Divertículo cólico gigante: manifestación infrecuente de una enfermedad muy frecuente / Giant colic diverticulum: rare manifestation of a very common disease

: A rare complication of diverticulosis of the colon is a giant colonic diverticulum. The condition was first described in French literature in 1946 and English literature in 1953. We communicate four personal cases including diagnosis by different modalities, evolution and surgical treatment, photography of pathological specimens and X ray study of the resected giant diverticula and colonic segment. A short review of the related literature is included.

Una complicación infrecuente de la diverticulosis del colon es el divertículo cólico gigante. Esta patología fue descrita inicialmente en la literatura francesa en 1946 y en la inglesa en 1953. Comunicamos cuatro casos, incluyendo los diagnósticos mediante diferentes exámenes de imágenes, evolución y tratamiento quirúrgico con fotografías intraoperatorias y de las piezas resecadas, como también radiografías de los especímenes. Se incluye una revisión concisa de la literatura.

Equity in the financing of social security for health in Chile.

Real public health spending has more than doubled since 1990, raising concerns about the targeting of public subsidies. This study examined the degree of equity in the financing of FONASA, the public insurer, which in 1995 covered 8.6 million beneficiaries, or 62% of the country's population. Study results, covering calendar year 1995, indicated that (1) government health subsidies were well-targeted, with about 90% reaching the indigent and 8% going to other, low-income beneficiaries; (2) only 2.5% of government subsidies leaked to higher-income, non-beneficiaries of FONASA (people covered by private insurers known as ISAPRES, otherwise covered, or without any coverage); (3) overall, FONASA's contributing beneficiaries (i.e. the indigent aside) self-financed their health benefits, although higher-income beneficiaries were providing significant cross-subsidies to low-income ones, making the internal financing of FONASA somewhat progressive; (4) the indigent received the highest amount of annual net benefits per capita, followed by low-income beneficiaries; and (5) the evasion of FONASA's payroll tax was pervasive, although public providers delivered care on an equal basis irrespective of the patients' contributions to FONASA. FONASA's finances would improve significantly if affiliation to health social security by both dependent and independent workers was made compulsory.

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition.

This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality.

PIP: This paper summarizes results from eight country studies of inequality in the health sector. The analyses included household data to examine the distribution of service use and health expenditures. In each case, the results were presented by income quintiles, estimated using consumption expenditures. Results revealed that the rich groups have a higher probability of obtaining care when sick, to be more likely to be seen by physicians, and have a higher probability of receiving medicines, than the poor groups. The rich also spend more in absolute terms on care. There was no consistent pattern in the use of private providers. Wealthier households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicated that intuition concerning inequalities could result in misguided decisions. Thus, it would be worthwhile to measure the direction and extent of inequality in order to identify problems and to gauge the success of policy-making. Implications for further research are discussed.