ABSTRACT
Drug repurposing can be cheaper and faster than developing new compounds. Yet, it remains underused, partially because of regulatory and intellectual property challenges. Policy-makers in the United States and Europe have created seven drug development programs that aim to overcome these challenges using a variety of different strategies.
Subject(s)
Drug Repositioning , Humans , United States , Europe , Uncertainty , Intellectual Property , Government Programs/economicsABSTRACT
INTRODUCTION: Studies examining profit suggest that former tobacco farmers do as well or better than current tobacco farmers. Research has yet to examine the relationship among current and former tobacco farmers, poverty, and receipt of government social assistance. This type of research is critical to understanding the direct and indirect subsidization of tobacco growing. This study analyzed tobacco farmers' poverty levels and receipt of government social assistance programs. AIMS AND METHODS: We designed and conducted an original four-wave economic survey of current and former tobacco farming households in Indonesia between 2016 and 2022. We then used descriptive analysis and probit regression for panel data to estimate the relationship between tobacco farming and poverty status. RESULTS: Tobacco farmers' per capita income and poverty rates vary across years. The poverty rate was significantly higher in the year with a higher-than-normal rainfall as it negatively affected farming outcomes. During this year, the poverty rate among current tobacco farmers was also higher than that of former tobacco farmers. Regression estimates from the panel data confirm the association between tobacco farming and the likelihood of being poor. We also found a high share of current tobacco farmers who receive government social assistance programs, such as cash transfer programs and a universal healthcare program. CONCLUSIONS: Our findings show high poverty rates-particularly during bad farming years-and high rates of government social assistance among tobacco farmers. The high rates of government assistance among tobacco farmers living in poverty show that the government is indirectly subsidizing the tobacco industry.
Subject(s)
Farmers , Poverty , Indonesia/epidemiology , Humans , Farmers/statistics & numerical data , Poverty/statistics & numerical data , Female , Male , Adult , Government Programs/economics , Government Programs/statistics & numerical data , Public Assistance/statistics & numerical data , Income/statistics & numerical data , Nicotiana , Surveys and QuestionnairesABSTRACT
Resumo A partir da criação de uma Secretaria de Atenção Primária à Saúde (SAPS) no Ministério da Saúde em maio de 2019, cinco novos desafios foram trazidos para a gestão federal do SUS: a) ampliação do acesso da população às unidades de saúde da família, b) definição de um novo modelo de financiamento baseado em resultados em saúde e eficiência, c) definição de um novo modelo de provimento e formação de médicos de família e comunidade para áreas remotas, d) fortalecimento da clínica e do trabalho em equipe multiprofissional, e) ampliação da informatização das unidades de saúde e uso de prontuário eletrônico. Esse ensaio discute esses elementos à luz de um novo modelo avaliativo que, ao mesmo tempo, seja capaz de orientar o novo processo de financiamento da Atenção Primária à Saúde (APS) no Brasil. Este baseia-se na correção de distorções distributivas e também busca orientar maior efetividade e eficiência no investimento público e qualidade do serviço prestado à população. Através de estudos dos melhores exemplos internacionais e discussão com os representantes do Conselho Nacional de Secretários Estaduais de Saúde (CONASS) e do Conselho Nacional dos Secretários Municipais de Saúde (CONASEMS) e com apoio técnico do Banco Mundial, foi elaborada a proposta de novo modelo avaliativo e de financiamento da APS.
Abstract Five new challenges were brought to the federal management of SUS from the establishment of the Primary Health Care Secretariat (SAPS) in May 2019, as follows: a) to expand people's access to health facilities; b) to define a new financing model from health outcomes and efficiency; c) to define a new model of provision and training of family and community doctors for remote areas; d) to strengthen clinic and multi-professional teamwork; e) to expand computerization of health facilities and use of electronic medical records. This essay discusses these elements in light of a new evaluation model that also guides a new process of financing the Brazilian Primary Health Care (PHC). It builds on the correction of distributive distortions, and also seeks to guide greater effectiveness and efficiency in public investment and quality of service provided to the population. The proposal for a new PHC evaluation and financing model was elaborated through studies of the best international examples and discussion with representatives of the National Council of State Health Secretaries (CONASS) and the National Council of Municipal Health Secretaries (CONASEMS), and with technical support from the World Bank.
Subject(s)
Humans , Primary Health Care/economics , Primary Health Care/legislation & jurisprudence , Primary Health Care/organization & administration , Government Programs/economics , Government Programs/legislation & jurisprudence , Health Plan Implementation/economics , Health Plan Implementation/legislation & jurisprudence , Health Services Accessibility/economics , Health Services Accessibility/legislation & jurisprudence , Health Services Accessibility/organization & administration , Reimbursement, Incentive , Brazil , Universal Health InsuranceABSTRACT
Resumo: Em abril de 2019, foi assinada a portaria de incorporação do medicamento nusinersena no Sistema Único de Saúde (SUS). É o medicamento mais caro já incorporado ao SUS, para uso no tratamento de atrofia muscular espinhal 5q tipo I. A incorporação é referida como um marco na tomada de decisão sobre novas tecnologias no SUS, a ser viabilizada por meio de acordo de partilha de risco. O trabalho discute o processo de incorporação do nusinersena, destacando aspectos contextuais, temporais e técnicos, além de possíveis consequências para a institucionalização da avaliação de tecnologias em saúde (ATS) no SUS. Seguiu método exploratório, com revisão de informações públicas produzidas pela Comissão de Incorporação de Tecnologias no SUS (CONITEC) e busca em bancos de dados governamentais de preços e compras. Foi produzida linha temporal descrevendo os pontos-chave do processo de incorporação. Houve dois pedidos de incorporação do medicamento. O primeiro, submetido pela Secretaria de Ciência, Tecnologia e Insumos Estratégicos (SCTIE) do Ministério da Saúde, negado por unanimidade, em novembro de 2018. Seguiu-se o pedido do Secretário da SCTIE à Advocacia-Geral da União (AGU), para que pudesse decidir de forma contrária à recomendação do plenário da CONITEC. A AGU recomendou uma nova submissão, feita pela empresa produtora e aprovada por unanimidade, em março de 2019. Não houve acréscimo de novas evidências ou redução de preço que justificassem a mudança de decisão. Não foram identificados os elementos constituintes do acordo de partilha de risco. São sinalizados problemas de transparência e accountability, bem como riscos ao processo de institucionalização da ATS que vinha em curso no SUS.
Abstract: In April 2019, a ruling was signed for the incorporation of the drug nusinersen by the Brazilian Unified National Health System (SUS). Nusinersen is the most expensive drug ever incorporated by the SUS and is used to treat type I 5q spinal muscular atrophy. The incorporation has been described as a milestone in decision-making on new technologies in the SUS, enabled through a risk-sharing agreement. The article discusses the process involved in the incorporation of nusinersen, highlighting the context, timing, and technical issues, in addition to possible consequences for the institutionalization of health technology assessment (HTA) in the SUS. The study used an exploratory method, reviewing public information produced by the Commission for Incorporation of Technologies in the SUS (CONITEC) and searches in government databanks on prices and purchases. A timeline was produced, describing the key points in the process of incorporation. There were two formal requests for the drug's incorporation. The first was submitted by the Division of Science, Technology, and Strategic Inputs (SCTIE) of the Brazilian Ministry of Health and was turned down unanimously in November 2018. This was followed by a petition by the head of the SCTIE to the Attorney General's Office (AGU) to overrule the recommendation by the CONITEC plenary. The AGU recommended a new submission, made by the drug's manufacturing company, which was approved unanimously in March 2019. The was no addition of new evidence or a price reduction to justify the change of decision. No elements were identified in the risk-sharing agreement. This suggests problems of transparency and accountability, as well as risks in the process of institutionalization of HTA that had been underway in the SUS.
Resumen: En abril de 2019, se firmó el decreto de incorporación del medicamento nusinersén en el Sistema Único de Salud brasileño (SUS). Es el medicamento más caro que se ha incorporado al SUS para su uso en el tratamiento de la atrofia muscular espinal 5q tipo I. La incorporación del mismo está considerada como un marco de referencia en la toma de decisiones sobre nuevas tecnologías en el SUS, que puede ser viable mediante el acuerdo de distribución de riesgo. El trabajo discute el proceso de incorporación del nusinersén, destacando aspectos contextuales, temporales y técnicos, además de posibles consecuencias para la institucionalización de la evaluación de tecnologías en salud (ETS) en el SUS. El trabajo siguió el método exploratorio, con una revisión de la información pública, generada por la Comisión de Incorporación de Tecnologías en el SUS (CONITEC) y la búsqueda en bancos de datos gubernamentales de precios y compras. Se creó una línea temporal, describiendo los puntos-clave del proceso de incorporación. Hubo dos peticiones de incorporación del medicamento. La primera, sometida a la Secretaría de Ciencia, Tecnología e Insumos Estratégicos (SCTIE) del Ministerio de Salud, rechazada por unanimidad, en noviembre de 2018. A lo que le siguió la petición del Secretario de la SCTIE a la Abogacía-General de la Unión (AGU), para que pudiese decidir en otro sentido respecto a la recomendación del pleno de la CONITEC. La AGU recomendó una nueva remisión, realizada por la empresa productora y aprobada por unanimidad, en marzo de 2019. No se produjo un incremento de nuevas evidencias o una reducción del precio que justificasen el cambio de decisión. No se identificaron los elementos constituyentes del acuerdo de distribución de riesgo. Se señalaron los problemas de transparencia y rendición de cuentas, así como riesgos para el proceso de institucionalización de la ETS que estaba en curso en el SUS.
Subject(s)
Humans , Oligonucleotides/economics , Technology Assessment, Biomedical/legislation & jurisprudence , Government Programs/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Technology Assessment, Biomedical/economics , Brazil , Muscular Atrophy, Spinal/drug therapy , Retrospective Studies , Decision Making , Government Programs/economics , National Health Programs/economicsABSTRACT
Resumo A Constituição Federal de 1988 introduziu o Benefício de Prestação Continuada (BPC) possibilitando a inclusão de pessoas com deficiência. Estudo descritivo, com dados municipais agregados, da distribuição temporal e geográfica da incidência de microcefalia relacionada ao Zika vírus no Brasil e dados das concessões de BPC a crianças com diagnóstico de microcefalia. Apresentam-se dados sobre a demanda e a concessão do BPC para crianças com microcefalia desde 2009. Os casos de microcefalia e/ou alteração do sistema nervoso central foram obtidos do Ministério da Saúde e totalizaram 2.366 casos confirmados de 01/01/2015 a 31/12/2016. A série histórica da concessão de BPC de 2009 a 2016 foi elaborada a partir de dados do Instituto Nacional do Seguro Social e mostrou, até 2014, uma linha de base com a média de 200 benefícios anuais para crianças menores de 48 meses com microcefalia. Em 2016 as concessões aumentaram oito vezes atingindo 1.603 benefícios concedidos a crianças de 731 municípios, das 27 Unidades da Federação. A Região Nordeste concentrou 73% dos BPC concedidos, mas, ainda assim, isto representou menos do que 65% da demanda de casos incidentes. É preciso reforçar a implementação do sistema de referência integrado, inclusive com busca ativa, para que todas as crianças com direito ao BPC tenham acesso.
Abstract The Brazilian Federal Constitution of 1988 introduced the Continuous Cash Benefits (BCP), allowing the inclusion of people with disabilities. This is a descriptive study with aggregate municipal data about the time and geographic distribution of the incidence of microcephaly related to the Zika virus in Brazil and data of the BCP grants to children diagnosed with microcephaly. Data on the demand and BCP grants to children with microcephaly since 2009 are shown. Cases of microcephaly and/or central nervous system disorders were obtained from the Ministry of Health and totaled 2,366 confirmed cases from January 1, 2015 to December 31, 2016. The historical series of BCP granted from 2009 to 2016 was based on data from the National Institute of Social Security and showed, until 2014, a baseline with an average of 200 annual benefits for children younger than 48 months with microcephaly. In 2016, grants increased eight times, reaching 1,603 benefits granted to children of 731 municipalities spread in the 27 States. The Northeast accounted for 73% of the BCPs granted, however, this was less than 65% of the demand for incident cases. The implementation of the integrated referral system, including active search, should be strengthened to ensure access to all children entitled to BCP.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Disabled Persons/statistics & numerical data , Zika Virus Infection/complications , Government Programs/statistics & numerical data , Microcephaly/epidemiology , Brazil/epidemiology , Incidence , Zika Virus Infection/economics , Zika Virus Infection/epidemiology , Government Programs/economics , Microcephaly/economics , Microcephaly/virologyABSTRACT
Resumo Este artigo tem por objetivo investigar se o programa Bolsa Família contribui para o processo de individualização das mulheres pobres. Para tanto, foi utilizada a técnica de pareamento por escore de propensão, a fim de identificar mulheres e homens não atendidos pelo programa comparáveis a mulheres e homens atendidos. Com base na Pesquisa Nacional por Amostra de Domicílio de 2006, estimaram-se a jornada de trabalho doméstico, a participação no mercado de trabalho e as horas de trabalho remunerado de homens e mulheres. Os resultados não foram conclusivos para participação no mercado de trabalho. Para a jornada de trabalho remunerado, há indícios de que o Programa Bolsa Família reduza as horas trabalhadas de homens e mulheres. Para a jornada de trabalho doméstico, há indicativos de aumento de tempo de cuidado doméstico para mulheres e redução para homens. Os resultados da pesquisa sugerem que o programa reforçaria papéis tradicionais de gênero, não contribuindo para a individualização das mulheres pobres.
Abstract This paper aims to investigate whether the Bolsa Família program contributes to the process of individualization of poor women. Propensity score matching techniques have been used to select comparable individuals, women and men, who are beneficiaries of the program and those who are not. Based on the 2006 Pesquisa Nacional por Amostra de Domicílio (PNAD) data, the following estimations were estimated: hours of housework, participation in the labor market, and hours of paid work for men and women. Results were inconclusive for participation in the labor market; no evidence has been found that the Bolsa Família Program reduces hours of work of either men or women. Our results indicate that housework hours increase for women and diminish for men. The survey results suggest that the program reinforces gender stereotypes, not contributing to the individualization of poor women.
Resumen Este artículo tiene como objetivo investigar si el programa Bolsa Familia contribuye al proceso de individualización de las mujeres pobres. Para ello se utilizó la técnica de correspondencia del puntaje de propensión para encontrar hombres y mujeres no beneficiarios del programa que pudieran ser comparados con mujeres y hombres que sí lo fueran. Con base en los datos de la Pesquisa Nacional por Amostra de Domicílio (PNAD) de 2006, se estimaron las horas de trabajo doméstico, la participación en el mercado de trabajo y las horas de trabajo remunerado de hombres y mujeres. Los resultados no fueron conclusivos para la participación en el mercado laboral. No hay evidencias de que el programa Bolsa Familia reduzca las horas de trabajo de hombres y mujeres, pero sí hay indicios de que aumenta el tiempo dedicado a las tareas del hogar de las mujeres y disminuye para los hombres. Los resultados sugieren que el programa reforzaría estereotipos de género, lo que no contribuye a la individualización de las mujeres pobres.
Subject(s)
Humans , Male , Female , Government Programs/economics , Income , Women, Working , Work Hours , Brazil , Gender Identity , Poverty , Socioeconomic FactorsABSTRACT
Os programas de transferência condicionada de renda estão disseminados em países em desenvolvimento na América Latina com ênfase no Brasil como um novo paradigma nas políticas sociais para erradicação da pobreza. Consistem no repasse de recusros monetários de renda do governo diretamente para familias pobres mediante cumprimento das condicionalidades em educação e saúde. Na saúde, memos com variçãoes entre os países as condicionalidades tem como público alvo gestantes e crianças com vistas à redução de indicadores de saúde da criança, como cescimento e desenvolvimento, mortalidade infantil e incemento do pré-natal. Os objetivos deste trabalho são comparar o programa de transferencia condicionada de renda brasileiro, o Bolsa Familia e os programas semelhantes na América Latina em relação aos seus efeitos no crescimento e desenvolvimento de crianças até 7 anos de idade e avaliar a prevalencia das condicionalidades em saúde da mulher e da criança entre usuárias dos serviços de saúde brasileiros cujas equipes aderiram ao Programa de Acesso e Qualidade da Aenção Básica (PMAQ). Para o primeiro objetivo foi realizada uma revisão sistemática onde selecionaram-se dez artigos entre mais de mil encontrados nas bases de dados Embase, Pubmed, Scopus, Scielo e Lilacs. Os artigos são estudos epidemiológicos observacionais dos tipos descritivos transversais e analíticos de coorte e casos-controle. Para o estudo de prevalencia, análise estatística utilizou a regressão de Poisson com variância robusta para investigar como a prevalência do cumprimento das condicionalidades na área de saúde foi influenciada pelas diversas variáveis explicativas.
Foram estimadas razões de prevalências brutas e ajustadas, com seus respectivos intervalos de confiança de 95%. O cadastro no programa bolsa família foi considerado como principal variável de exposição. As variáveis de confundimento foram: idade da mãe, escolaridade, raça/cor, saber ler, viver sozinha e região de moradia. Na análise dos dados foi utilizado o software R 3.0.1 (RDevelopment Core Team, 2013). Em relação a comparação do Bolsa Familia com demais programas da América Latina, a revisão mostrou resultados semelhantes quanto ao efeito positivo dos programas de transferência de renda no estado nutricional de crianças beneficiárias, sendo que estes efeitos são mais evidenciados em crianças menores de dois anos de idade, bem como pertencentes às famílias de mais baixo nível socioeconômico. Para a prevalencia das condicionalidades entres os diferentes grupos de usuárias do Bolsa Família e não usuárias Os resultados apontaram que não houve diferença estatística significativa entre respondentes (com filhos menores de dois anos) cadastrados e não cadastrados no PBF quanto às questões referentes aos seguintes aspectos: cumprimento do calendário vacinal da criança, realização de pelo menos sete consultas de pré natal, realização do acompanhamento do crescimento e desenvolvimento da criança e receber orientação da equipe de saúde quanto a alimentação da criança. Conlui-se de um lado que aumento de renda mínima para familias de exterma pobreza mostrou impacto possitivo na saúde das cranças no Brasil e América Latina. Do outro não confirmou, no Brasil, uma incremento das condicionalidades expressas numa utlização dos serviços de atenção básica por parte das usuárias do Bolsa Familia. (AU)
The programs of conditional cash transfer are widespread in developing countries in Latin America with emphasis on Brazil as a new paradigm in social policies for poverty eradication. Consist of transferring monetary funds from the government directly to poor families by fulfilling the conditionalities on education and health. In health, even with variations between countries, conditionality targeting public pregnant women and children with a view to improving health indicators maternoinfantil as growth, infant mortality and prenatal care. The objectives of this study are to compare the transfer program conditional Brazilian income, the Family and similar programs in Latin America in relation to its effects on growth in children, and to evaluate the effect of Bolsa Família in the prevalence of use of services (conditionalities) of prenatal care in Brazilian health services whose teams joined the Programa de Acesso e Melhoria da Qualidade da Atenção Básica (PMAQ-AB). For the first objective a systematic review , we selected ten articles between 1007 (one thousand and seven) found in the databases Embase, PubMed, Scopus, Scielo and Lilacs databases was performed. Articles are observational epidemiological studies of transverse descriptive and analytical types of cohort and case - control. For the second objective, for it is a prevalence study, a statistical analysis using Poisson regression with robust variance was performed to investigate how the prevalence of compliance with conditionalities on health was influenced by various explanatory variables. Ratios, crude and adjusted prevalence, with their respective confidence intervals of 95 % were estimated. The family joined the scholarship program was considered as the main exposure variable. Confounding variables were: maternal age, race / color, paid employment , marital status and region of residence. In data analysis software R 3.0.1 (RDevelopment Core Team 2013) was used . Regarding the comparison of the Bolsa Família with other programs in Latin America, the review found similar results regarding the positive effect of income transfer in the nutritional status of beneficiary children programs, and these effects are more evident in children under two years old and belonging to families of lower socioeconomic status. For the prevalence of conditionalities entres different groups of users of the Bolsa Família and nonusers results showed no statistically significant difference between respondents (with children under two years) registered and not registered in PBF on issues relating to: meet at least six prenatal visits, meet and participate in health education activities. It follows from side to increase minimum income for families in extreme poverty showed positive impact on children's health in Brazil and Latin America. The other is not confirmed in Brazil, an increase in conditionality expressed in use of primary care by the users of the Bolsa Família services. (AU)
Subject(s)
Primary Health Care , Public Policy , Government Programs/economics , Income , Child Health , Social Support , Brazil , Social Mobility , Poverty , Public PolicyABSTRACT
OBJETIVO: estimar os custos do Programa Municipal de Controle da Dengue de Goiânia-GO, Brasil. MÉTODOS: estudo de custo de programa considerando períodos epidêmico (outubro/2009-abril/2010) e endêmico (maio-setembro/2010) de transmissão da doença, na perspectiva do Sistema Único de Saúde (SUS); os componentes de custo analisados foram recursos humanos, capacitação, infraestrutura, equipamentos de escritório, transporte, equipamentos de proteção individual, material de campo, material laboratorial, inseticidas e mobilização social; custos de capital (investimento) e recorrentes foram considerados. RESULTADOS: a média mensal de custos recorrentes foi de R$1.355.760 (US$814,075) e R$981.100 (US$589,108) nos períodos epidêmico e endêmico respectivamente; o custo de capital anual foi estimado em R$683.315 (US$410,301); cerca de 82%, 15% e 3% do custo total referem-se, respectivamente, às fontes de recurso municipal, federal e estadual. CONCLUSÃO: o custo adicional resultante das epidemias de dengue fornece subsídios para um melhor planejamento das atividades de prevenção e controle da infecção.
OBJECTIVE: to estimate the cost of the Municipal Program for Dengue Control in Goiânia, GO, Brazil. METHODS: Costs of program considering epidemic (October/2009-April/2010) and endemic (May-September/2010) periods of dengue transmission, from the perspective of the National Unified Health System (SUS); cost components considered were human resources, training, infrastructure, office equipment, transportation, personal protective equipment, field equipment, laboratory equipment, insecticides and social mobilization; capital (investment) and recurring costs were considered. RESULTS: average monthly recurring costs were R$1,355,760 (US$814,075) and R$981,100 (US$589,108), for the epidemic and endemic periods, respectively; annual capital cost was R$683,315 (US$410,301); approximately 82%, 15% and 3% of the total cost were from municipal, federal and state level funding sources, respectively. CONCLUSION: estimated incremental costs resulting from dengue epidemics provide information to support planning of dengue prevention and control activities.
OBJETIVO: estimar los costos del Programa Municipal de Control de Dengue en el municipio de Goiânia-GO, Brasil. MÉTODOS: estudio de costos del programa teniendo en cuenta períodos epidémicos (octubre/2009-abril/2010) y endémicos (mayo-septiembre/2010) de la transmisión de dengue; dentro de la perspectiva del Sistema Único de Salud (SUS); los componentes de los costos analizados fueron recursos humanos, capacitación, infraestructura, equipo de oficina, transporte, equipo de protección personal, equipo de campo, materiales de laboratorio, insecticidas y movilización social, teniendo en cuenta los costos de capital (inversión) y recurrentes. RESULTADOS: el valor mensual de costos recurrentes fue R$1.355.760 (US$814,075) y R$981.100 (US$589,108), en los períodos epidémicos y endémicos, respectivamente; los costos de capital durante el periodo de estudio fueron R$683,315 (US$410,301); alrededor de 82%, 15% y 3% de los costos totales fueron de fuente municipal, federal y estatal, respectivamente. CONCLUSIÓN: el conocimiento de los costos adicionales resultantes de las epidemias de dengue puede apoyar a una mejor planificación de las actividades de prevención y control del dengue.
Subject(s)
Humans , Male , Female , Dengue/prevention & control , Dengue/epidemiology , Government Programs/economics , Health Care Economics and Organizations , Unified Health System , Brazil/epidemiology , Costs and Cost Analysis/economics , Local GovernmentABSTRACT
La escasez de recursos disponibles para satisfacer una demanda creciente de servicios sanitarios ha hecho que las miradas se dirijan hacia la evaluación económica como instrumento para informar la asignación de recursos. Su objetivo es comparar diversas alternativas de actuación en términos de sus costes y efectos sobre la salud. Para ello, utiliza diversas técnicas: el análisis de minimización de costes, el análisis coste-efectividad, el análisis coste-utilidad y el análisis coste-beneficio. Sea cuál sea la metodología utilizada, toda evaluación debe incluir la definición del problema, la selección de opciones a comparar, la explicitación de la perspectiva del análisis y del horizonte temporal, la medida y la valoración de los costes y los efectos sobre la salud relevantes, la presentación de resultados, y la realización de análisis de sensibilidad. En España sería conveniente que se evaluaran las intervenciones preventivas actualmente en marcha, y que los investigadores se adhiriesen a las guías de evaluación económica existentes (AU)
The scarcity of resources available to meet the growing demand for healthcare services has increased interest in economic evaluation as a tool to inform resource allocation. The aim of economic evaluation is to compare various alternatives for action, in terms of their costs and effects on health, by using several techniques: cost minimization analysis, cost-effectiveness analysis, cost-utility analysis, and cost-benefit analysis. Irrespective of the methodology used, any assessment must include scope of the problem, selection of alternatives for comparison, explication of the perspective of analysis and the time horizon, measurement and evaluation of costs and health effects, presentation of results, and sensitivity analysis. In Spain, evaluation of currently ongoing preventive interventions, and adherence to the existing economic evaluation guidelines by researchers would be desirable (AU)
Subject(s)
Humans , Government Programs/economics , Preventive Health Services/economics , Public Health/economics , Program Evaluation/methods , Resource Allocation , Cost-Benefit Analysis , Cost Efficiency Analysis , Clinical Trial , Preventive Health Services/organization & administration , Spain , Time Factors , Research DesignABSTRACT
O Programa de Saúde da Família (PSF) foi instituído pelo governo federal como estratégia para reverter o modelo assistencial. Este artigo objetiva identificar o fluxo das contas municipais desde as fontes de financiamento até as atividades de saúde, além de problematizar e avaliar a alocação dos recursos financeiros e a execução orçamentária do PSF no município de Santo Antônio de Jesus (Bahia) em 2005. Os dados financeiros foram coletados através de quatro tabelas propostas pelo National Health Accounts (NHA) e comparados com as fontes documentais. O resultado da pesquisa revelou gastos per capita das 16 unidades do PSF que variaram de R$ 465,40 a R$ 62,30 per capita/unidade/ano. O gasto médio de uma unidade do PSF foi de R$ 17.302/unidade/mês em 2005, e o financiamento do governo federal foi de R$ 2.834/unidade/mês. Conclui-se que houve um financiamento irrisório do Programa (PSF) por parte do governo federal e uma inexistência de cofinanciamento estadual e um grande esforço do município em ampliar o acesso aos serviços de saúde através da ESF. A escolha do município por essa estratégia pode ter inviabilizado outras atividades prioritárias devido aos recursos escassos, e a descrição das atividades registra um perfil que servirá para comparação em pesquisas futuras.
The Family Health Program (PSF) was established by the federal government as a strategy to reverse the care model. This article aimed to identify the flow of accounts from local sources of funding to the activities of health; problematize and evaluate the allocation of financial resources and implementation of the PSF budget in the municipality of Santo Antonio de Jesus (Bahia, Brazil) in the year of 2005. The financial data were collected through four tables proposed by the National Health Accounts (NHA) and compared with data of official reports. The data result on the survey showed a expenditure per capita of 16 PSF units ranging from R$ 465.40 to R$ 62.30 per capita/unit/year. The average expenditure of a unit was R$ 17.302/unit/month) in 2005 and the federal government spent R$ 2.834/unit/month. In conclusion: there was a decisory financing of the PSF by the federal government and a lack of co-financing from state of Bahia; there was a great effort from the council to expand access to health services through the PSF. The choice of the municipality by this strategy may have make unviable other priority activities due to scarce resources; and the limits found in the expenditure description of activities register a profile that will allow comparisons in future researches.
Subject(s)
Humans , Family Health , Government Programs/economics , Health Expenditures , Primary Health Care/economics , Brazil , BudgetsABSTRACT
En este artículo se describe el sistema de salud de Argentina, que está compuesto por tres sectores: público, de seguridad social y privado. El sector público está integrado por los ministerios nacional y provincial, y la red de hospitales y centros de salud públicos que prestan atención gratuita a toda persona que lo demande, fundamentalmente a personas sin seguridad social y sin capacidad de pago. Se financia con recursos fiscales y recibe pagos ocasionales de parte del sistema de seguridad social cuando atiende a sus afiliados. El sector del seguro social obligatorio está organizado en torno a las Obras Sociales (OS), que aseguran y prestan servicios a los trabajadores y sus familias. La mayoría de las OS operan a través de contratos con prestadores privados y se financian con contribuciones de los trabajadores y patronales. El sector privado está conformado por profesionales de la salud y establecimientos que atienden a demandantes individuales, a los beneficiarios de las OS y de los seguros privados. Este sector también incluye entidades de seguro voluntario llamadas Empresas de Medicina Prepaga que se financian sobre todo con primas que pagan las familias y/o las empresas. En este trabajo también se describen las innovaciones recientes en el sistema de salud, incluyendo el Programa Remediar.
This paper describes the health system of Argentina.This system has three sectors: public, social security and private.The public sector includes the national and provincial ministries as well as the network of public hospitals and primary health care units which provide care to the poor and uninsured population. This sector is financed with taxes and payments made by social security beneficiaries that use public health care facilities. The social security sector or Obras Sociales (OS) covers all workers of the formal economy and their families. Most OS operate through contracts with private providers and are financed with payroll contributions of employers and employees. Finally, the private sector includes all those private providers offering services to individuals, OS beneficiaries and all those with private health insurance.This sector also includes private insurance agencies called Prepaid Medicine Enterprises, financed mostly through premiums paid by families and/or employers.This paper also discusses some of the recent innovations implemented in Argentina, including the program Remediar.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Argentina , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describen las características generales del sistema de salud de Bolivia: su organización y cobertura; sus fuentes de financiamiento y gasto en salud; los recursos físicos, materiales y humanos de los que dispone; las actividades de rectoría que desarrolla, y el nivel que ha alcanzado la investigación en salud. También se discuten las innovaciones más recientes que se han llevado a cabo en los últimos años, incluyendo el Seguro Universal Materno Infantil, el Programa de Extensión de Cobertura a Áreas Rurales, el Modelo de Salud Familiar, Comunitaria e Intercultural y el programa de subsidios monetarios Juana Azurduy, dirigido a fortalecer la atención prenatal y del parto.
This paper describes the Bolivian health system, including its structure and organization, its financing sources, its health expenditure, its physical, material and humans resources, its stewardship activities and the its health research institutions. It also discusses the most recent policy innovations developed in Bolivia: the Maternal and Child Universal Insurance, the Program for the Extension of Coverage to Rural Areas, the Family, Community and Inter-Cultural Health Model and the cash-transfer program Juana Azurduy intended to strengthen maternal and child care.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Bolivia , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describe el sistema de salud de Brasil, que está compuesto por un sector público que cubre alrededor de 75 por ciento de la población y un creciente sector privado que ofrece atención a la salud al restante 25 por ciento de los brasileños. El sector público está constituido por el Sistema Único de Salud (SUS) y su financiamiento proviene de impuestos generales y contribuciones sociales recaudadas por los tres niveles de gobierno (federal, estatal y municipal). El SUS presta servicios de manera descentralizada a través de sus redes de clínicas, hospitales y otro tipo de instalaciones, y a través de contratos con establecimientos privados. El SUS es además responsable de la coordinación del sector público. El sector privado está conformado por un sistema de esquemas de aseguramiento conocido como Salud Suplementaria financiado con recursos de las empresas y/o las familias: la medicina de grupo (empresas y familias), las cooperativas médicas, los llamados Planes Autoadministrados (empresas) y los planes de seguros de salud individuales. También existen consultorios, hospitales, clínicas y laboratorios privados que funcionan sobre la base de pagos de bolsillo, que utilizan sobre todo la población de mayores ingresos. En este trabajo se analizan los recursos con los que cuenta el sistema, las actividades de rectoría que se desarrollan y las innovaciones más recientemente implantadas, incluyendo el Programa de Salud de la Familia y el Programa Más Salud.
This paper describes the Brazilian health system, which includes a public sector covering almost 75 percent of the population and an expanding private sector offering health services to the rest of the population. The public sector is organized around the Sistema Único de Saúde (SUS) and it is financed with general taxes and social contributions collected by the three levels of government (federal, state and municipal). SUS provides health care through a decentralized network of clinics, hospitals and other establishments, as well as through contracts with private providers. SUS is also responsible for the coordination of the public sector. The private sector includes a system of insurance schemes known as Supplementary Health which is financed by employers and/or households: group medicine (companies and households), medical cooperatives, the so called Self-Administered Plans (companies) and individual insurance plans.The private sector also includes clinics, hospitals and laboratories offering services on out-of-pocket basis mostly used by the high-income population. This paper also describes the resources of the system, the stewardship activities developed by the Ministry of Health and other actors, and the most recent policy innovations implemented in Brazil, including the programs saúde da Familia and Mais Saúde.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Brazil , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describe el sistema de salud de Chile, incluyendo su estructura, financiamiento, beneficiarios y recursos físicos, materiales y humanos de los que dispone. Este sistema está compuesto por dos sectores, público y privado. El sector público está formado por todos los organismos que constituyen el Sistema Nacional de Servicios de Salud y cubre aproximadamente a 70 por ciento de la población, incluyendo a los pobres del campo y las ciudades, la clase media baja y los jubilados, así como los profesionales y técnicos. El sector privado cubre aproximadamente a 17.5 por ciento de la población perteneciente a los grupos sociales de mayores ingresos. Un pequeño sector de la población, perteneciente a la clase alta, realiza pagos directos de bolsillo a proveedores privados de servicios de atención a la salud. Alrededor de 10 por ciento de la población está cubierta por otras agencias públicas, fundamentalmente los Servicios de Salud de las Fuerzas Armadas. Recientemente el sistema se reformó creando el Régimen General de Garantías en Salud, que establece un Sistema Universal con Garantías Explícitas que se tradujo, en 2005, en el Plan de Acceso Universal con Garantías Explícitas (AUGE), que garantiza el acceso oportuno a servicios de calidad para 56 problemas de salud, incluyendo cáncer en niños, cáncer de mama, trastornos isquémicos del corazón, VIH/SIDA y diabetes.
This paper describes the Chilean health system, including its structure, financing, beneficiaries, and its physical, material and human resources. This system has two sectors, public and private. The public sector comprises all the organisms that constitute the National System of Health Services, which covers 70 percent of the population, including the rural and urban poor, the low middle-class, the retired, and the self-employed professionals and technicians.The private sector covers 17.5 percent of the population, mostly the upper middle-class and the high-income population. A small proportion of the population uses private health services and pays for them out-of-pocket. Around l0 percent of the population is covered by other public agencies, basically the Health Services for the Armed Forces. The system was recently reformed with the establishment of a Universal System of Explicit Entitlements, which operates through a Universal Plan of Explicit Entitlements (AUGE), which guarantees timely access to treatment for 56 health problems, including cancer in children, breast cancer, ischaemic heart disease, HIV/AIDS and diabetes.
Subject(s)
Delivery of Health Care/organization & administration , Health Services Administration , Chile , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se presenta una breve descripción de las condiciones de salud de Colombia y una descripción detallada del sistema colombiano de salud. Esta última incluye una descripción de su estructura y cobertura, sus fuentes de financiamiento, el gasto en salud, los recursos con los que cuenta, quién vigila y evalúa al sector salud y qué herramientas de participación tienen los usuarios. Dentro de las innovaciones más recientes del sistema se incluyen las modificaciones al Plan Obligatorio de Salud y a los montos de la unidad de pago por capitación, la integración vertical entre empresas promotoras de salud y las instituciones prestadoras de servicios, así como el establecimiento de nuevas fuentes de recursos para lograr la universalidad e igualar los planes de beneficios entre los distintos regímenes.
This document briefly describes the health conditions of the Colombian population and, in more detail, the characteristics of the Colombian health system. The description of the system includes its structure and coverage; financing sources; expenditure in health; physical material and human resources available; monitoring and evaluation procedures; and mechanisms through which the population participates in the evaluation of the system. Salient among the most recent innovations implemented in the Colombian health system are the modification of the Compulsory Health Plan and the capitation payment unit, the vertical integration of the health promotion enterprises and the institutions in charge of the provision of services and the mobilization of additional resources to meet the objectives of universal coverage and the homologation of health benefits among health regimes.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Colombia , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describe el sistema de salud de Costa Rica, que presta servicios de salud, agua y saneamiento. El componente de servicios de salud incluye un sector público y uno privado. El sector público está dominado por la Caja Costarricense de Seguro Social (CCSS), institución autónoma encargada del financiamiento, compra y prestación de la mayoría de los servicios personales. La CCSS se financia con contribuciones de los afiliados, los empleadores y el Estado, y administra tres regímenes: el seguro de enfermedad y maternidad, el seguro de invalidez, vejez y muerte, y el régimen no contributivo. La CCSS presta servicios en sus propias instalaciones o contrata prestadores del sector privado con los que establece contratos denominados "compromisos de gestión". El sector privado comprende una amplia red de prestadores que ofrecen servicios ambulatorios y de especialidad con fines lucrativos. Estos servicios se financian sobre todo con pagos de bolsillo, pero también con primas de seguros privados. El Ministerio de Salud es el rector del sistema y como tal cumple con funciones de dirección política, regulación sanitaria, direccionamiento de la investigación y desarrollo tecnológico. Dentro de las innovaciones relativamente recientes que se han implantado en Costa Rica destacan la implantación de los equipos básicos de atención integral de salud (EBAIS), la desconcentración de los hospitales y clínicas públicos, la introducción de los acuerdos de gestión y la creación de las Juntas de Salud.
This paper describes the Costa Rican health system which provides health, water and sanitation services. The health component of the system includes a public and a private sector. The public sector is dominated by the Caja Costarricense de Seguro Social (CCSS), an autonomous institution in charge of financing, purchasing and delivering most of the personal health services in Costa Rica. CCSS is financed with contributions of the affiliates, employers and the state, and manages three regimes: maternity and illness insurance, disability, old age and death insurance, and a non-contributive regime. CCSS provides services in its own facilities but also contracts with private providers. The private sector includes a broad set of services offering ambulatory and hospital care. These services are financed mostly out-of-pocket, but also with private insurance premiums. The Ministry of Health is the steward of the system, in charge of strategic planning, sanitary regulation, and research and technology development. Among the recent policy innovations we can mention the establishment of the basic teams for comprehensive health care (EBAIS), the de-concentration of hospitals and public clinics, the introduction of management agreements and the creation of the Health Boards.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Community Participation/statistics & numerical data , Costa Rica , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Sanitation/economics , Sanitation/statistics & numerical data , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describen las condiciones de salud de Cuba y el sistema cubano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, su gasto en salud, los recursos físicos, materiales y humanos de los que dispone, y las actividades de rectoría e investigación que desarrolla. También se discute la importancia de sus instituciones de investigación y se describe el papel de los usuarios de los servicios en la operación y evaluación del sistema, así como las actividades que en este sentido desarrollan la Federación de Mujeres Cubanas y los Comités de Defensa de la Revolución. La parte final de este trabajo se dedica a discutir las innovaciones más recientes dentro de las que destacan las redes de cardiología, la Misión Milagro y la Batalla de Ideas.
This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Community Participation/statistics & numerical data , Cuba , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Financing, Government/economics , Financing, Government/organization & administration , Financing, Government/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Organizational Innovation , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , State Medicine/economics , State Medicine/organization & administration , State Medicine/statistics & numerical data , Universal Health Insurance/economics , Universal Health Insurance/statistics & numerical data , Vital StatisticsABSTRACT
En este trabajo se describen las condiciones de salud en Ecuador y, con mayor detalle, las características del sistema ecuatoriano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, los recursos físicos, materiales y humanos de los que dispone, las tareas de rectoría que desarrolla el Ministerio de Salud Pública, la generación de información en salud, las tareas de investigación, y la participación de los ciudadanos en la operación y evaluación del sistema. También se discuten las innovaciones más recientes que se han implantado en el sistema ecuatoriano de salud dentro de las que destaca la incorporación de un capítulo específico sobre salud a la nueva Constitución que reconoce a la protección de la salud como un derecho humano y la construcción de la Red Pública Integral de Salud.
This paper describes the health conditions in Ecuador and, in more detail, the characteristics of the Ecuadorian health system, including its structure and coverage, its financial sources, the physical, material and human resources available, and the stewardship activities developed by the Ministry of Public Health. It also describes the structure and content of its health information system, and the participation of citizens in the operation and evaluation of the health system. The paper ends with a discussion of the most recent policy innovations implemented in the Ecuadorian system, including the incorporation of a chapter on health into the new Constitution which recognizes the protection of health as a human right, and the construction of the Comprehensive Public Health Network.
Subject(s)
Humans , Delivery of Health Care/organization & administration , Health Services Administration , Community Participation/statistics & numerical data , Delivery of Health Care/economics , Delivery of Health Care/statistics & numerical data , Demography , Ecuador , Financing, Organized/economics , Financing, Organized/organization & administration , Financing, Organized/statistics & numerical data , Government Programs/economics , Government Programs/organization & administration , Government Programs/statistics & numerical data , Health Expenditures/statistics & numerical data , Health Resources/organization & administration , Health Resources/statistics & numerical data , Health Resources/supply & distribution , Health Services Administration/economics , Health Services Administration/statistics & numerical data , Health Services/economics , Health Services/statistics & numerical data , Health Status Indicators , Human Rights/legislation & jurisprudence , Information Services/organization & administration , Insurance Benefits/economics , Insurance Benefits/statistics & numerical data , Insurance Coverage/economics , Insurance Coverage/statistics & numerical data , Insurance, Health/economics , Insurance, Health/organization & administration , Insurance, Health/statistics & numerical data , National Health Programs/economics , National Health Programs/organization & administration , National Health Programs/statistics & numerical data , Organizational Innovation , Private Sector/economics , Private Sector/organization & administration , Private Sector/statistics & numerical data , Quality Assurance, Health Care/organization & administration , Social Security/economics , Social Security/organization & administration , Social Security/statistics & numerical data , Vital StatisticsABSTRACT
En este artículo se describen las condiciones de salud de la población salvadoreña y, con mayor detalle, el sistema de salud de El Salvador, incluyendo su estructura y cobertura, sus fuentes de financiamiento, los recursos físicos, materiales y humanos con los que cuenta, las actividades de rectoría que desarrolla el Ministerio de Salud Pública y Asistencia Social, y la participación de los usuarios de los servicios de salud en la evaluación del sistema. Asimismo se discuten las más recientes innovaciones implantadas por el sistema salvadoreño de salud, dentro de las que destacan la aprobación de la Ley de Creación del Sistema Nacional de Salud que busca ampliar la cobertura, disminuir las desigualdades y mejorar la coordinación de las instituciones públicas de salud.
This paper describes the health conditions in El Salvador and the main característics of the Salvadoran health system, including its structure and coverage, its financial sources, the physical, material and human resources available, the stewardship functions developed by the Ministry of Public Health, and the participation of health care users in the evaluation of the system. It also discusses the most recent policy innovations including the approval of the Law for the Creation of the National Health System, which intends to expand coverage, reduce health inequalities and improve the coordination of public health institutions.