediating effect of subjective unmet healthcare needs on poor health. The mediating effect of unmet needs on health outcomes was estimated. METHODS: Cross-sectional research method was used to analyze Korea Health Panel data from 2011 to 2015, investigating the mediating effect for each annual dataset and lagged dependent variables. RESULTS: The magnitude of the effect of low income on poor health and the mediating effect of unmet needs were estimated using age, sex, education level, employment status, healthcare insurance status, disability, and chronic disease as control variables and self-rated health as the dependent variable. The mediating effect of unmet needs due to financial reasons was between 14.7% to 32.9% of the total marginal effect, and 7.2% to 18.7% in lagged model. CONCLUSIONS: The fixed-effect logit model demonstrated that the existence of unmet needs raised the likelihood of poor self-rated health. However, only a small proportion of the effects of low income on health was mediated by unmet needs, and the results varied annually. Further studies are necessary to search for ways to explain the varying results in the Korea Health Panel data, as well as to consider a time series analysis of the mediating effect. The results of this study present the clear implication that even though it is crucial to address the unmet needs, but it is not enough to tackle the income related health inequalities.