The health, environmental, and economic dimensions of future dietary transitions in Argentina.

Diets link human health with environmental sustainability, offering promising pressure points to enhance the sustainability of food systems. We investigated the health, environmental, and economic dimensions of the current diet in Argentina and the possible effects of six dietary change scenarios on nutrient adequacy, dietary quality, food expenditure, and six environmental impact categories (i.e., GHG emissions, total land occupation, cropland use, fossil energy use, freshwater consumption, and the emission of eutrophying pollutants). Current dietary patterns are unhealthy, unsustainable, and relatively expensive, and all things being equal, an increase in income levels would not alter the health dimension, but increase environmental impacts by 33-38%, and costs by 38%. Compared to the prevailing diet, the six healthier diet alternatives could improve health with an expenditure between + 27% (National Dietary Guidelines) to -5% (vegan diet) of the current diet. These dietary changes could result in trade-offs between different environmental impacts. Plant-based diets showed the lowest overall environmental impact, with GHG emissions and land occupation reduced by up to 79% and 88%, respectively, without significant changes in cropland demand. However, fossil energy use and freshwater consumption could increase by up to 101% and 220%, respectively. The emission of eutrophying pollutants could increase by up to 54% for all healthy diet scenarios, except for the vegan one (18% decrease). We conclude that the health and environmental crisis that Argentina (and other developing countries) currently face could be mitigated by adopting healthy diets (particularly plant-based), bringing in the process benefits to both people and nature. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11625-021-01087-7.

[Engel's coefficient and dietary quality in Argentine households inhabited by older adults (2004-2018)]. / Coeficiente de Engel y calidad dietaria en hogares argentinos habitados por adultos mayores (2004-2018).

BACKGROUND AND OBJECTIVES: To determine if there were alterations in the proportion of spending that Argentine households of older adults spend on the purchase of food (Engel's coefficient) and other goods and services, as well as to evaluate the dietary quality of the members of these households. MATERIALS AND METHODS: From the last three waves of the National Household Expenditure Survey (2004-2005, 2012-2013 and 2017-2018) those households in the province of Buenos Aires inhabited by older adults are filtered and carried out. Median difference tests for the proportion of spending these households spend on food and other goods and services. In turn, the per capita quantities acquired from 17 food groups are compared with the quantities recommended in the dietary guidelines for the Argentine population. RESULTS: A statistically significant reduction is found in the median of the proportion of spending that older adults in the province of Buenos Aires spend on the purchase of food, in combination with a statistically significant increase in the proportion of spending directed to equipment and operation home, education and various services. However, the amounts purchased of milk and yogurt and vegetables A and B are insufficient in relation to those recommended, while the consumption of meat is excessive. CONCLUSIONS: Although economic theory would interpret a reduction in the Engel coefficient as an indication of improved well-being, it should be taken into account that these households might not be following an optimal diet if they consumed the amounts of food that they claim to buy.

Descomposición de la inequidad en la distribución de dependencias funcionales entre adultos mayores de Argentina / Decomposition of Inequity in the Distribution of Functional Dependences in Older Adults from Argentina

Introducción: El envejecimiento poblacional trae aparejado un incremento de individuos en situación de dependencia funcional, que se entiende como la necesidad de asistencia para realizar las actividades de la vida diaria. Objetivo: Evaluar si existe inequidad en la distribución de la dependencia funcional entre adultos mayores de Argentina y cuáles son los factores que mayormente la explican. Métodos: Con datos de la Encuesta Nacional sobre Calidad de Vida de los Adultos Mayores para el año 2012 se llevaron a cabo los siguientes pasos: i) cómputo del índice de concentración corregido para variables asociadas a la dependencia funcional y explicativas de la inequidad en su distribución mediante la transformación de Erreygers y ii) descomposición de la inequidad en la distribución de dependencias básicas y ampliadas, siguiendo la metodología propuesta por Wagstaff. Resultados: La distribución de todas las dependencias funcionales (tanto básicas como ampliadas) es propobre. El ingreso per cápita, el hecho de presentar algún tipo de deficiencia visual o auditiva y vivir en hogares unipersonales son las variables explicativas que más contribuyen a incrementar la inequidad en la distribución de las dependencias funcionales básicas o ampliadas. Conclusiones: Los resultados que se desprenden de este estudio constituyen un insumo importante a la hora de procurar programas de asistencia a los adultos mayores que permitan evitar consecuencias negativas a futuro sobre su salud (y disminuir los gastos del sistema de salud en su conjunto). Estas acciones deben estar enfocadas específicamente en los adultos mayores de bajo nivel socioeconómico y que viven solos(AU)

Introduction: Population aging brings about an increase in the number of individuals in situations of functional dependence, which is understood as the need for assistance to carry out daily life activities. Objective: To assess whether there is inequity in the distribution of functional dependence among older adults in Argentina and what are the fundamental causative factors. Methods: With data from the 2012 National Survey on Quality of Life of Older Adults, the following steps were carried out: i) calculation of corrected concentration index for variables associated with functional dependence and explanatory of distributed inequity, using Erreygers transformation and ii) decomposition of inequality in the distribution of basic and extended dependences, following the methodology proposed by Wagstaff. Results: The distribution of all functional dependencies (both basic and extended) is poor. Per capita income, the fact of having any type of visual or hearing impairment, and living in one-person households are the explanatory variables that most contribute to increasing inequality regarding the distribution of basic or extended functional dependencies. Conclusions: The results derived from this study are an important input when it comes to ensuring assistance programs for older adults that make it possible to avoid negative consequences on their health in the future; as well as reduce expenses to the health system as a whole). These actions should be focused specifically on older adults of low socioeconomic status and who live alone(AU)

Quality and environmental footprints of diets by socio-economic status in Argentina.

Food consumption and production plays a major role on human health and environmental sustainability. In addition, socio-economic status (SES) could be an important determinant on these impacts. Here we investigated the quality and environmental footprints of diets of different SES in Argentina. Dietary data was obtained from a recent national-wide representative survey (21,547 households), and individual intake was estimated by applying the Adult-Male Equivalent (AME) approach. Dietary quality was assessed by comparing the apparent consumption of foods and nutrients with the level of intake associated with the lowest risk of mortality, and applying the Alternate Healthy Eating Index 2010 (AHEI-2010). The environmental footprints were assessed with a set of six environmental indicators: greenhouse gas (GHG) emissions, total land occupation, cropland demand, fossil energy use, freshwater consumption and eutrophying emissions. Per capita total expenditure was utilized as an indicator of SES. We found a suboptimal intake of healthy and excess of unhealthy foods and nutrients in all SES, as well as a low AHEI-2010 score (34.7 ± 3.56 over 100). Regarding environmental footprints per AME, we estimated 8.91 ± 2.49 kg CO2-eq/day for GHG emissions, 9.30 ± 2.93 MJ/day for fossil energy use, 54.2 ± 14.8 m2/day for total land occupation, 7.07 ± 1.90 m2/day for cropland demand, 205 ± 65.3 L/day for freshwater consumption and 19.8 ± 6.43 g PO4-eq/day for eutrophying emissions. The Argentinian diet was found to be both unhealthy and unsustainable in all socio-economic levels.

Inequidad en el consumo de gaseosas en Argentina: análisis en base a los datos de las Encuestas Nacionales de Gastos de los Hogares (ENGHo) de los años 1996-1997, 2004-2005 y 2012-2013 / Inequity in consumption of carbonated beverage in Argentina: analysis based on data from the National Household Expenditure Surveys (ENGHo) (1996-2013)

FUNDAMENTOS: El consumo de gaseosas se asocia positivamente al padecimiento de enfermedades cardiovasculares. Dicho consumo difiere entre países de distinto nivel de ingreso y entre individuos de distinto nivel socioeconómico. A pesar de gravar el consumo de estas bebidas, Argentina se ubica entre lospaíses de mayor consumo de gaseosa per cápita, lo que motiva estudiar su distribución según región y nivel socioeconómico. MÉTODOS: A partir de 3 encuestas nacionales de gastos de los hogares (1996-2013) se efectúan pruebas de diferencia de medias (test de Welch y Games-Howell al 5%) entre 12 sub-regiones del país y entre deciles de gasto per cápita para el consumo mensual de gaseosa por adulto equivalente. Asimismo, se verifica la presencia de inequidad a partir del cómputo del índice de concentración de Wagstaff. RESULTADOS: Entre las provincias que conforman el noroeste argentino no se encuentran diferencias significativas en el consumo, pero sí entre ellas y las que conforman la Patagonia. Valores positivos del índice de concentración indican que no existe inequidad en el consumo de gaseosas. CONCLUSIONES: Si bien no se verificó inequidad en el consumo en ningún período, la evolución decreciente del índice de concentración indicaría un aumento del consumo entre hogares más pobres

BACKGROUND: Carbonated beverage consumption is positively associated with cardiovascular disease. Such consumption differs between countries of different income levels and between individuals of different socioeconomic levels. Despite taxing the consumption of these drinks, Argentina is among the countries with the highest consumption of soda per capita, which motivates studying its distribution according to region and socioeconomic level. METHODS: From 3 national surveys of household expenditures (1996-2013), mean difference tests (Welch and Games-Howell test at 5%) are carried out between 12 sub-regions of the country and between deciles of per capita spending for the monthly consumption of soda per equivalent adult. Likewise, the presence of inequity is checked from the computation of the Wagstaff concentration index. RESULTS: Among the provinces that are part of the Argentine northwest, there are no significant differences in consumption, but there are differences between them and those that are part of Patagonia. Positive values of the concentration index indicate that there is no inequity in the consumption of carbonated beverage. CONCLUSIONS: Although there was no inequity in consumption in any period, the decreasing evolution of the concentration index would indicate an increase in consumption among poorer households

Incubation period and serial interval of Covid-19 in a chain of infections in Bahia Blanca (Argentina). / Período de incubación e intervalo serial para COVID-19 en una cadena de transmisión en Bahia Blanca (Argentina).

The objective of this work was to estimate the incubation period and the serial interval of Covid-19 from a sample of symptomatic patients in Bahia Blanca city during the period March-May 2020. We collected dates of illness onset for primary cases and secondary cases for the first 18 secondary patients infected with SARS-Cov-2. Estimations of incubation period are based on a log-normal distribution while we assume a Gamma distribution for the serial interval. In both cases maximum likelihood estimator was applied to estimate main parameters. Of the total of 18 cases of local transmission analyzed, 17% occurred in the presymptomatic and asymptomatic phase. The mean incubation period for symptomatic patients is 7.9 days (95%CI: 4.6, 11.1) considering the full sample and 7.5 days (95%CI: 4.1, 10.9) if the sample is restricted to the most certain cases. The median is 6.1 and 5.8 days respectively. The point estimation for the mean serial interval is 6.8 days (95%CI: 4.0-9.6). or 5.5 days (95%CI: 2.8, 8.1) for most certain pairs. The estimated median serial intervals were 5.2 and 4.1 days respectively. Comparisons with foreign estimates show that incubation period and serial interval could be longer in Bahia Blanca city than in other regions. Transmission from pre-symptomatic and asymptomatic is not negligible.

Período de incubación e intervalo serial para COVID-19 en una cadena de transmisión en Bahia Blanca (Argentina) / Incubation period and serial interval of Covid-19 in a chain of infections in Bahia Blanca (Argentina)

Resumen El objetivo de este trabajo es estimar el período de incubación y el intervalo serial de Covid-19 en una muestra de pacientes sintomáticos en la ciudad de Bahía Blanca durante marzo-mayo de 2020. Se registraron fechas de aparición de síntomas de casos primarios y secundarios y para los primeros 18 casos de transmisión local de SARS-Cov2 en Bahía Blanca (Argentina). La duración de la aparición de síntomas fue estimada suponiendo una distribución log normal. Para el intervalo serial se supuso una distribución gamma. Los parámetros fueron estimados por máxima verosimilitud. Del total de 18 casos de transmisión local analizados, 17% ocurrió en fase presintomática y asintomática. El período de incubación promedio es de 7.9 días (95% IC 4.6, 11.1) y de 7.5 días (95% IC 4.1, 10.9) si se toman los casos con mayor certidumbre sobre infectores y fechas de exposición. La mediana es 6.1 y 5.8 días respectivamente. La estimación puntual del intervalo serial es 6.8 días (95% IC: 4.0-9.6) y 5.5 días (95% IC: 2.8, 8.1) considerando solo los pares más fiables. La mediana del intervalo serial se ubica en 5.2 y 4.1 días respectivamente. La incubación y el intervalo serial podrían ser algo más largos en Bahía Blanca que en otras ciudades. La transmisión de asintomáticos y de pre-sintomáticos no es despreciable.

Abstract The objective of this work was to estimate the incubation period and the serial interval of Covid-19 from a sample of symptomatic patients in Bahia Blanca city during the period March-May 2020. We collected dates of illness onset for primary cases and secondary cases for the first 18 secondary patients infected with SARS-Cov-2. Estimations of incubation period are based on a log-normal distribution while we assume a Gamma distribution for the serial interval. In both cases maximum likelihood estimator was applied to estimate main parameters. Of the total of 18 cases of local transmission analyzed, 17% occurred in the presymptomatic and asymptomatic phase. The mean incubation period for symptomatic patients is 7.9 days (95%CI: 4.6, 11.1) considering the full sample and 7.5 days (95%CI: 4.1, 10.9) if the sample is restricted to the most certain cases. The median is 6.1 and 5.8 days respectively. The point estimation for the mean serial interval is 6.8 days (95%CI: 4.0-9.6). or 5.5 days (95%CI: 2.8, 8.1) for most certain pairs. The estimated median serial intervals were 5.2 and 4.1 days respectively. Comparisons with foreign estimates show that incubation period and serial interval could be longer in Bahia Blanca city than in other regions. Transmission from pre-symptomatic and asymptomatic is not negligible.

Patrones alimentarios de adultos mayores en una región argentina y su relación con factores socioeconómicos / Dietary patterns of older adults in an Argentine region and their relationship with socioeconomic factors

RESUMEN Objetivos Estudiar los patrones de consumo de alimentos en adultos mayores de la provincia de Buenos Aires (Argentina) y relacionarlos con factores socioeconómicos. Métodos A partir de la Encuesta Nacional de Gasto de los Hogares (2012-2013) se efectúa un análisis de componentes principales para encontrar y describir patrones alimentarios adoptados por hogares de la provincia de Buenos Aires habitados por adultos mayores. Mediante pruebas de diferencia de media y proporciones, se establecen relaciones entre el puntaje de los hogares en cada patrón alimentario, el ingreso promedio y la condición de vivir solo o sola. Resultados En función de las cargas factoriales asociadas a cada grupo alimentario, los patrones que, en conjunto, explican el 44,6% de la varianza total son: i) dieta variada tradicional, ii) dieta antiproteica, iii) dieta vegetariana y iv) dieta de hidratos de carbono. Se encuentra que el nivel de ingreso y la condición de vivir solo(a) son factores que podrían estar asociados a la adopción (o no) de la dieta variada tradicional, patrón alimentario recomendado por las guías alimentarias para la población argentina. Discusión La menor frecuencia de hogares habitados por adultos mayores solos y el menor nivel de ingreso promedio de los hogares que presentan un elevado puntaje en la dieta variada tradicional, podría ser utilizada por las autoridades sanitarias a la hora de tomar medidas tendientes a mejorar los patrones alimentarios de los adultos mayores que viven solos y cobran la pensión mínima.(AU)

ABSTRACT Objectives To study the patterns of food consumption in older adults in the province of Buenos Aires (Argentina) and relate them to socioeconomic factors. Methods Based on the National Household Expenditure Survey (2012-2013), an analysis of main components is carried out to find and describe dietary patterns adopted by households in the province of Buenos Aires habited by older adults. Through tests of mean difference and proportions, relationships between household scores in each food pattern, average income and living alone or alone are established. Results Depending on the factor loads associated with each food group, the patterns that together explain 44.6% of the total variance are: i) traditional varied diet, ii) anti-protein diet, iii) vegetarian diet and iv) carbohydrate diet. It is found that the level of income and the condition of living alone are factors that could be associated with the adoption (or not) of the traditional varied diet, food pattern recommended by the dietary guidelines for the Argentine population. Discussion The lower frequency of households habited by older adults alone and the lower average income level of households that have a high score in the traditional varied diet, could be used by health authorities when taking measures to improve the eating patterns of older adults who live alone and receive the minimum pension.(AU)

Canasta básica alimentaria para la persona mayor en Argentina / Basic food basket for the elderly in Argentina

FUNDAMENTOS: En Argentina existe una canasta básica alimentaria que se valoriza mensualmente para medir pobreza por insuficiencia de ingresos. Dicha canasta no contempla adecuadamente los requerimientos nutricionales de las personas mayores. El objetivo del artículo es proponer una canasta alimentaria básica para distintos perfiles de personas mayores. MÉTODOS: Se definen los valores energéticos para hombres y mujeres de la tercera y cuarta edad. Se identifican los grupos de alimentos necesarios según recomendación de expertos. Se seleccionan los alimentos a incorporar en cada grupo según el patrón de consumo de las personas mayores en Argentina. Se determinan los valores monetarios en base al índice de precios al consumidor (IPC) online. RESULTADOS: En octubre de 2018 el costo de la canasta básica alimentaria para las personas mayores fue en promedio de USD 83,34. Este valor es superior al estimado por el Instituto Nacional de Estadísticas y Censos de la República Argentina (INDEC). Las personas mayores beneficiarias de la pensión universal debieron destinar en promedio el 42% de la misma a cubrir las necesidades alimentarias. CONCLUSIONES: Se propone una metodología para obtener y valorizar una canasta básica alimentaria ajustada a los requerimientos nutricionales de las personas mayores en Argentina. Esta permite estimar los ingresos mínimos necesarios para que las personas mayores no sean consideradas indigentes

BACKGROUND: In Argentina, there is a basic food basket that is valued monthly to measure poverty due to insufficient income. This basket does not adequately cover the nutritional requirements of the elderly. The objective of the articleis to propose a basic food basket for different profiles of older adults. METHODS: Caloric values are defined for men and women of the third and fourth age. The necessary food groups are identified according to experts' recommendations. The foods to be incorporated in each group are selected according to the pattern of consumption of the elderly in Argentina. Monetary values are determined based on the IPC online price index. RESULTS: In October 2018, the cost of the basic food basket for the elderly was, on average, USD 83.34. This value is higher than the one estimated by the INDEC. The elderly beneficiaries of the universal pension had to allocate an average of 42% of it to cover the food needs. CONCLUSIONS: A methodology is proposed to obtain and value a basic food basket adjusted to the nutritional requirements of the elderly in Argentina. This allows estimating the minimum income necessary so that the elderly are not considered indigents

Eficiencia en el uso de mamógrafos públicos en una región de Argentina / Efficiency in the use of public mammography devices in an Argentinean region

Introducción: En Argentina el cáncer de mama es el de mayor incidencia en mujeres. La mamografía es un método de prevención secundario que permite su detección temprana y mejora notoriamente las perspectivas de curación. Objetivo: Determinar si un incremento en la demanda efectiva de mamografías requiere aumentar la oferta de equipos o si puede satisfacerse mejorando la eficiencia en su uso. Métodos: Investigación evaluativa realizada entre 2010 y 2012. Se consideraron las mujeres sin cobertura médica residentes en los partidos que componen la Región Sanitaria I de la Provincia de Buenos Aires, Argentina. La demanda potencial de mamografías se estimó utilizando dos protocolos clínicos alternativos. Para estimar la eficiencia relativa de los mamógrafos públicos de la Región Sanitaria I se empleó el análisis de envolvente de datos, mediante un modelo básico orientado a insumos suponiendo en primer lugar la existencia de rendimientos constantes a escala, para luego contemplar la existencia de rendimientos variables. En cada caso se calcularon los coeficientes de eficiencia relativa y las holguras (slacks) de las variables de insumos y producto. Resultados: Dada la cantidad de mamografías efectivamente realizados, en ningún caso se cubrió la totalidad de la demanda potencial. En 2012 solo uno de los ocho mamógrafos existentes en esta región operó en condiciones de plena eficiencia (técnica y de escala). Conclusiones: De mediar incrementos en la eficiencia, sería posible aumentar la cantidad de mamografías realizadas con los recursos disponibles y cubrir la demanda potencial de las mujeres sin cobertura médica de la Región Sanitaria I(AU)

Introduction: In Argentina, breast cancer is the one with the highest incidence in women. Mammography is a secondary prevention method that allows early detection and improves the prospects of cure. Objective: To determine if an increase in the effective demand for mammographies requires increasing the supply of equipment, or if it can be satisfied by improving the efficiency of its use. Methods: Evaluative research conducted from 2010 to 2012. Women without medical coverage who are residents in Sanitary Region I of Buenos Aires Province (Argentina) were the ones included in the study. The potential demand for mammograms was estimated using two alternative clinical protocols. In order to estimate the relative efficiency of the public mammography devices of Sanitary Region I, Data Envelopment Analysis was used, through a basic input-oriented model. Firstly, it was assumed the existence of constant outputs to scale and then considering the existence of unsettled outputs. In each case, the relative efficiency coefficients and the slacks of the input and output variables were calculated. Results: Given the number of mammographies actually carried out, in no case the total potential demand was covered. In 2012, only one of the eight mammography devices in this region operated under full efficiency conditions (technical and scale). Conclusions: If efficiency increases, it would be possible to increase the number of mammographies performed with available resources, and to cover the potential demand of women without medical coverage in the Sanitary Region I(AU)

Eficiencia del Gasto Total en Salud: Análisis no paramétrico en una muestra amplia de países / Total health expenditure efficiency: non-parametric analysis in a large sample of countries

RESUMEN Objetivo Mostrar la utilidad de una herramienta estadística no paramétrica para medir la eficiencia de 190 países en la producción de status de salud, así como conocer los determinantes de dicha eficiencia. Métodos Con datos de 2009, y utilizando la técnica de Envolvente de Datos, se estima la frontera de eficiencia, utilizando como insumo al gasto total en salud per cápita y como productos la tasa de mortalidad infantil y la esperanza de vida al nacer. Se realiza un análisis de los determinantes de la eficiencia del gasto mediante el uso de modelos Tobit. Resultados Las naciones del continente africano presentan menor eficiencia técnico-asignativa, aunque mayor eficiencia de escala. La calidad de las instituciones muestra un impacto estadísticamente significativo sobre los niveles de eficiencia técnico-asignativa y de escala. El porcentaje de financiamiento del gasto por parte de aseguradoras privadas incide sobre la eficiencia técnico-asignativa mientras que el porcentaje de urbanización lo hace sobre la eficiencia de escala. Discusión El hecho de que más del 70 % de los países presente rendimientos decrecientes del gasto en salud sugeriría que, una vez alcanzados ciertos estándares mínimos de calidad de vida, el efecto marginal de cada dólar adicional destinado a salud no es sustancial. En países pobres donde el gasto en salud presenta rendimientos crecientes, el desempeño sanitario podría mejorar significativamente con incrementos marginales del gasto. Las estructuras de financiamiento del gasto en salud podrían estar influyendo sobre la eficiencia técnico-asignativa y el grado de urbanización podría hacerlo sobre la eficiencia de escala.(AU)

Objective To measure the efficiency of 190 countries in producing health results and the factors that determine such efficiency. Methodology A data envelopment analysis was conducted on worldwide data from the year 2009 in order to estimate the efficient frontier, based on total health expenditure per capita, as well on infant mortality rate and life expectancy at birth. At the same time, an analysis of the determinants of expenditure efficiency was performed through Tobit models. Results African nations have lower technical and allocative efficiency, but higher scale efficiency. The quality of institutions has a statistically significant impact on the levels of technical and allocative efficiency and on the levels of scale efficiency. The percentage of health expenditure financed by private insurers has an impact on technical and allocative efficiency, while urbanization rates affect the scale efficiency. Discussion the fact that more than 70 % of countries show decreasing returns suggest that, once certain minimal standards of life quality are achieved, the marginal effect of each additional dollar assigned to health is not substantial. Conversely, in poor countries, where the expenditure in health presents increasing returns, the health performance could be substantially better by marginally raising the expenditure. On the other hand, financing structures of health expenditures may influence technical-allocative efficiency, while urbanization levels may impact scale efficiency (source: MeSH, NLM).(AU)

[Total health expenditure efficiency: non-parametric analysis in a large sample of countries]. / Eficiencia del Gasto Total en Salud: Análisis no paramétrico en una muestra amplia de países.

OBJECTIVE: To measure the efficiency of 190 countries in producing health results and the factors that determine such efficiency. METHODOLOGY: A data envelopment analysis was conducted on worldwide data from the year 2009 in order to estimate the efficient frontier, based on total health expenditure per capita, as well on infant mortality rate and life expectancy at birth. At the same time, an analysis of the determinants of expenditure efficiency was performed through Tobit models. RESULTS: African nations have lower technical and allocative efficiency, but higher scale efficiency. The quality of institutions has a statistically significant impact on the levels of technical and allocative efficiency and on the levels of scale efficiency. The percentage of health expenditure financed by private insurers has an impact on technical and allocative efficiency, while urbanization rates affect the scale efficiency. DISCUSSION: the fact that more than 70 % of countries show decreasing returns suggest that, once certain minimal standards of life quality are achieved, the marginal effect of each additional dollar assigned to health is not substantial. Conversely, in poor countries, where the expenditure in health presents increasing returns, the health performance could be substantially better by marginally raising the expenditure. On the other hand, financing structures of health expenditures may influence technical-allocative efficiency, while urbanization levels may impact scale efficiency (source: MeSH, NLM).

OBJETIVO: Mostrar la utilidad de una herramienta estadística no paramétrica para medir la eficiencia de 190 países en la producción de status de salud, así como conocer los determinantes de dicha eficiencia. MÉTODOS: Con datos de 2009, y utilizando la técnica de Envolvente de Datos, se estima la frontera de eficiencia, utilizando como insumo al gasto total en salud per cápita y como productos la tasa de mortalidad infantil y la esperanza de vida al nacer. Se realiza un análisis de los determinantes de la eficiencia del gasto mediante el uso de modelos Tobit. RESULTADOS: Las naciones del continente africano presentan menor eficiencia técnico-asignativa, aunque mayor eficiencia de escala. La calidad de las instituciones muestra un impacto estadísticamente significativo sobre los niveles de eficiencia técnico-asignativa y de escala. El porcentaje de financiamiento del gasto por parte de aseguradoras privadas incide sobre la eficiencia técnico-asignativa mientras que el porcentaje de urbanización lo hace sobre la eficiencia de escala. DISCUSIÓN: El hecho de que más del 70 % de los países presente rendimientos decrecientes del gasto en salud sugeriría que, una vez alcanzados ciertos estándares mínimos de calidad de vida, el efecto marginal de cada dólar adicional destinado a salud no es sustancial. En países pobres donde el gasto en salud presenta rendimientos crecientes, el desempeño sanitario podría mejorar significativamente con incrementos marginales del gasto. Las estructuras de financiamiento del gasto en salud podrían estar influyendo sobre la eficiencia técnico-asignativa y el grado de urbanización podría hacerlo sobre la eficiencia de escala.

Financiamiento público del gasto total en salud: un estudio ecológico por países según niveles de ingreso / Public funding of the total health expenditure: an ecological study by countries according to income levels / Financiamento público da despesa total em saúde: um estudo ecológico por países por nível de renda

En las últimas décadas el gasto total en salud (GTS) ha aumentado tanto en las economías desarrolladas como en las emergentes. El presente trabajo es un estudio ecológico descriptivo y mixto. Tomando una muestra de 192 países agrupados por niveles de ingresos, se analizó: i) los patrones de financiamiento público del GTS, ii) la proporción que representó el gasto público en salud en los gastos generales de gobierno, y iii) la hipótesis de Globerman y Vining referida a la existencia de una correlación negativa entre el financiamiento público y el GTS como porcentaje del PBI. Los resultados muestran que los gobiernos que más se involucran en el sector salud poseen en promedio un GTS per cápita más alto. Asimismo, la relación entre financiamiento público del GTS y GTS como porcentaje del PBI es negativa y estadísticamente significativa solo en los países ricos de la OCDE y en los pobres.

Over the last decades, total health expenditure (the) has increased, not only in developed economies but also in emerging ones. This paper is a descriptive and mixed ecological study. We took a sample of 192 countries grouped by income levels, and analyzed i) the patterns of public funding of the, ii) the share of public health expenditure in the general government budgets, and iii) the Globermann and Vining hypothesis about the existence of a negative correlation between the proportion of the financed by the governments and the as a percentage of the gdp. We found that governments most involved in the health sector showed, on average, a higher per capita the. We also found that the relationship between public funding of the and the the as a percentage of gdp is negative and statistically significant only in rich oecd countries and the poor ones.

Nas últimas décadas a despesa total em saúde (DTS) aumentou tanto nas economias desenvolvidas como nas emergentes. O presente trabalho é um estudo ecológico descritivo e misturado. Tomando uma amostra de 192 países agrupados por nível de renda, foram analisados: i) os padrões de financiamento público do DTS, ii) a proporção que representou a despesa pública em saúde nas despesas gerais de governo, e iii) a hipótese de Globerman e Vining referida à existência de uma correlação negativa entre financiamento público e DTS como porcentagem do PBI. Os resultados demostram que os governos que mais estão envolvidos com o setor da saúde possuem em média um DTS per capita mais alto. Além disso, a relação entre financiamento público do DTS e DTS como porcentagem do PBI é negativa e estatisticamente significativa apenas nos países ricos da OCDE e nos pobres.