[Cost-effectiveness analysis of nuclear cardiology and its impact on total expense for diagnosis of coronary artery disease]. / Costo-efectividad de los estudios de gamagrafía miocárdica e impacto al gasto total por diagnóstico de cardiopatía isquémica.

BACKGROUND: Medical care in a hospital under a socialized medicine system should be highly effective at the lowest expense possible. When myocardial perfusion studies are performed in well-selected patients, the costs decrease because of the need for fewer invasive studies. When patients are not selected properly, there is an increase-wasted resource, making it necessary to perform cost-effective studies. The goal of this study is to evaluate the economical impact of the diagnostic process in patients suspected of having coronary artery disease, referred to our service (Nuclear Medicine, Hospital de Cardiología CMN, IMSS) in 2002. METHODS: We analyzed 1966 reports of myocardial gammagrams. Patient reports were stratified according to their referring unit. The sum of the unitary fixed cost was converted to the unitary cost for each reason for referral. Kappa was used to evaluate concordance. RESULTS: Patients were 62 +/- 11.39 years old, 52% male. Concordance between the referring diagnosis and the myocardial gammagram was <1% (p <0.001). The cost of cardiac gammagrams varied between $2,613.11 and $3,306.77 (Mexican pesos). Waste was calculated at 30%, which represented $1.8 million (Mexican pesos). CONCLUSIONS: Cost-effective studies are important tools in the administration of resources. In this particular case the results indicate the necessity for systematic registration of financial information, periodic review of operation costs by service, and criteria for use of high-cost services.

La asistencia materno infantil, como instrumento básico de la atención médica a las poblaciones en desarrollo / Maternal-child asistance as basic-instrument of the medical care for developing populations

Los motivos de consulta de atención hospitalaria y defunción en la población del Instituto Mexicano del Seguro Social, demuestran la importancia de la patología perinatal y, como consecuencia, la demanda de atención materno infantil, que tiene que organizarse dentro del conjunto de acciones médicas, las cuales se basan en el concepto de riesgo, la participación del personal paramédico, la supervisión y evaluación, a fin de conseguir la atención integral que sea de mayor utilidad social