[Municipalities Stratification for Health Performance Evaluation]. / Estratificação de municípios brasileiros para avaliação de desempenho em saúde.

OBJECTIVE: to propose and present a stratification of Brazilian municipalities into homogeneous groups for evaluation studies of health management performance. METHODS: this was a methodological study, with selected indicators which classify municipalities according to conditions that influence the health management and population size; data for the year 2010 were collected from demographic and health databases; correlation tests and factor analysis were used. RESULTS: seven strata were identified - Large-sized; Medium-sized with favorable, regular or unfavorable influences; and Small-sized with favorable, regular or unfavorable influences -; there was a concentration of municipalities with favorable influences in strata with better purchasing power and funding, as well as a concentration of municipalities with unfavorable influences in the North and Northeast regions. CONCLUSION: the proposed classification grouped similar municipalities regarding influential factors in health management, which allowed the identification of comparable groups of municipalities, setting up a consistent alternative to performance evaluation studies.

Custo-benefício do serviço de telecardiologia no Estado de Minas Gerais: projeto Minas Telecardio / Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project

FUNDAMENTO: A telecardiologia é instrumento que pode auxiliar na atenção cardiovascular, principalmente em municípios localizados em áreas remotas. Entretanto, as avaliações econômicas sobre o assunto são escassas e com resultados controversos. OBJETIVO: Avaliar o custo-benefício da implantação do serviço de telecardiologia em municípios remotos, de pequeno porte, no estado de Minas Gerais, Brasil. MÉTODOS: O estudo utilizou a base de dados do Projeto Minas Telecardio (MTC), desenvolvido de junho/2006 a novembro/2008, em 82 municípios do interior do estado. Cada município recebeu um microcomputador com eletrocardiógrafo digital, com possibilidade de envio dos traçados e comunicação com plantão de cardiologia em pólo universitário. A análise custo-benefício foi realizada comparando o custo de realização de um ECG no projeto MTC ao custo de realizar este exame por encaminhamento em outra localidade. RESULTADOS: O custo médio de um ECG no projeto MTC foi de R$ 28,92, decomposto em R$ 8,08 referente ao custo de implantação e R$ 20,84 ao de manutenção do programa. A simulação do custo do ECG com encaminhamento variou de R$ 30,91 a R$ 54,58, sendo a relação custo-benefício sempre favorável ao programa MTC, independente da forma de cálculo da distância de encaminhamento. Nas simulações, foram consideradas as abordagens do financiador e da sociedade. A análise de sensibilidade com variação dos parâmetros de calibração confirmou esses resultados. CONCLUSÃO: A implantação de sistema de telecardiologia como apoio a atenção primária em cidades brasileiras de pequeno porte é factível e economicamente benéfica, podendo ser transformada em programa regular do sistema público de saúde.

BACKGROUND: Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. OBJECTIVE: To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. METHODS: The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. RESULTS: The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. CONCLUSION: The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.

Cost-benefit of the telecardiology service in the state of Minas Gerais: Minas Telecardio Project.

BACKGROUND: Telecardiology is a tool that can aid in cardiovascular care, mainly in towns located in remote areas. However, economic assessments on this subject are scarce and have yielded controversial results. OBJECTIVE: To evaluate the cost-benefit of implementing a Telecardiology service in remote, small towns in the state of Minas Gerais, Brazil. METHODS: The study used the database from the Minas Telecardio (MTC) Project, developed from June 2006 to November 2008, in 82 towns in the countryside of the state. Each municipality received a microcomputer with a digital electrocardiograph, with the possibility of transmitting ECG tracings and communicating with the on-duty cardiologist at the University hospital. The cost-benefit analysis was carried out by comparing the cost of performing an ECG in the project versus the cost of performing it by patient referral to another city. RESULTS: The average cost of an ECG in the MTC project was R$ 28.92, decomposed into R$ 8.08 for the cost of implementation and R$ 20.84 for maintenance. The cost simulation of the ECG with referral ranged from R$ 30.91 to R$ 54.58, with the cost-benefit ratio being always favorable to the MTC program, regardless of the type of calculation used for referral distance. The simulations considered the financial sponsor's and society's points-of-view. The sensitivity analysis with variation of calibration parameters confirmed these results. CONCLUSION: The implementation of a Telecardiology system as support to primary care in small Brazilian towns is feasible and economically beneficial, and can be used as a regular program within the Brazilian public health system.