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1.
Medicine (Baltimore) ; 98(37): e17090, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517831

RESUMO

The decision as to whether patients should be admitted to a medical intensive care unit (ICU), in the absence of information concerning survival rates or prognostic factors in survival, is often challenging. We analyzed survival trends in relation to hospital discharge and examined patient and hospital characteristics associated with survival following ICU care, using a sample of nationwide claims data in Korea from 2002 through 2013. The Korean government implements a compulsory social insurance program that covers the country's entire population, and the Korean National Health Insurance Service-National Sample Cohort (NHIS-NSC) data from 2002 based on this program were used for this study. The NHIS-NSC is a stratified random sample of 1,025,340 subjects selected from around 46 million Koreans. We evaluated annual survival trends using the Kaplan-Meier test. Analyses of the relationship between survival and patient and hospital characteristics were performed using Cox regression analyses. Employing a multivariate model, variables were selected using the forward selection method to consider the multicollinearity of variables. A total of 32,553 patients admitted to an ICU between 2002 and 2013 were identified among the eligible beneficiaries. The number of patients who had histories of ICU admission steadily increased throughout the study period, and patients older than 80 years constituted a progressively increasing proportion of ICU admissions, from 7.3% in 2002 to 16.9% in 2007 to 23.1% in 2013. The mean number of mechanical equipment items applied consistently increased, while no difference was observed in the trend for overall 1-year survival in patients following ICU treatment across the study period: the 1-year survival rate ranged from 66.7% (year 2003) to 64.2% (year 2010). Advanced age, cancer, renal failure, pneumonia, and influenza were all associated with heightened risk of mortality within 1 year. Our results should prove useful to older patients and their clinicians in their decisions regarding whether to seek ICU care, with the goals of improving the end-of life care and optimizing resource utilization.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Mortalidade Hospitalar/tendências , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/economia , Unidades de Terapia Intensiva/organização & administração , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , República da Coreia , Análise de Sobrevida
4.
Rev Saude Publica ; 53: 58, 2019 Jul 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340350

RESUMO

To advance in order to overcome the challenge of enabling greater autonomy in the use of financial resources in the Unified Health System (SUS), system managers agreed that transfers from the Union to other federated entities will be carried out through a financial investment account and a costing account. Over the past few years, states and municipalities managed more than 34,000 bank accounts dedicated to the Union's on-lendings, in which balance exceeded R$8 billion. However, from 2018, Ordinance 3,992/2017 unequivocally separated the budget flow from the financial flow, and the fund-to-fund transfers started to be carried out in only 11,190 bank accounts. Since then, managers have had financial autonomy in the management of financial resources received from the Union, if in accordance with the parameters established in their respective budget items at the end of each fiscal year.


Assuntos
Orçamentos/legislação & jurisprudência , Orçamentos/organização & administração , Gastos em Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Brasil , Orçamentos/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Humanos , Programas Nacionais de Saúde/organização & administração , Setor Público/economia , Setor Público/legislação & jurisprudência , Setor Público/organização & administração
5.
BMC Health Serv Res ; 19(1): 354, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164130

RESUMO

BACKGROUND: We examined the utilization of rehabilitation resources among children with autism spectrum condition (ASC), a neurodevelopmental condition, in Taiwan. METHODS: We derived from the National Health Insurance Research Database of Taiwan data pertaining to 3- to 12-year-old children for the period 2008-2010. Based on diagnoses executed in accordance with the International Classification of Diseases, Ninth Revision, Clinical Modification, we classified these data into the ASC and non-ASC groups and analyzed them through multiple linear regression model, negative binomial model, independent sample t testing, and χ2 testing. RESULTS: Compared with the non-ASC group, the ASC group exhibited higher utilization of rehabilitation resources. Because hospitals are constrained by overall expenditure limits, expenditure on rehabilitation resources has plateaued, preventing any increase in the utilization of rehabilitation resources. In our ASC group, preschool-aged children significantly outnumbered (p < 0.001) school-aged children. When stratified by the hospital level, district hospitals reported the highest utilization (p < 0.001). When stratified by region, the highest utilization was in Taipei, whereas the lowest was in the East region (p < 0.001). The total annual cost, average frequency of visits, utilization of rehabilitation resources, and average cost were all affected by such elements as patient demographics, hospital type and location (p < 0.001). CONCLUSIONS: For improving treatment outcomes among children with ASC and decreasing treatment expenditure, policies that promote the timely ASC detection and treatment should be implemented.


Assuntos
Assistência Ambulatorial/economia , Transtorno Autístico , Gastos em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Pacientes Ambulatoriais , Transtorno Autístico/economia , Transtorno Autístico/reabilitação , Criança , Pré-Escolar , Bases de Dados Factuais , Feminino , Humanos , Revisão da Utilização de Seguros , Masculino , Taiwan
7.
Cancer Causes Control ; 30(8): 813-818, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31187351

RESUMO

PURPOSE: We estimated the costs and effectiveness of state programs in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) based on the type of delivery structure. METHODS: Programs were classified into three delivery structures: (1) centralized, (2) decentralized, and (3) mixed. Centralized programs offer clinical services in satellite offices, but all other program activities are performed centrally. Decentralized programs contract with other entities to fully manage and provide screening and diagnostic services and other program activities. Programs with mixed service delivery structures have both centralized and decentralized features. Programmatic costs were averaged over a 3 year period (2006-2007, 2008-2009, and 2009-2010). Effectiveness was defined in terms of the average number of women served over the 3 years. We report costs per woman served by program activity and delivery structure and incremental cost effectiveness by program structure and by breast/cervical services. RESULTS: Average costs per woman served were lowest for mixed program structures (breast = $225, cervical = $216) compared to decentralized (breast = cervical = $276) and centralized program structures (breast = $259, cervical = $251). Compared with decentralized programs, for each additional woman served, centralized programs saved costs of $281 (breast) and $284 (cervical). Compared with decentralized programs, for each additional woman served, mixed programs added an additional $109 cost for breast but saved $1,777 for cervical cancer. CONCLUSIONS: Mixed program structures were associated with the lowest screening and diagnostic costs per woman served and had generally favorable incremental costs relative to the other program structures.


Assuntos
Neoplasias da Mama/diagnóstico , Assistência à Saúde/economia , Detecção Precoce de Câncer/economia , Programas Nacionais de Saúde/economia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias da Mama/economia , Custos e Análise de Custo , Feminino , Promoção da Saúde/economia , Humanos , Programas de Rastreamento/economia , Estados Unidos , Neoplasias do Colo do Útero/economia
8.
BMC Health Serv Res ; 19(1): 360, 2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31174516

RESUMO

BACKGROUND: High medical expenditures serve as a major obstacle for many people trying to access healthcare. Our goals are to provide an updated and comprehensive description of each category of medical expenditure in inpatient and outpatient treatment, and to identify factors associated with medical expenditures. METHODS: A survey of the middle-aged and elderly was conducted in August 2016 in Beijing, China. Data were collected from 808 random samples. Each participant had reported at least one inpatient or outpatient treatment episode and was 45 years old or older, were collected. Chi-squared tests, t-tests, multivariate analysis, and a linear regression were conducted in the data analysis. RESULTS: A total of 452 and 734 subjects had at least one inpatient and outpatient treatment, respectively. Even though insurance covered a significant amount of the total cost, the remaining out-of-pocket cost was still high, possibly resulting in financial difficulties for a number of the subjects. Demographic and socioeconomic factors were found to be associated with various costs. CONCLUSIONS: Our findings suggest that the government may need to further adjust health care and health insurance systems to alleviate financial burdens caused by illness and improve the effective utilization of healthcare services.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde para Idosos/estatística & dados numéricos , Assistência Médica/estatística & dados numéricos , Programas Nacionais de Saúde/organização & administração , Idoso , Pequim/epidemiologia , Feminino , Serviços de Saúde para Idosos/economia , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Fatores Socioeconômicos
9.
Cancer Causes Control ; 30(8): 819-826, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31098856

RESUMO

PURPOSE: To estimate the cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS: Using a modified CISNET breast cancer simulation model, we estimated outcomes for women aged 40-64 years associated with three scenarios: breast cancer screening within the NBCCEDP, screening in the absence of the NBCCEDP (no program), and no screening through any program. We report screening outcomes, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and sensitivity analyses results. RESULTS: Compared with no program and no screening, the NBCCEDP lowers breast cancer mortality and improves QALYs, but raises health care costs. Base-case ICER for the program was $51,754/QALY versus no program and $50,223/QALY versus no screening. Probabilistic sensitivity analysis ICER for the program was $56,615/QALY [95% CI $24,069, $134,230/QALY] versus no program and $51,096/QALY gained [95% CI $26,423, $97,315/QALY] versus no screening. CONCLUSIONS: On average, breast cancer screening in the NBCCEDP was cost-effective compared with no program or no screening.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/economia , Programas Nacionais de Saúde/economia , Adulto , Neoplasias da Mama/economia , Análise Custo-Benefício , Feminino , Humanos , Programas de Rastreamento/economia , Pessoa de Meia-Idade , Anos de Vida Ajustados por Qualidade de Vida
11.
Rev Saude Publica ; 53: 39, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31066817

RESUMO

OBJECTIVE: To analyze the allocation of financial resources in the Brazilian Unified Health System (SUS) in the state of São Paulo by level of care, health region, source of funds and level of government. METHODS: This is an exploratory study based on 2014 data extracted from the Public Health Budget Database, presented in absolute terms, relative terms and per capita . RESULTS: In 2014, R$52.1 bi were spent on public health, 58.0% having corresponded to the expenditures of the municipalities and 42.0% to those of the state government. Regional per capita spending varied from R$561.75 to R$824.85. As for the per capita spending on primary health care, which represented 37.5% of the municipalities' total expenditure, the lowest value was found in the city of São Paulo and the highest, in Araçatuba. Campinas had the highest per capita expenditure on medium and high complexity care, while Presidente Prudente had the lowest. The highest regional percentage of the current net revenue spent on health was verified in Registro, and the lowest, in the city of São Paulo. CONCLUSIONS: The paradigm of the health sector's financing in São Paulo revealed that the expenditure on primary health care, level elected by health policy as strategic because it depends on coordination and integral health care in the attention networks, was not considered a priority in relation to the expenditure with the medium and high complexity, exposing the iniquities in the state's regions.


Assuntos
Alocação de Recursos para a Atenção à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Política de Saúde , Financiamento da Assistência à Saúde , Programas Nacionais de Saúde/economia , Brasil , Orçamentos/estatística & dados numéricos , Cidades , Financiamento Governamental/economia , Financiamento Governamental/estatística & dados numéricos , Humanos , Valores de Referência
12.
Rev Saude Publica ; 53: 50, 2019 May 20.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31116239

RESUMO

OBJECTIVE: To analyze the regional allocation of the resources from the Brazilian Popular Pharmacy Program, taking into account the relative availability of the program and the potential needs of the region. METHODS: Data from the National Health Survey of the Annual Report of Social Information and the administrative database of the program were used to create a non-parametric indicator of coverage using multiple data envelopment analysis technique. This indicator considers the relative availability of the program, taking into account equal access to equal needs (equity based on regional needs). The analysis of this indicator shows if the regions that most need pharmaceutical assistance are those that receive more resources from the Brazilian Popular Pharmacy Program. RESULTS: The states belonging to the richest regions of the country, Southeast and South, present wider relative coverage of the Brazilian Popular Pharmacy Program compared to poorer localities. In addition, the inequalities observed between locations are better explained by inefficiency in the transfer of resources to the basic component of pharmaceutical care than by the Brazilian Popular Pharmacy Program itself. According to the model, a 43.76% increase in the transfer to the basic component of pharmaceutical care would be required in order to improve equity, whereas the increase required by the Brazilian Popular Pharmacy Program is equivalent to 22.71%. CONCLUSIONS: Although the Brazilian Popular Pharmacy Program seeks to reduce the socioeconomic inequalities observed in access to pharmaceutical care, which integrates health care services, regional disparities in access to medicine persist. These regional differences are attributed mostly to allocation failures and problems in managing the conventional pharmaceutical care cycle provided through SUS pharmacies.


Assuntos
Medicamentos Essenciais/provisão & distribução , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Alocação de Recursos/estatística & dados numéricos , Brasil , Orçamentos/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Alocação de Recursos para a Atenção à Saúde/economia , Equidade em Saúde/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Valores de Referência , Alocação de Recursos/economia , Fatores Socioeconômicos , Análise Espacial
13.
Rev Lat Am Enfermagem ; 27: e3136, 2019 Apr 29.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31038630

RESUMO

OBJECTIVE: to analyze the time trend of surgical admissions by the Unified Health System according to hospital stay, costs and mortality by subgroups of surgical procedures in Brazil. METHOD: ecological study of time series. The variables surgical hospitalization, permanence, cost and mortality were obtained from the Department of Informatics of the Unified Health System. The trend analysis used the polynomial regression model. RESULTS: in nine years, 37,565,785 surgical admissions were recorded. The mean duration of surgical admissions was constant (p = 0.449); the mean stay (3.8 days) was decreasing and significant (p <0.01); the mean cost (389.16 dollars) and mortality (1.63%) were increasing and significant (p <0.01). In subgroups of eye, thoracic, oncological and other surgeries, the temporal evolution of surgeries was increasing and significant (p <0.05). In contrast, endocrine glands, digestive tract, genitourinary, breast, reconstruction and buco-maxillofacial surgeries showed a significant trend of decline (p <0.05). In the other subgroups, the trend was constant. CONCLUSION: evidence shows the trend of surgical admissions in the last decade in the country and provide subsidies for the efficient elaboration of public policies, planning and management towards universal coverage in surgical care.


Assuntos
Hospitalização/economia , Programas Nacionais de Saúde/economia , Procedimentos Cirúrgicos Operatórios/economia , Brasil/epidemiologia , Custos e Análise de Custo , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação , Programas Nacionais de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidade
15.
Int J Equity Health ; 18(1): 65, 2019 05 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064355

RESUMO

BACKGROUND: Universal health coverage (UHC) is growing as a national political priority, within the context of recently devolved decision-making processes in Kenya. Increasingly voices within these discussions are highlighting the need for actions towards UHC to focus on quality of services, as well as improving coverage through expansion of national health insurance fund (NHIF) enrolment. Improving health equity is one of the most frequently described objectives for devolution of health services. Previous studies, however, highlight the complexity and unpredictability of devolution processes, potentially contributing to widening rather than reducing disparities. Our study applied Tanahashi's equity model (according to availability, accessibility, acceptability, contact with and quality) to review perceived equity of health services by actors across the health system and at community level, following changes to the priority-setting process at sub-national levels post devolution in Kenya. METHODS: We carried out a qualitative study between March 2015 and April 2016, involving 269 key informant and in-depth interviews from different levels of the health system in ten counties and 14 focus group discussions with community members in two of these counties. Qualitative data were analysed using the framework approach. RESULTS: Our findings reveal that devolution in Kenya has focused on improving the supply side of health services, by expanding the availability, geographic and financial accessibility of health services across many counties. However, there has been limited emphasis and investment in promoting the demand side, including restricted efforts to promote acceptability or use of services. Respondents perceived that the quality of health services has typically been neglected within priority-setting to date. CONCLUSIONS: If Kenya is to achieve universal health coverage for all citizens, then county governments must address all aspects of equity, including quality. Through application of the Tanahashi framework, we find that community health services can play a crucial role towards achieving health equity.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Equidade em Saúde , Feminino , Grupos Focais , Humanos , Quênia , Masculino , Modelos Teóricos , Programas Nacionais de Saúde/economia , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Cobertura Universal do Seguro de Saúde
16.
Artigo em Inglês | MEDLINE | ID: mdl-30987264

RESUMO

This paper examines the capacity determination factors of medical services at a national level through the analysis of a mathematical model that maximizes social welfare, which consists of the consumption of private goods and the medical capacity provided by the society. A sensitivity analysis is conducted to investigate the impact of these factors on the medical capacity provided. Furthermore, a case example based on the data provided by the government is presented to discuss the results derived from the theoretical analysis. The results of the sensitivity analysis indicate that individual disposable income, the medical expenditure for each treatment, the level of premium payments, and substitution parameters have a positive impact on medical capacity, while the medical costs and preference parameter negatively affect medical capacity. The results of the correlation analysis based on the data of the case example are consistent with the findings of the theoretical analysis.


Assuntos
Seguro Saúde/economia , Programas Nacionais de Saúde/organização & administração , Honorários e Preços , Humanos , Modelos Organizacionais , Programas Nacionais de Saúde/economia
17.
Wien Med Wochenschr ; 169(11-12): 271-283, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30868427

RESUMO

BACKGROUND: Given limited resources compared to the demand for them, spending resources efficiently is important. Key methods applied for supporting efficient resource allocation are health economic evaluations. METHODS: Based on secondary literature, we analyze international challenges for using two types of economic evaluations-cost-effectiveness analysis and cost-utility analysis-in reimbursement decisions and reflect on them for the Austrian case. RESULTS: The main challenges with the application of economic evaluations are related to the methods, the decision-making culture, and the respective system. The challenges also apply to the Austrian Bismarck system, where almost no formal requirements for using economic evaluations exist, except on a case-by-case basis. Resource allocation in Austria hence occurs, for the most part, implicitly. CONCLUSION: One way forward towards more explicit efficiency considerations may be to consider more descriptive study types and foster capacity building, standardization of methods and presentation of results, and a mandatory detailed guideline.


Assuntos
Tomada de Decisões , Assistência à Saúde , Custos de Cuidados de Saúde , Alocação de Recursos , Áustria , Controle de Custos/economia , Análise Custo-Benefício/economia , Assistência à Saúde/economia , Humanos , Programas Nacionais de Saúde/economia , Alocação de Recursos/economia
19.
Rev Bras Epidemiol ; 22: e190006, 2019 Mar 14.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892469

RESUMO

INTRODUCTION: The lack of availability of the Therasuit Method by the Unified Health System associated with its high cost has led to the prosecution of this treatment. The study aimed to outline the profile of this judicialization, as well as to estimate the direct costs resulting from compliance with the deferred judicial decisions. METHOD: Weanalyzed the cases submitted to the Court of Justice of Rio de Janeiro between January 2013 and January 2017, in which the Therasuit Method was applied. Demographic, clinical, advocacy and legal data were extracted, as was the timing of the court's decision and the required technology budgets. RESULTS: Atotal of 11 processes was analyzed. The authors had a mean age of 6.8 years and a median of 6, the majority being male, and resident in thestate capital. Quadriparesis was the most reported condition. The gratuity of justice was requested by all, and the Public Defender's Officewas used by 9 of the 11 processes. The judicial decisions at first instance were considered. In all of processes there was application of the legal tool called guardianship. The time of the judicial decision was on average of 266.5 days with a median of 35.5. The deferral index was 90%, totaling an annual direct cost of R$501,894.09. DISCUSSION: The judicialization of this treatment can cause an unforeseen displacement of public funds, transgressing the principles of equity and the integrality of Unified Health System. CONCLUSION: It was observed a high rate of deferred processes, resulting in a high cost spent by the Public Power to attend a small portion of patients.


Assuntos
Paralisia Cerebral/terapia , Custos de Cuidados de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Modalidades de Fisioterapia/instrumentação , Adolescente , Brasil , Paralisia Cerebral/economia , Criança , Pré-Escolar , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Masculino , Programas Nacionais de Saúde/economia , Modalidades de Fisioterapia/economia
20.
BMC Health Serv Res ; 19(1): 196, 2019 Mar 28.
Artigo em Inglês | MEDLINE | ID: mdl-30922298

RESUMO

BACKGROUND: Ghana's National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana's NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. METHODS: The study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban). RESULTS: Rural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas. CONCLUSION: Different factors affect the perception of quality of services provided to rural and urban subscribers of Ghana's NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.


Assuntos
Atitude Frente a Saúde , Programas Nacionais de Saúde/normas , Adolescente , Adulto , Confiabilidade dos Dados , Assistência à Saúde/economia , Assistência à Saúde/normas , Demografia , Feminino , Gana , Gastos em Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Seguro Saúde/economia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Percepção , Opinião Pública , Qualidade da Assistência à Saúde , Saúde da População Rural/economia , Saúde da População Rural/normas , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/normas , Saúde da População Urbana/economia , Saúde da População Urbana/normas , Adulto Jovem
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