The cost of postabortion care and legal abortion in Colombia.

CONTEXT: Although Colombia partially liberalized its abortion law in 2006, many abortions continue to occur outside the law and result in complications. Assessing the costs to the health care system of safe, legal abortions and of treating complications of unsafe, illegal abortions has important policy implications. METHODS: The Post-Abortion Care Costing Methodology was used to produce estimates of direct and indirect costs of postabortion care and direct costs of legal abortions in Colombia. Data on estimated costs were obtained through structured interviews with key informants at a randomly selected sample of facilities that provide abortion-related care, including 25 public and private secondary and tertiary facilities and five primary-level private facilities that provide specialized reproductive health services. RESULTS: The median direct cost of treating a woman with abortion complications ranged from $44 to $141 (in U.S. dollars), representing an annual direct cost to the health system of about $14 million per year. A legal abortion at a secondary or tertiary facility was costly (medians, $213 and $189, respectively), in part because of the use of dilation and curettage, as well as because of administrative barriers. At specialized facilities, where manual vacuum aspiration and medication abortion are used, the median cost of provision was much lower ($45). CONCLUSIONS: Provision of postabortion care and legal abortion services at higher-level facilities results in unnecessarily high health care costs. These costs can be reduced significantly by providing services in a timely fashion at primary-level facilities and by using safe, noninvasive and less costly abortion methods.

Breast cancer in Mexico: a growing challenge to health and the health system.

Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.

[Haitian women living with HIV/AIDS in Guadeloupe: pregnancy between medical stakes, social benefits and administrative vulnerability. A qualitative study]. / Les femmes Haïtiennes vivant avec le VIH en Guadeloupe: la grossesse entre enjeux mérablité administrative. Une étude qualitative.

Guadeloupe (French West Indies) is a part of French departments which has the large number of persons living with HIV/AIDS. A large part of them consists of foreign women, mainly native of Haiti. This article is based on an anthropological study conducted in 2009 among professionals of health, social and associative sectors taking care of persons living with HIV in Guadeloupe, and among 10 infected women, 6 of them are native of Haiti. Semi-directive and individual qualitative interviews were conducted with each of these persons. During their course of illness and migration, many women experienced one or several pregnancies. The analysis of their discourses and trajectories underlines the articulation of the multiple stakes − medical, social, political, emotional stakes − with which they are confronted.

A multidisciplinary approach to improving women's health in semi-urban Ecuador.

OBJECTIVE: To examine women's reasons for seeking care at The Quito Project (TQP), a student-led organization that aims to improve the health, education, and well-being of a semi-urban community in Quito, Ecuador, and to explore the need for additional preventative interventions. METHODS: An oral survey was administered to 86 adult patients in 2008. We also completed a chart review to evaluate patient demographics and medical conditions. RESULTS: Sixty-three (73.3%) survey respondents were female. Nearly three-quarters of the women reported an income below the minimum wage; 60% reported that the cost of medical care posed a burden. Fifty-two percent sought care at TQP because the services were free. Additionally, 77% of women reported going to the doctor only when ill and did not access preventative services. CONCLUSIONS: By offering medical, dental, and tutoring services, along with preventative health workshops, TQP addresses established barriers to achieving adequate women's health. Survey results have reinforced TQP's focus on prevention.

Reproductive health surveillance in the US-Mexico border region, 2003-2006: the Brownsville-Matamoros Sister City Project for Women's Health.

INTRODUCTION: High birth and immigration rates in the US-Mexico border region have led to large population increases in recent decades. Two national, 10 state, and more than 100 local government entities deliver reproductive health services to the region's 14 million residents. Limited standardized information about health risks in this population hampers capacity to address local needs and assess effectiveness of public health programs. METHODS: We worked with binational partners to develop a system for reproductive health surveillance in the sister communities of Matamoros, Tamaulipas, Mexico, and Cameron County, Texas, as a model for a broader regional approach. We used a stratified, systematic cluster-sampling design to sample women giving birth in hospitals in each community during an 81-day period (August 21-November 9) in 2005. We conducted in-hospital computer-assisted personal interviews that addressed prenatal, behavioral, and lifestyle factors. We evaluated survey response rates, data quality, and other attributes of effective surveillance systems. We estimated population coverage using vital records data. RESULTS: Among the 999 women sampled, 947 (95%) completed interviews, and the item nonresponse rate was low. The study sample included 92.7% of live births in Matamoros and 98.3% in Cameron County. Differences between percentage distributions of birth certificate characteristics in the study and target populations did not exceed 2.0. Study population coverage among hospitals ranged from 92.9% to 100.0%, averaging 97.3% in Matamoros and 97.4% in Cameron County. CONCLUSION: Results indicate that hospital-based sampling and postpartum interviewing constitute an effective approach to reproductive health surveillance. Such a system can yield valuable information for public health programs serving the growing US-Mexico border population.

Care needs of pregnant women with a private health insurance: a comprehensive social phenomenology approach.

This study aimed to understand the meanings women who possess health plans hold regarding pregnancy and get to know their care needs in this phase of the vital cycle. It was based on the qualitative research of phenomenological inspiration. The discourses analysis was based on the sociologist and fenomenologist Alfred Schutz's thought. Having health plans and being attended in private institutions were defined as inclusion criteria. The following categories emerged from the discourses: having new responsibilities; experiencing a special situation; experiencing insecurity, anxiety and expectations; feeling limited; trusting the health professional. It was found, through the analysis of categories, that the experience of the pregnant women who participated in the study is similar to those who do not possess health plans. However, in the category "trusting the health professional" it was possible to perceive the importance of possessing health plan, which allows the intersubjectivity between the woman and the health professional.

Care needs of pregnant women with a private health insurance: a comprehensive social phenomenology approach / Necesidades de cuidado de mujeres embarazadas que poseen seguro de salud: una aproximación comprensiva de la fenomenología social / Necessidades de cuidado das mulheres grávidas que possuem convênio saúde: abordagem compreensiva da fenomenologia social

This study aimed to understand the meanings women who possess health plans hold regarding pregnancy and get to know their care needs in this phase of the vital cycle. It was based on the qualitative research of phenomenological inspiration. The discourses analysis was based on the sociologist and fenomenologist Alfred Schutz's thought. Having health plans and being attended in private institutions were defined as inclusion criteria. The following categories emerged from the discourses: having new responsibilities; experiencing a special situation; experiencing insecurity, anxiety and expectations; feeling limited; trusting the health professional. It was found, through the analysis of categories, that the experience of the pregnant women who participated in the study is similar to those who do not possess health plans. However, in the category "trusting the health professional" it was possible to perceive the importance of possessing health plan, which allows the intersubjectivity between the woman and the health professional.

Este estudio tiene como objetivo comprender los significados que las mujeres que poseen seguro de salud atribuyen al embarazo y conocer sus necesidades de cuidado en esta fase del ciclo vital. El estudio fue fundamentado en la investigación cualitativa de inspiración fenomenológica. El pensamiento del sociólogo y fenomenólogo Alfred Schutz condujo el análisis de los discursos. Como criterio de inclusión, se definió que los individuos deberían ser atendidos en instituciones privadas y poseer seguro de salud. De las declaraciones surgieram las categorías: teniendo nuevas responsabilidades; vivenciando una situación especial; vivenciando inseguridad, ansiedad y expectativas; sintiéndose limitadas; confiando en el profesional de salud. Por medio del análisis de las categorías, fue constatado que la vivencia de las mujeres embarazadas que participaron de este estudio se mostró de forma similar a la de las mujeres que no poseen seguro de salud. Sin embargo, en la categoría "confiando en el profesional de salud", fue posible percibir la importancia de poseer plano de salud, hecho que posibilita la intersubjetividad entre la mujer y el profesional de salud.

Este estudo objetivou compreender os significados que as mulheres que possuem convênio saúde têm da gravidez e conhecer quais as necessidades de cuidado das mulheres nessa fase do ciclo vital. Fundamentou-se na pesquisa qualitativa de inspiração fenomenológica. O pensamento do sociólogo e fenomenólogo Alfred Schutz conduziu a análise das falas. Como critério de inclusão, definiu-se que os sujeitos deveriam ser atendidos em instituições privadas e possuir convênio saúde. Dos depoimentos emergiram as categorias: tendo novas responsabilidades; vivenciando uma situação especial; vivenciando insegurança, ansiedade e expectativas; sentindo-se limitada; confiando no profissional de saúde. Por meio da análise das categorias, constatou-se que a vivência das mulheres grávidas que participaram deste estudo mostrou-se de forma similar à daquelas mulheres grávidas que não possuem convênio saúde. No entanto, na categoria "confiando no profissional de saúde" foi possível perceber a importância de possuir convênio saúde, fato que possibilita a intersubjetividade entre a mulher e o profissional de saúde.

Estimativa de custo do rastreamento mamográfico em mulheres no climatério / Cost estimate of mammographic screening in climacteric women

OBJETIVOS: analisar os custos de um ciclo de rastreamento mamográfico do câncer de mama em população de 1014 mulheres no climatério e comparar com os custos do tratamento do câncer da mama em estádios mais avançados. MÉTODOS: realizou-se rastreamento em 1014 mulheres atendidas em ambulatório de Climatério. Todas as mamografias foram classificadas de acordo com as categorias do BI-RADSã (Breast Imaging Reporting and Data System American College of Radiology) e as lesões detectadas foram submetidas a estudo citológico ou histológico. A estimativa dos custos dos exames e procedimentos realizados foram obtidos da Tabela AMB 92. RESULTADOS: a impressão diagnóstica final dos 1014 exames, de acordo com a classificação em categorias do BI-RADSã, foi: 1=261; 2=671; 3=59; 4=22; 5=1. Os procedimentos invasivos realizados totalizaram 33 punções com agulha fina dirigida por USG, 6 biópsias com agulha grossa orientada por USG e 20 biópsias orientadas por mamografia (estereotaxia). Com base nos valores da tabela AMB 92, foram necessários para rastrear e diagnosticar essa população cerca de R$ 76.000,00. Detectaram-se 5 cânceres de mama, ao custo aproximado de R$ 15.318,75 por diagnóstico e média de custo por paciente de R$ 75,53. CONCLUSÕES: considerando que o custo total do tratamento de um único caso de câncer de mama em estádio II ou mais pode atingir R$ 75.000,00, concluímos que os programas de rastreamento mamográfico podem ser incluídos entre as políticas de saúde

Comprehensive health care for women in a public hospital in São Paulo, Brazil.

This paper describes a model of integrated reproductive health care services for women at the primary health care level, put into practice at the Pérola Byington Hospital, São Paulo, Brazil, from 1991 to 1998. Some 2,000 women from poor social strata, whose health condition was poor, were being seen every day in the last two years of the programme, including new consultations and women with a previous attendance returning. Women were attended first by nurse-assistants, who had been trained to screen for the most frequent gynaecological problems, and then a physician. Because doctors spent less time with each patient, four times as many women could be seen. Programmes were set up for the diagnosis and treatment of gynaecological cancers, STDs, HIV/AIDS, hypertension and other degenerative disorders such as diabetes. Screening and treatment programmes for cervical and breast cancer achieved significant improvements in the stage at which a diagnosis was made, allowing more lives to be saved. This model also succeeded in decreasing the costs for these health services per woman seen.

El cuidado de la salud de la mujer y la atención médica gerenciada / Women's health care and managed care

El objetivo del presente trabajo es destacar la importancia que en la actualidad presenta el cuidado de la salud de la mujer en los Estados Unidos. En función de esto se discute el creciente rol que desempeñan los médicos de atención primaria y los sistemas de managed care en este aspecto. Después de comparar los diferentes estados evolutivos de la atención médica gerenciada en Argentina y en los Estados Unidos los autores realizan recomendaciones tendientes a impulsar la introducción, en la Argentina, de técnicas propias del gerenciamiento de la atención médica principalmente en los aspectos concernientes a la salud de las mujeres

El cuidado de la salud de la mujer y la atención médica gerenciada / Womens health care and managed care

El objetivo del presente trabajo es destacar la importancia que en la actualidad presenta el cuidado de la salud de la mujer en los Estados Unidos. En función de esto se discute el creciente rol que desempeñan los médicos de atención primaria y los sistemas de managed care en este aspecto. Después de comparar los diferentes estados evolutivos de la atención médica gerenciada en Argentina y en los Estados Unidos los autores realizan recomendaciones tendientes a impulsar la introducción, en la Argentina, de técnicas propias del gerenciamiento de la atención médica principalmente en los aspectos concernientes a la salud de las mujeres (AU)

Measuring public hospital costs: empirical evidence from the Dominican Republic.

Effective analysis of hospital performance requires the existence of accurate cost and output data. However, these are missing ingredients in most developing countries due to lack of information systems or other sources of data. Typically, expenditures are substituted for actual costs in analyzing hospital finance. This paper presents a methodology and analysis of the actual costs of inpatient, emergency, and outpatient services in a Dominican hospital. Through applying a set of survey instruments to a large sample of patients, the study measures and costs all hospital staff time, in-kind goods (drugs, medical supplies, reagents, etc.), overhead, and the depreciated value of plant and equipment related to the treatment of each patient. The results are striking. The budget is over 50% higher than the actual costs of services, reflecting the high cost of waste, down time, and low productivity. For example, high fixed costs translate into immunizations that on the average cost over 20% more than outpatient surgical interventions. The most disturbing finding is that although physicians represent the bulk of personnel spending, the surveys could account for only 12% of the contracted time of staff physicians, including time dedicated to treatment, supervision, administration, and teaching. As a proportion of the hospital total budget, personnel spending represents a high 84%. Yet staff costs for patient treatment never exceed 12%. These results suggest gross inefficiency, chaotic medical care organization, and poor hospital management.