Impact of a teaching hospital-based multidisciplinary telemedicine programme in Southwestern Colombia: a cross-sectional resource analysis.

BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.

Cost-effectiveness analysis of VECTOS software for the control of diseases transmitted by Aedes aegypti in two Colombian municipalities / [Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia].

Introduction: Diseases transmitted by Aedes aegypti are considered a public health problem. VECTOS is a novel software for the integration of vector control strategies. Objective: To assess the cost-effectiveness of the use of VECTOS in the routine control programs of diseases transmitted by A. aegypti in the municipality of San Juan de Girón (Santander). Materials and methods: We conducted a cost-effectiveness analysis using a decision analysis model from the perspective of the local health authorities. We considered the use of the VECTOS software in the routine control activities in the municipality of San Juan de Girón during 2016 as the treatment group while the routine control in the municipality of Floridablanca, where VECTOS is not implemented, was considered as the comparator. We calculated the incremental cost-effectiveness ratio (ICER) taking as effectiveness measure the disability-adjusted life years (DALY). Results: VECTOS was cost-effective at a rate of USD$ 660,4 savings per each DALY avoided compared to the routine control in Floridablanca. The probabilistic model showed that the system was cost-effective in 70% of the 10.000 iterations for a threshold between 1 to 3 GDP per capita. Conclusions: VECTOS software as implemented in the municipality of San Juan de Girón is highly cost-effective and could be used in other municipalities in the country where diseases transmitted by A. aegypti are endemic.

Introducción. Las enfermedades transmitidas por Aedes aegypti son un problema de salud pública. VECTOS es un programa novedoso de integración de estrategias de control de vectores. Objetivo. Evaluar el costo-efectividad del uso del VECTOS en los programas de control rutinario de enfermedades transmitidas por el vector Aedes aegypti en el municipio de San Juan de Girón (Santander). Materiales y métodos. Se evaluó el costo-efectividad del programa empleando un modelo de análisis de decisiones desde la perspectiva de las autoridades locales de salud. Se estudió la integración de las estrategias de control de vectores mediante el programa VECTOS utilizado en el municipio de San Juan de Girón durante el 2016, con el control rutinario llevado a cabo sin VECTOS en el municipio de Floridablanca. Se calculó la razón incremental del costo-efectividad (RICE), usando como medida de efectividad los años de vida ajustados por discapacidad (AVAD). Resultados. El uso del programa VECTOS fue rentable a una tasa de ahorro de USD$660,4 por cada AVAD evitado en comparación con el control de rutina en Floridablanca. El modelo probabilístico indicó que el sistema fue costo-efectivo en el 70 % de las 10.000 iteraciones para un umbral entre 1 y 3 PIB per cápita. Conclusiones. El programa VECTOS fue muy costo-efectivo en el municipio de San Juan de Girón. Su uso puede adoptarse en otros municipios del país donde las enfermedades transmitidas por A. aegypti son endémicas.

Análisis de costo-efectividad del uso del programa VECTOS en el control rutinario de enfermedades transmitidas por Aedes aegypti en dos municipios de Santander, Colombia / Cost-effectiveness analysis of VECTOS software for the control of diseases transmitted by Aedes aegypti in two Colombian municipalities

Introducción. Las enfermedades transmitidas por Aedes aegypti son un problema de salud pública. VECTOS es un programa novedoso de integración de estrategias de control de vectores. Objetivo. Evaluar el costo-efectividad del uso del VECTOS en los programas de control rutinario de enfermedades transmitidas por el vector Aedes aegypti en el municipio de San Juan de Girón (Santander). Materiales y métodos. Se evaluó el costo-efectividad del programa empleando un modelo de análisis de decisiones desde la perspectiva de las autoridades locales de salud. Se estudió la integración de las estrategias de control de vectores mediante el programa VECTOS utilizado en el municipio de San Juan de Girón durante el 2016, con el control rutinario llevado a cabo sin VECTOS en el municipio de Floridablanca. Se calculó la razón incremental del costo-efectividad (RICE), usando como medida de efectividad los años de vida ajustados por discapacidad (AVAD). Resultados. El uso del programa VECTOS fue rentable a una tasa de ahorro de USD$ 660,4 por cada AVAD evitado en comparación con el control de rutina en Floridablanca. El modelo probabilístico indicó que el sistema fue costo-efectivo en el 70 % de las 10.000 iteraciones para un umbral entre 1 y 3 PIB per cápita. Conclusiones. El programa VECTOS fue muy costo-efectivo en el municipio de San Juan de Girón. Su uso puede adoptarse en otros municipios del país donde las enfermedades transmitidas por A. aegypti son endémicas.

Introduction: Diseases transmitted by Aedes aegypti are considered a public health problem. VECTOS is a novel software for the integration of vector control strategies. Objective: To assess the cost-effectiveness of the use of VECTOS in the routine control programs of diseases transmitted by A. aegypti in the municipality of San Juan de Girón (Santander). Materials and methods: We conducted a cost-effectiveness analysis using a decision analysis model from the perspective of the local health authorities. We considered the use of the VECTOS software in the routine control activities in the municipality of San Juan de Girón during 2016 as the treatment group while the routine control in the municipality of Floridablanca, where VECTOS is not implemented, was considered as the comparator. We calculated the incremental cost-effectiveness ratio (ICER) taking as effectiveness measure the disability-adjusted life years (DALY). Results: VECTOS was cost-effective at a rate of USD$ 660,4 savings per each DALY avoided compared to the routine control in Floridablanca. The probabilistic model showed that the system was cost-effective in 70% of the 10.000 iterations for a threshold between 1 to 3 GDP per capita. Conclusions: VECTOS software as implemented in the municipality of San Juan de Girón is highly cost-effective and could be used in other municipalities in the country where diseases transmitted by A. aegypti are endemic.

Costs of health care in the last-year-of-life in Colombia: Evidence from two contributive regime health plans / Gasto en el último año de vida en Colombia: evidencia proveniente de aseguradores del régimen contributivo

Abstract Introduction: In USA, each year 5% of Medicare beneficiaries die, accounting for 25% of total Medicare health spending. Currently there are no studies addressing this issue in Latin American countries. Objective: To estimate how much money do health care plans spend, in comparison with their total health spending, in the provision of health care to people in their last-year-of-life in Colombia. Materials and methods: Based on claims data from two health plans with approximately 3.7 million people enrolled in the Colombian health system contributory regime, health care costs associated with patients in their last-year-of-life from 2011 to 2013 were estimated by using the decedent-survivor allocation method. Results: Last-year-of-life health expenditure in people aged 65 and above accounted for 18% of total spending. The decedent-survivor ratio in this group age was 4.7. Last-year-of-life health spending in all age ranges was 6.2% while the decedent-survivor ratio was 15.1. Conclusions: With the exception of USA, findings reported here suggest that last-year-of-life health care costs in Colombia are higher than those reported in other countries in the case of the elderly. Therefore, policymakers and health plans should work in strategies promoting palliative care programs in order to reduce these costs.

Resumen Introducción. En EE. UU., el 5% de los beneficiarios del seguro Medicare mueren cada año y dan cuenta del 25% del gasto del seguro anual. No existen estudios al respecto para países latinoamericanos. Objetivo. Estimar la proporción de recursos que destina un asegurador, en comparación con sus gastos totales, a personas que están en su último año de vida en Colombia. Materiales y métodos. Usando los datos de facturación de dos entidades promotoras de salud del régimen contributivo con más de 3.7 millones de afiliados, se estimó el gasto en el último año de vida de sus afiliados con el método de asignación de gastos a fallecidos y sobrevivientes. Resultados. El gasto en el último año de vida para población >65 años correspondió al 18% con una razón de gasto entre fallecidos y sobrevivientes de 4.7. Para todas las edades el gasto en el último año de vida fue 6.2% y la razón de gasto entre fallecidos y sobrevivientes fue de 15.1. Conclusiones. En comparación con otros países, a excepción de EE. UU., el gasto en el último año de vida en Colombia para los adultos mayores es superior. Los hacedores de política y los gerentes de aseguradoras deben prestar mayor atención a incentivar programas de cuidado paliativo.

Barrier to Access or Cost Share? Coinsurance and Dental-Care Utilization in Colombia.

BACKGROUND: Copayments, deductibles, and coinsurance, are elements of health-care systems to make prices salient for the insured. Individuals may respond differently to cost sharing, according to the type of care they seek; dental care, as a combination of both acute and elective care, is an ideal setting to study the effects of cost-sharing mechanisms on utilization. OBJECTIVE: To test how coinsurance affects dental-care utilization in a middle-income country context. METHODS: This study uses policy variations in the Colombian health-care system to analyze changes in dental-care utilization due to different levels of coinsurance. We used matching procedures to balance observed differences in pre-treatment variables between those who face coinsurance (non-policy holders, or beneficiaries) and those who don't (policyholders). We use zero-inflated negative binomial models for the count of visits and two-part models for total expenditures, and test for unobservable confounders with random-effect models and instrumental variables. RESULTS: Individuals who face coinsurance are less likely to have any dental-care utilization, at a relatively small scale. Facing coinsurance does not correlate with changes in total expenditures. Falsification tests with dental-care visits exempt from coinsurance show no statistically distinguishable changes in utilization. Random-effect models and instrumental variable models show results similar to the main specification. CONCLUSIONS: Cost-sharing policies in Colombia seem to be well designed because they don't represent an important barrier to dental-care access.