Realizing the right to health in Latin America, equitably.

This special issue "Realizing the Right to Health in Latin America and the Caribbean" provides an overview of one of the most challenging objectives of health systems: equity and the realization of the right to health. In particular, it concentrates on the issues associated with such a challenge in countries suffering of deep inequity. The experience in Latin America and the Caribbean demonstrates that the efforts of health systems to achieve Universal Health Coverage are necessary but not sufficient to achieve an equitable realization of the right to health for all. The inequitable realization of all other human rights also determines the realization of the right to health.

Confidentiality agreements: a challenge in market regulation.

BACKGROUND: Sustainability and the ability to maintain the right to health, with the guarantee of access to quality medicines and health services, have been a great challenge for countries with universal health systems. The great technological advances bring with it an expressive increase in the expenditures of the health systems, especially those directed towards the acquisition of high-cost drugs, which are still under patent protection, have a high cost and, in some cases, present uncertainties about their effectiveness and safety. As a way of maintaining the proper functioning of the systems and guaranteeing access to these medicines, some countries started to negotiate discounts with manufacturing companies. Pricing agreements have been adopted by developed countries with the objective of reducing their spending on high-cost medicines and, although they represent an opportunity for better negotiation with the industries, they violate the principle of transparency that regulates the world market. However, the existence of confidentiality agreements has meant that the declared prices are not the actual prices, unfairly harming the countries that use these price lists as beacons in their systems. METHODS: Representatives of health, judicial, legislative, patient organizations and academics from eight countries in Latin America and South Korea participated in a meeting in September 2017 in Chile to discuss price confidentiality agreements and the impact on public health policies. During the meeting, participants were presented with a hypothetical case to subsidize the discussion on the topic. Divided into groups, participants should propose recommendations for the problem by pointing out the pros and cons if each proposed recommendation was adopted. The groups were then confronted by a simulated jury and finally issued a single and final recommendation for the problem. RESULTS: The topic was widely discussed and recommendations were raised by the participants. Among them, it is worth noting the elaboration of norms that regulate the negotiations of prices between the countries bringing transparency and harmony in the adopted conducts. In addition, the possible consequences and potential impacts of confidentiality on drug prices and inputs, such as information asymmetry and inequity of access between countries, were pointed out. CONCLUSION: Despite there are efforts to make price negotiations more transparent, there is still no well-established standardization that promotes a well-functioning market. Confidentiality agreements hamper the fairness of access to essential health products.

Distributional health and financial benefits of increased tobacco taxes in Colombia: results from a modelling study.

BACKGROUND: In Colombia, smoking is the second leading modifiable risk factor for premature mortality. In December 2016, Colombia passed a major tax increase on tobacco products in an effort to decrease smoking and improve population health. While tobacco taxes are known to be highly effective in reducing the prevalence of smoking, they are often criticised as being regressive in consumption. This analysis attempts to assess the distributional impact (across socioeconomic groups) of the new tax on selected health and financial outcomes. METHODS: This study builds on extended cost-effectiveness analysis methods to study the new tobacco tax in Colombia, and estimates, over a time period of 20 years and across income quintiles of the current urban population (80% of the country population), the years of life gained with smoking cessation and the increased tax revenues, all associated with a 70% relative price increase of the pack of cigarettes. Where possible, we use parameters that vary by income quintile, including price elasticity of demand for cigarettes (average of -0.44 estimated from household survey data). FINDINGS: Over 20 years, the tax increase would lead to an estimated 191 000 years of life gained among Colombia's current urban population, with the largest gains among the bottom two income quintiles. The additional annual tax revenues raised would amount to about 2%-4% of Colombia's annual government health expenditure, with the poorest quintiles bearing the smallest tax burden increase. CONCLUSIONS: The tobacco tax increase passed by Colombia has substantial implications for the country's population health and financial well-being, with large benefits likely to accrue to the two poorest quintiles of the population.

Occupational risks in Latin America and the Caribbean: economic and health dimensions.

This study analyzes health and economic aspects of occupational safety in Latin America and the Caribbean. Work-related injuries and illnesses represent a primary health risk in the region. Specific factors negatively affect work safety in the region: the structure of the labour market, the lack of adequate resources for enforcement, prevention and research, the hazard profile, as well as the presence of vulnerable groups in the workforce. This study estimates that between 27,270 and 73,500 occupational fatal accidents occur in the region each year. It also calculates that the economic costs of these hazards represent between 2 and 4% of regional Gross Domestic Product. The paper concludes by discussing public policies that could address this problem and improve compliance with appropriate safety standards in the region.

A Concepção econômica de custos

Aborda os aspectos microeconômicos da saúde ocupando-se da concepção econômica dos custos e introduz o leitor em outros conceitos básicos tais como custo-oportunidade (ou custo social), custo médio marginal e as diferenças entre custo econômico e custo contábil.

Demanda e demanda em saúde

Aborda os aspectos conceituais da demanda global e da demanda em saúde, seus determinantes e o conflito, ou as diferenças entre demanda (procura do serviço) e "necessidade".

III- Impacto econômico das causas externas no Brasil: um esforço de mensuraçäo / III- Economic impact of external causes in Brazil: an attempt at measurement

Procurou-se obter uma primeira estimativa do impacto econômico das lesöes e envenenamentos no Brasil, medido através dos gastos hopitalares com internaçäo - dias de permanência geral e em Unidades de Terapia Intensiva. Säo analisadas internaçöes em hospitais conveniados com o Sistema Unico de Saúde, através das AIH - Autorizaçäo de Internaçäo Hospitalar, sendo verificado que essas internaçöes geram um gasto anual, correspondendo a, aproximadamente, 0,07 do Produto Interno Bruto do País. Com relaçäo à mortalidade, o impacto econômico foi analisado por meio do indicador Anos Potenciais de Vida Perdidos. Os acidentes e violências representaram cerca de 2,6 milhöes de anos de vida perdidos, em 1981, e 3,4 milhöes, em 1991. O aumento verificado foi cerca de 30 por cento, enquanto que para o conjunto de dados os óbitos apresentaram-se em queda. Apesar de algumas limitaçöes, é possível estimar a dimensäo geral do impacto econômico das causas externas. Espera-se que essas limitaçöes sirvam de estímulo a novas investigaçöes e aprofundamentos.

A concepçäo econômica de custos / The economic concept of costs

Traduz e explica conceitos econômicos em uma linguagem mais acessível ao näo-economista, particularmente àquele ligado à área da saúde, apresentando a noçäo de custo de oportunidade e mostra sua relevância esta área