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3.
Rev Peru Med Exp Salud Publica ; 36(2): 196-206, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460630

RESUMO

OBJECTIVE.: To describe the trends in health insurance coverage (HIC) in Peru during the period 2009-2017 and evaluate associations with demographic, social and economic factors. MATERIALS AND METHODS.: We carried out a secondary data-analysis from the Peruvian National Household Survey. For each year, we estimated the global HIC, for the Integral Health Insurance (SIS) and the Social Security system (EsSalud). In addition, we performed a trend analysis. For 2009 (Universal Health Insurance Act), 2013 (health care reform act) and 2017, we used a polytomous variable for the insurance type (SIS/EsSalud/Non-affiliated). We performed logistic multinomial regressions to estimate relative prevalence ratios (RPR) and their 95% CI with correction for complex sampling. RESULTS.: We observed an increasing trend in the global HIC (2009:60.5%; 2013:65.5%; 2017:76.4%), SIS coverage (2009:34%; 2013:35.4%; 2017:47%) and EsSalud coverage (2009:22.8%; 2013:26.4%; 2017:26.3%). Multinomial logistic regressions showed that being a woman increased the likelihood to be affiliated to the SIS (RPR= 2009:1.64 and 2017:1.53), while people between 18 and 39 years old, living in Lima Metropolitan area under non-poverty conditions reduced the likelihood to be affiliated to the SIS (RPR= 2009:0.16 and 2017:0.31; 2009:0.17 and 2017:0.37; 2009:0.51 and 2017:0.53; respectively). Furthermore, being a woman, 65 years old or over, living in urban Lima, and under non-poverty conditions increased the likelihood of being affiliated with the EsSalud (RPR= 2013:1.12 and 2017:1.24; 2013:1.32 and 2017:1.34; 2009:2.18 and 2017:2.08; 2009:2.14 and 2017:2.54; 2009:3.57 and 2017:2.53; respectively). CONCLUSIONS.: HIC has increased during the period 2009-2017. However, the characteristics of those affiliated are different between the various types of health insurance.


Assuntos
Cobertura do Seguro/tendências , Seguro Saúde/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Peru , Pobreza , População Rural , Fatores Sexuais , Inquéritos e Questionários , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , População Urbana , Adulto Jovem
4.
PLoS One ; 14(5): e0209126, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31116754

RESUMO

Ghana has made significant stride towards universal health coverage (UHC) by implementing the National Health Insurance Scheme (NHIS) in 2003. This paper investigates the progress of UHC indicators in Ghana from 1995 to 2015 and makes future predictions up to 2030 to assess the probability of achieving UHC targets. National representative surveys of Ghana were used to assess health service coverage and financial risk protection. The analyses estimated the coverage of 13 prevention and four treatment service indicators at the national level and across wealth quintiles. In addition, we calculated catastrophic health payments and impoverishment to assess financial hardship and used a Bayesian regression model to estimate trends and future projections as well as the probabilities of achieving UHC targets by 2030. Wealth-based inequalities and regional disparities were also assessed. At the national level, 14 out of the 17 health service indicators are projected to reach the target of 80% coverage by 2030. Across wealth quintiles, inequalities were observed amongst most indicators with richer groups obtaining more coverage than their poorer counterparts. Subnational analysis revealed while all regions will achieve the 80% coverage target with high probabilities for the prevention services, the same cannot be applied to the treatment services. In 2015, the proportion of households that suffered catastrophic health payments and impoverishment at a threshold of 25% non-food expenditure were 1.9% (95%CrI: 0.9-3.5) and 0.4% (95%CrI: 0.2-0.8), respectively. These are projected to reduce to 0.4% (95% CrI: 0.1-1.3) and 0.2% (0.0-0.5) respectively by 2030. Inequality measures and subnational assessment revealed that catastrophic expenditure experienced by wealth quintiles and regions are not equal. Significant improvements were seen in both health service coverage and financial risk protection over the years. However, inequalities across wealth quintiles and regions continue to be cause of concerns. Further efforts are needed to narrow these gaps.


Assuntos
Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde/tendências , Gana/epidemiologia , Gastos em Saúde , Serviços de Saúde , Indicadores Básicos de Saúde , História do Século XX , História do Século XXI , Humanos , Programas Nacionais de Saúde , Vigilância em Saúde Pública , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/história
5.
Curationis ; 42(1): e1-e8, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31038329

RESUMO

BACKGROUND:  The Republic of South Africa (RSA) is shifting towards universal health coverage and a unified health system. This milestone can be achieved through the implementation of National Health Insurance (NHI). To employ NHI, health establishments in the country are compelled to comply with quality standards. The non-compliance with quality standards at primary health care (PHC) clinics within a district in Gauteng, which was verified by quality standards' audit reports, prompted an intervention. No prior research aimed at facilitating managers' compliance with quality standards has been conducted within the context under study. This research gap necessitated an exploration on how managers' compliance to quality standards at PHC clinics within a district in Gauteng could best be facilitated. OBJECTIVES:  To describe recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual research design was used in this study. Semi-structured, individual interviews were conducted. RESULTS:  The recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng were described. However, for the purpose of this article, only the recommendations seeking to address challenges with management practices as a reason for non-compliance with quality standards at PHC clinics will be discussed. These recommendations include involvement of PHC clinic managers in decision-making, adequate support from senior management and improvement of internal communication practices. CONCLUSION:  The researcher concludes that the senior management team in the district under study should strive to embrace the described recommendations as a strategy to facilitate managers' compliance to quality standards at PHC clinics.


Assuntos
Instituições de Assistência Ambulatorial/normas , Enfermeiras Administradoras/psicologia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Instituições de Assistência Ambulatorial/organização & administração , Humanos , Entrevistas como Assunto/métodos , Enfermeiras Administradoras/normas , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , África do Sul , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/tendências
6.
Int J Rheum Dis ; 22(5): 880-889, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30950207

RESUMO

AIM: This study aims to measure current situation with regard to access and financial protection towards healthcare for rheumatic diseases (RDs) in India. METHOD: The first part of this study is quantitative, and uses the data generated by the 71st Round of National Sample Survey 2014, which measured self-reported morbidity, choice of provider and utilization of services and out of pocket expenditure (OOPE) incurred on healthcare services in a sample of 65 932 households and 333 104 individuals from all across India. The second qualitative part of the study was done in one sample district to understand the barriers to access and financial protection. RESULTS: 3.5% of all hospitalizations in the preceding one year and 9.9% of all ambulatory care in the preceding 15 days of this study period were due to RDs. Cost of care for RDs was three times higher in private sector. Cost on medicines comprised the largest share in both sectors. 54% of the households faced catastrophic health expenditure at 10% threshold (CHE-10) and this was nine times higher in private provisioning (OR: 8.8, CI: 6.8-11.4). 24% of the households had to borrow or sell household assets to meet the hospitalization expenditure. Insurance had marginal impact and it did not help in preventing household from facing CHE-10 for the lowermost three economic quintiles. There was significant unmet health care needs and lack of continuity of care of RDs in India. CONCLUSION: Addressing the gaps in access and financial protection for patients with RDs need greater emphasis in policy as well as implementation, if the country has to achieve Universal Health Coverage.


Assuntos
Custos de Cuidados de Saúde , Gastos em Saúde , Acesso aos Serviços de Saúde/economia , Doenças Reumáticas/economia , Doenças Reumáticas/terapia , Reumatologia/economia , Cobertura Universal do Seguro de Saúde/economia , Adolescente , Adulto , Criança , Pré-Escolar , Continuidade da Assistência ao Paciente/economia , Continuidade da Assistência ao Paciente/tendências , Feminino , Custos de Cuidados de Saúde/tendências , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Disparidades em Assistência à Saúde/economia , Disparidades em Assistência à Saúde/tendências , Humanos , Índia/epidemiologia , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Doenças Reumáticas/epidemiologia , Reumatologia/tendências , Cobertura Universal do Seguro de Saúde/tendências , Adulto Jovem
7.
Artigo em Inglês | MEDLINE | ID: mdl-30950427

RESUMO

The launch of the Global compact for safe, orderly and regular migration in December 2018 marked the first-ever United Nations global agreement on a common approach to international migration in all its dimensions. The global compact aims to reduce the risks and vulnerabilities migrants face at different stages of migration, by respecting, protecting and fulfilling their human rights and providing them with care and assistance. A key example of the intersection of the right to health and migration is seen in the Greater Mekong Subregion (GMS) - comprising Cambodia, Lao People's Democratic Republic, Myanmar, the People's Republic of China (Yunnan Province and Guangxi Zhuang Autonomous Region), Thailand and Viet Nam. The GMS has a highly dynamic and complex pattern of fluctuating migration, and population mobility has been identified as an important concern in the GMS, since five of the six GMS countries are endemic for malaria. Based on the concept of universal health coverage, and as endorsed by the 61st World Health Assembly in 2008, migrants, independently of their legal status, should be included in national health schemes. This paper summarizes work done to understand and address the legal obstacles that migrants face in accessing health services in the GMS countries, and the impact that these obstacles have in relation to elimination of malaria and containment of artemisinin resistance. Despite efforts being made towards achieving universal health coverage in all the GMS countries, no country has current health and social protection regulations to ensure migrants' access to health services, although in Thailand documented and undocumented migrants can opt for acquiring health insurance. Additionally, there is a lack of migrant-inclusive legislation in GMS countries, since barriers to accessing health services for migrants - such as language and/or socioeconomic factors - have been scarcely considered. Advocacy to promote legislative approaches that include migrants' health needs has been made at global and regional levels, to overcome these barriers. Assistance is available to Member States for reviewing and adopting migrant-friendly policies and legal frameworks that promote rather than hinder migrants' and mobile populations' access to health services.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/normas , Malária/prevenção & controle , Antimaláricos/uso terapêutico , Camboja , China , Emigração e Imigração/tendências , Política de Saúde/tendências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Direitos Humanos , Humanos , Laos , Malária/tratamento farmacológico , Vacinas Antimaláricas/uso terapêutico , Mianmar , Tailândia , Nações Unidas/organização & administração , Cobertura Universal do Seguro de Saúde/normas , Cobertura Universal do Seguro de Saúde/tendências , Vietnã
8.
Artigo em Inglês | MEDLINE | ID: mdl-30950428

RESUMO

According to the constitution of Bangladesh, health is a right and, in 2012, initial work towards universal health coverage was marked by introduction of a health-care financing strategy. However, for 2016, Bangladesh's domestic general government health expenditure was only 0.42% of gross domestic product, making it one of the lowest-spending countries in the world, with 72% of current health expenditure coming from out-of-pocket spending. One factor that is key to the challenge of providing universal health coverage in Bangladesh is the large proportion of the population who work in the informal sector - an estimated 51.7 million people or 85.1% of the labour force in 2017. Most workers engaged in the informal sector lack job security, social benefits and legal protection. The evidence base on the health needs and health-seeking behaviours of this large population is sparse. The government has recognized that increased efforts are needed to ensure that the country's notable successes in improving maternal, neonatal and child health need to be expanded to cover the full range of health services to the whole population, and specifically the more marginalized and impoverished sectors of society. In addition to the universal need to increase funding and to improve the availability and quality of primary health care, workers in the informal sector need to be targeted through an explicit mechanism, with enhanced budgetary allocation to health facilities serving these communities. Importantly, there is a clear need to build an evidence base to inform policies that seek to ensure that informal sector workers have greater access to quality health services.


Assuntos
Acesso aos Serviços de Saúde/normas , Setor Informal , Bangladesh , Custos de Cuidados de Saúde/normas , Custos de Cuidados de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Direitos Humanos , Humanos , Cobertura Universal do Seguro de Saúde/normas , Cobertura Universal do Seguro de Saúde/tendências
9.
Lancet ; 393(10181): 1570, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-31007184
11.
Value Health Reg Issues ; 18: 78-82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30641410

RESUMO

OBJECTIVES: To describe the process, challenges, and future direction of health technology assessment (HTA), focusing on the drug selection of the National List of Essential Medicines (NLEM) in Thailand. METHODS: Literature and government documents were reviewed and analyzed by authors with experiences in HTA and drug policy in the country. RESULTS: The structure of HTA and its process in the drug selection of the NLEM were described, followed by the outcomes of the use of HTA. Examples of lowering drug prices, as a result of price negotiation using HTA, were presented. A few examples were also provided to demonstrate how decisions were made from considering factors beyond cost-effectiveness findings. Finally, challenges on various issues including improvement of HTA structure and process were discussed for the future direction of HTA in Thailand. CONCLUSIONS: HTA has been adopted as a tool for the drug selection of the NLEM to help Thailand achieve universal health coverage. Nevertheless, various challenges exist and need to be addressed.


Assuntos
Controle de Medicamentos e Entorpecentes/métodos , Avaliação da Tecnologia Biomédica/métodos , Cobertura Universal do Seguro de Saúde/tendências , Previsões , Humanos , Avaliação da Tecnologia Biomédica/tendências , Tailândia , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência
12.
J Neurointerv Surg ; 11(2): 159-165, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29934441

RESUMO

BACKGROUND: Despite increasing usage of endovascular treatments for intracranial aneurysms, few research studies have been conducted on the incidence of unruptured aneurysm (UA) and subarachnoid hemorrhage (SAH), and could not show a decrease in the incidence of SAH. Moreover, research on socioeconomic disparities with respect to the diagnosis and treatment of UA and SAH is lacking. METHOD: Trends in the incidences of newly detected UA and SAH and trends in the treatment modalities used were assessed from 2005 to 2015 using the nationwide database of the Korean National Health Insurance Service in South Korea. We also evaluated the influence of demographic characteristics including socioeconomic factors on the incidence and treatment of UA and SAH. RESULT: The rates of newly detected UA and SAH were 28.3 and 13.7 per 100 000 of the general population, respectively, in 2015. The incidence of UA increased markedly over the 11-year study period, whereas that of SAH decreased slightly. UA patients were more likely to be female, older, employee-insured, and to have high incomes than SAH patients. In 2015, coiling was the most common treatment modality for both UA and SAH patients. Those who were female, employee-insured, or self-employed, with high income were likely to have a higher probability to be treated for UA and SAH. CONCLUSION: The marked increase in the detection and treatment of UA might have contributed to the decreasing incidence of SAH, though levels of contribution depend on socioeconomic status despite universal medical insurance coverage.


Assuntos
Disparidades em Assistência à Saúde/economia , Aneurisma Intracraniano/economia , Fatores Socioeconômicos , Hemorragia Subaracnóidea/economia , Cobertura Universal do Seguro de Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Casos e Controles , Estudos Transversais , Bases de Dados Factuais/economia , Bases de Dados Factuais/tendências , Procedimentos Endovasculares/economia , Procedimentos Endovasculares/métodos , Procedimentos Endovasculares/tendências , Feminino , Disparidades em Assistência à Saúde/tendências , Humanos , Incidência , Aneurisma Intracraniano/epidemiologia , Aneurisma Intracraniano/terapia , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapia , Resultado do Tratamento , Cobertura Universal do Seguro de Saúde/tendências
13.
Lancet ; 393(10166): 75-102, 2019 01 05.
Artigo em Inglês | MEDLINE | ID: mdl-30579611

RESUMO

Indonesia is a rapidly growing middle-income country with 262 million inhabitants from more than 300 ethnic and 730 language groups spread over 17 744 islands, and presents unique challenges for health systems and universal health coverage (UHC). From 1960 to 2001, the centralised health system of Indonesia made gains as medical care infrastructure grew from virtually no primary health centres to 20 900 centres. Life expectancy improved from 48 to 69 years, infant mortality decreased from 76 deaths per 1000 livebirths to 23 per 1000, and the total fertility rate decreased from 5·61 to 2·11. However, gains across the country were starkly uneven with major health gaps, such as the stagnant maternal mortality of around 300 deaths per 100 000 livebirths, and minimal change in neonatal mortality. The centralised one size fits all approach did not address the complexity and diversity in population density and dispersion across islands, diets, diseases, local living styles, health beliefs, human development, and community participation. Decentralisation of governance to 354 districts in 2001, and currently 514 districts, further increased health system heterogeneity and exacerbated equity gaps. The novel UHC system introduced in 2014 focused on accommodating diversity with flexible and adaptive implementation features and quick evidence-driven decisions based on changing needs. The UHC system grew rapidly and covers 203 million people, the largest single-payer scheme in the world, and has improved health equity and service access. With early success, challenges have emerged, such as the so-called missing-middle group, a term used to designate the smaller number of people who have enrolled in UHC in wealth quintiles Q2-Q3 than in other quintiles, and the low UHC coverage of children from birth to age 4 years. Moreover, high costs for non-communicable diseases warrant new features for prevention and promotion of healthy lifestyles, and investment in a robust integrated digital health-information system for front-line health workers is crucial for impact and sustainability. This Review describes the innovative UHC initiative of Indonesia along with the future roadmap required to meet sustainable development goals by 2030.


Assuntos
Reforma dos Serviços de Saúde/tendências , Cobertura Universal do Seguro de Saúde/tendências , Assistência à Saúde/tendências , Desenvolvimento Econômico/tendências , Nível de Saúde , Humanos , Indonésia , Expectativa de Vida/tendências , Fatores Socioeconômicos
14.
Int J Cardiol ; 277: 250-257, 2019 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-30413306

RESUMO

BACKGROUND: To evaluate the associations between individual income, all-cause mortality and use of healthcare resources in a very large population of chronic heart failure (CHF) patients living in Catalonia (Spain), where access to public healthcare is granted by law. METHODS AND RESULTS: We used 2016 data from the Catalan Health Surveillance System, a large, exhaustive, administrative healthcare database which includes information on medical diagnoses, healthcare resource use, and individual income for all Catalan residents (N = 7,638,524). Individual annual income was categorized as high (>100,000€), medium (18,000-100,000€), low (<18,000€), and very low (welfare support). Among 155,883 CHF patients, lower individual income was associated with a shorter life expectancy at age 50 (life expectancy for high income patients 22.2 years, for very low income patients 12.8), and were independently associated with higher all-cause mortality adjusting for age, sex, comorbidities, and duration of the CHF diagnosis (odds ratio very low vs. medium income 1.21 [95% CI 1.11, 1.33]). Also, in patients with lower income levels the burden of public healthcare resource use was displaced towards urgent hospitalizations and frequent emergency department visits, as opposed to regular, specialized CHF ambulatory-based care. CONCLUSION: In a very large population of CHF patients with access to universal healthcare, lower income was independently associated with higher mortality and with lower use of ambulatory-based healthcare resources. Our findings suggest that CHF patients may benefit from systematic assessment of their socioeconomic status, as this may aid the identification of vulnerable subgroups who may benefit from tailored health education and management.


Assuntos
Insuficiência Cardíaca/economia , Insuficiência Cardíaca/mortalidade , Renda , Aceitação pelo Paciente de Cuidados de Saúde , Vigilância da População , Cobertura Universal do Seguro de Saúde/economia , Idoso , Idoso de 80 Anos ou mais , Doença Crônica , Feminino , Insuficiência Cardíaca/terapia , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Cobertura Universal do Seguro de Saúde/tendências
15.
Int J Cardiol ; 276: 26-30, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30514579

RESUMO

BACKGROUND: Lower socioeconomic status (SES) has been associated with worse outcomes after acute myocardial infarction. Data for survival after ST-elevation myocardial infarction (STEMI) by SES in the current era of primary percutaneous coronary intervention (PCI) is more limited. METHODS: Data was collected for all patients with acute STEMI undergoing primary PCI at The South Yorkshire Cardiothoracic Centre, UK between 2009 and 2014. A Cox regression analysis was used to assess differences in survival by SES quartile (using an area-level measure). RESULTS: Of the 3126 STEMI patients, 2655 (84.9%) were first presentations of STEMI. Lower SES groups generally had a less favourable baseline cardiovascular risk factor profile, with higher rates of smoking (p = 0.001), diabetes (p = 0.007) and previous coronary heart disease (p = 0.025). With the exception of beta-blockers, the use of secondary preventative medications was similar between SES quartiles. Adjusting for age and gender, the most disadvantaged SES quartile trended to a non-significant increased mortality at 30 days (hazard ratio 1.35 (0.79-2.33)), 1 year (1.12 (0.76-1.65)), or 3 years (1.22 (0.88-1.70)) compared to the least disadvantaged SES quartile, but this was attenuated by adjusting for additional cardiovascular risk factors and medication use on discharge. CONCLUSIONS: In this large study of unselected STEMI patients managed by primary PCI, we did not find any significant differences in survival by SES at 30 days, 1 year, or 3 years.


Assuntos
Intervenção Coronária Percutânea/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/economia , Infarto do Miocárdio com Supradesnível do Segmento ST/mortalidade , Classe Social , Cobertura Universal do Seguro de Saúde/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intervenção Coronária Percutânea/mortalidade , Intervenção Coronária Percutânea/tendências , Estudos Retrospectivos , Fatores de Risco , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Taxa de Sobrevida/tendências , Reino Unido/epidemiologia , Cobertura Universal do Seguro de Saúde/tendências
17.
Value Health Reg Issues ; 17: 219-223, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30528780

RESUMO

In February and September of 2017, the International Society for Pharmacoeconomics and Outcomes Research Health Technology Assessment Council held roundtables focused on Latin America to discuss health technology assessment best practices, collaboration opportunities, and regional experiences regarding health policies to improve the affordability of and access to healthcare technologies. The access to high-cost technologies, increased social pressure to achieve universal coverage, population aging, and the limits of traditional mechanisms to control costs create political pressure to begin considering other pricing alternatives, including value-based pricing, in Latin America. This article attempts to conceptualize key stakeholders' perceptions of their experiences, opportunities, and barriers to implementing value-based pricing in Latin America.


Assuntos
Custos e Análise de Custo , Farmacoeconomia/tendências , Avaliação da Tecnologia Biomédica/tendências , Cobertura Universal do Seguro de Saúde/tendências , Envelhecimento , Tecnologia Biomédica/economia , Política de Saúde , Humanos , América Latina
18.
Cad Saude Publica ; 34(11): e00002018, 2018 11 08.
Artigo em Espanhol | MEDLINE | ID: mdl-30427407

RESUMO

In the context of a federal and highly fragmented institutional framework like that Argentina, the article analyzes the concepts and ideas on which government actors organize their health policy instruments at three different levels of government. Based on this focus, the article investigates the convergences, divergences, and tensions permeating the exercising of the right to health. The analysis is organized in three dimensions of universal care that became challenges for the national policy during the period in question: ease of access to services, insured coverage, and a guaranteed set of explicit benefits for the entire population. Concerning these challenges, the actors deconstruct and reconstruct the meaning of the policies for universal health care, based on the issues on their agendas, the ideas existing prior to the programs (and based on which the changes are conceived), and the political logic by which their decisions are made. This perspective seeks to transcend the programs' underlying technical ideas in order to capture the political dimension of their implementation, seen as a complex social construction, which also faces structural problems that are part of the agenda at each level of government in relation to health services provision.


Assuntos
Acesso aos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Argentina , Política de Saúde , Humanos , Pesquisa Qualitativa , Cobertura Universal do Seguro de Saúde/tendências , População Urbana
19.
Int J Equity Health ; 17(1): 169, 2018 11 20.
Artigo em Inglês | MEDLINE | ID: mdl-30454018

RESUMO

BACKGROUND: Equity, financial sustainability, and quality in healthcare are key goals embraced by universal health systems. However, systematic performance management strategies for achieving equity are still weaker than those aimed at achieving financial sustainability and quality of care. Using a vertical equity perspective, the overarching aim of this paper is to examine how improving equity in quality of care impacts on financial sustainability. We applied a simulation to indicators of the heart failure clinical pathway in Tuscany (central Italy), in order to quantify the equity gaps and financial resources that could be reallocated in the absence of performance inequities. METHODS: The analysis included all patients hospitalized for heart failure as a principal diagnosis in 2014. We selected five indicators: hospitalization rate, 30-day readmission, cardiology visits, and the utilization of beta-blockers, and ACE inhibitors and sartans. For each indicator, the simulation followed three steps: 1) stratification by socioeconomic status (SES), using education as a proxy for SES; 2) computation of the vertical equity indicator; and 3) assessment of the financial value of the equity gap. RESULTS: All indicators showed performance gaps regarding inequities across SES-groups. For the hospitalization rate and 30-day readmission, resources could have been reallocated, if the performance of patients with a low SES had been equal to the performance of patients with a high SES, which amounted to €2,144,422 and €892,790 respectively. In contrast, limited additional resources would have been required for prescriptions and cardiology visits. CONCLUSIONS: Reducing equity gaps by improving the performance of low-SES patients may be a crucial strategy to achieving financial sustainability in universal coverage healthcare systems. Universal healthcare systems, which aim to pursue financial sustainability and quality of care, are thus urged to develop performance management actions to improve equity. This approach should not only include the measurement and public disclosure of equity indicators but be part of a comprehensive evidence-based strategy for the management of chronic conditions along the clinical pathway.


Assuntos
Promoção da Saúde/economia , Acesso aos Serviços de Saúde/economia , Readmissão do Paciente/economia , Cobertura Universal do Seguro de Saúde/economia , Promoção da Saúde/tendências , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/economia , Humanos , Itália , Readmissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/normas , Classe Social , Cobertura Universal do Seguro de Saúde/tendências
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