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2.
Cochrane Database Syst Rev ; 2: CD011512, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33617665

RESUMO

BACKGROUND: The strain on public resources to meet the healthcare needs of populations through publicly-provided health insurance programmes is increasing and many governments turn to private health insurance (PHI) to ease the pressure on government budgets. With the goal of improving access to basic health care for citizens through PHI programmes, several high-income countries have developed strong regulations for PHI schemes. Low- and middle-income countries have the opportunity to learn from this experience to optimise PHI. If poorly regulated, PHI can hardly achieve an adequate quantity or quality of population coverage, as can be seen in the USA where a third of adults younger than 65 years of age have no insurance, sporadic coverage or coverage that exposes them to high out-of-pocket healthcare costs. OBJECTIVES: To assess the effects of policies that regulate private health insurance on utilisation, quality, and cost of health care provided. SEARCH METHODS: In November 2019 we searched CENTRAL; MEDLINE; Embase; Sociological Abstracts and Social Services Abstracts; ICTRP; ClinicalTrials.gov; and Web of Science Core Collection for papers that have cited the included studies. This complemented the search conducted in February 2017 in IBSS; EconLit; and Global Health. We also searched selected grey literature databases and web-sites.  SELECTION CRITERIA: Randomised trials, non-randomised trials, interrupted time series (ITS) studies, and controlled before-after (CBA) studies conducted in any population or setting that assessed one or more of the following interventions that governments use to regulate private health insurance: legislation and licensing, monitoring, auditing, and intelligence. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed study eligibility, extracted data, and assessed risk of bias and certainty of the evidence resolving discrepancies by consensus. We planned to summarise the results (using random-effects or fixed-effect meta-analysis) to produce an overall summary if an average intervention effect across studies was considered meaningful, and we would have discussed the implications of any differences in intervention effects across studies. However, due to the nature of the data obtained, we have provided a narrative synthesis of the findings. MAIN RESULTS: We included seven CBA studies, conducted in the USA, and that directly assessed state laws on cancer screening. Only for-profit PHI schemes were addressed in the included studies and no study addressed other types of PHI (community and not for-profit). The seven studies were assessed as having 'unclear risk' of bias. All seven studies reported on utilisation of healthcare services, and one study reported on costs. None of the included studies reported on quality of health care and patient health outcomes. We assessed the certainty of evidence for patient health outcomes, and utilisation and costs of healthcare services as very low. Therefore, we are uncertain of the effects of government mandates on for-profit PHI schemes. AUTHORS' CONCLUSIONS: Our review suggests that, from currently available evidence, it is uncertain whether policies that regulate private health insurance have an effect on utilisation of healthcare services, costs, quality of care, or patient health outcomes. The findings come from studies conducted in the USA and might therefore not be applicable to other countries; since the regulatory environment could be different. Studies are required in countries at different income levels because the effects of government regulation of PHI are likely to differ across these income and health system settings. Further studies should assess the different types of regulation (including regulation and licensing, monitoring, auditing, and intelligence). While regulatory research on PHI remains relatively scanty, future research can draw on the rich body of research on the regulation of other health financing interventions such as user fees and results-based provider payments.


Assuntos
Regulamentação Governamental , Seguro Saúde/legislação & jurisprudência , Setor Privado/legislação & jurisprudência , Governo Estadual , Viés , Neoplasias Colorretais/diagnóstico , Estudos Controlados Antes e Depois/estatística & dados numéricos , Feminino , Custos de Cuidados de Saúde , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Seguro Saúde/economia , Masculino , Setor Privado/economia , Neoplasias da Próstata/diagnóstico , Estados Unidos , Neoplasias do Colo do Útero/diagnóstico
3.
PLoS One ; 15(12): e0241555, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33362249

RESUMO

BACKGROUND: Availability of essential medicines for non-communicable diseases (NCDs) is poor in low- and middle-income countries. Availability and cost are conventionally assessed using cross-sectional data. However, these characteristics may vary over time. METHODS: We carried out a prospective, descriptive analysis of the availability and cost of essential medicines in 23 Ugandan health facilities over a five-week period. We surveyed facility pharmacies in-person up to five times, recording availability and cost of 19 essential medicines for NCDs and four essential medicines for communicable diseases. RESULTS: Availability of medicines varied substantially over time, especially among public facilities. Among private-for-profit facilities, the cost of the same medicine varied from week to week. Private-not-for-profit facilities experienced less dramatic fluctuations in price. CONCLUSIONS: We conclude that there is a need for standardized, continuous monitoring to better characterize the availability and cost of essential medicines, understand demand for these medicines, and reduce uncertainty for patients.


Assuntos
Custos de Medicamentos , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Doenças não Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/tratamento farmacológico , Doenças Transmissíveis/economia , Custos de Medicamentos/tendências , Instalações de Saúde/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/tendências , Humanos , Doenças não Transmissíveis/economia , Setor Privado/economia , Estudos Prospectivos , Setor Público/economia , Inquéritos e Questionários , Fatores de Tempo , Uganda
4.
PLoS One ; 15(10): e0241017, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104705

RESUMO

BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.


Assuntos
Pessoal Administrativo/psicologia , Betacoronavirus , Infecções por Coronavirus , Recessão Econômica , Setor de Assistência à Saúde/economia , Administradores de Instituições de Saúde/psicologia , Pessoal de Saúde/psicologia , Pandemias , Pneumonia Viral , Setor Privado/economia , Setor Público/economia , Instituições de Assistência Ambulatorial/economia , Atitude do Pessoal de Saúde , Brasil , Serviços de Saúde Comunitária/economia , Países em Desenvolvimento , Humanos , Reembolso de Seguro de Saúde , Entrevistas como Assunto , Médicos/psicologia , Pesquisa Qualitativa , Telemedicina , Desemprego
6.
S Afr Med J ; 110(2): 88-91, 2020 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-32657675

RESUMO

The Competition Commission's Health Market Inquiry (HMI) is the most systematic and comprehensive investigation carried out into the South African private health sector. The recommendations as set out in the HMI Final Report merit extensive discussion and debate, as they could - if implemented - have far-reaching consequences for the future of the healthcare system. The objective of this article is to contribute to this discussion by providing an overview of the key findings and recommendations of the HMI and highlighting the resultant key imperatives at this critical juncture of policy development.


Assuntos
Assistência à Saúde/organização & administração , Competição Econômica , Setor de Assistência à Saúde/organização & administração , Setor Privado/organização & administração , Assistência à Saúde/economia , Setor de Assistência à Saúde/economia , Política de Saúde , Humanos , Setor Privado/economia , África do Sul
7.
S Afr Med J ; 110(4): 274-283, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657738

RESUMO

BACKGROUND: Over the past 18 years, the South African (SA) Ministry of Health has committed to allocate 2% of the national health budget to research, while the National Health Research Policy (2001) proposed that the health research budget should be 2% of total public sector health expenditure. A review was conducted by the National Health Research Committee (NHRC) in 2014 to determine whether these goals had been met, using available data up to 2009/10. It revealed that public sector health research funding remained below 2% of the national health budget, supporting the perception of reduced public sector health research funding. OBJECTIVES: To provide an update on the previous review to investigate changes in the health research landscape since 2009/10 and whether goals have been met. METHODS: Various publicly available sources of information on public and private expenditure on health research in SA were used to investigate health research funding and expenditure. In addition, questionnaires were sent to 35 major national and international funders of health research in SA to obtain data on the level of funding provided and the fields of research funded. RESULTS: Total health research expenditure in SA was ZAR6.9 billion in 2016/17, or 19.2% of gross expenditure on research and development, with 1.7% of the ZAR38.6 billion National Department of Health budget from National Treasury being spent on health research through the South African Medical Research Council (ZAR658 million), corresponding to 0.4% of the consolidated government expenditure on health. However, although the total government plus science council spend on health research in 2016/17 was ZAR1.45 billion, this represents just 0.033% of the gross domestic product (GDP), thus remaining well below the aspirational target of 0.15% of the GDP set by the NHRC in 2014. Based on feedback from the funders, the estimated baseline health research funding in 2016/17 was in excess of ZAR4.1 billion, which is considerably higher than many researchers may realise. Three-quarters of this funding originated from foreign sources, suggesting both strengths and opportunities for health research in SA, but also highlighting increasing dependence on foreign funding. Notably, the majority of funders approached were not able to readily break down expenditure according to disease area. CONCLUSIONS: Health research funding has changed significantly since our previous review, although the government's own commitments to it remain unmet. Improved mechanisms to track health research expenditure are urgently required for better alignment of funding priorities and increased co-ordination between science councils in health research funding.


Assuntos
Pesquisa Biomédica/economia , Governo , Gastos em Saúde/tendências , Apoio à Pesquisa como Assunto/economia , Pesquisa Biomédica/tendências , Orçamentos , Educação/economia , Humanos , Organizações/economia , Organizações sem Fins Lucrativos/economia , Setor Privado/economia , Setor Público/economia , Apoio à Pesquisa como Assunto/tendências , África do Sul
8.
BMC Public Health ; 20(1): 880, 2020 06 08.
Artigo em Inglês | MEDLINE | ID: mdl-32513131

RESUMO

BACKGROUND: The dynamic intersection of a pluralistic health system, large informal sector, and poor regulatory environment have provided conditions favourable for 'corruption' in the LMICs of south and south-east Asia region. 'Corruption' works to undermine the UHC goals of achieving equity, quality, and responsiveness including financial protection, especially while delivering frontline health care services. This scoping review examines current situation regarding health sector corruption at frontlines of service delivery in this region, related policy perspectives, and alternative strategies currently being tested to address this pervasive phenomenon. METHODS: A scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was conducted, using three search engines i.e., PubMed, SCOPUS and Google Scholar. A total of 15 articles and documents on corruption and 18 on governance were selected for analysis. A PRISMA extension for Scoping Reviews (PRISMA-ScR) checklist was filled-in to complete this report. Data were extracted using a pre-designed template and analysed by 'mixed studies review' method. RESULTS: Common types of corruption like informal payments, bribery and absenteeism identified in the review have largely financial factors as the underlying cause. Poor salary and benefits, poor incentives and motivation, and poor governance have a damaging impact on health outcomes and the quality of health care services. These result in high out-of-pocket expenditure, erosion of trust in the system, and reduced service utilization. Implementing regulations remain constrained not only due to lack of institutional capacity but also political commitment. Lack of good governance encourage frontline health care providers to bend the rules of law and make centrally designed anti-corruption measures largely in-effective. Alternatively, a few bottom-up community-engaged interventions have been tested showing promising results. The challenge is to scale up the successful ones for measurable impact. CONCLUSIONS: Corruption and lack of good governance in these countries undermine the delivery of quality essential health care services in an equitable manner, make it costly for the poor and disadvantaged, and results in poor health outcomes. Traditional measures to combat corruption have largely been ineffective, necessitating the need for innovative thinking if UHC is to be achieved by 2030.


Assuntos
Fraude/economia , Setor de Assistência à Saúde/organização & administração , Política de Saúde/economia , Setor Privado/economia , Setor Público/economia , Ásia , Países em Desenvolvimento , Governo , Pessoal de Saúde/economia , Humanos , Renda , Assistência Médica/economia , Características de Residência
10.
Occup Med (Lond) ; 70(4): 251-258, 2020 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-32421800

RESUMO

BACKGROUND: Workplace bullying is a pervasive problem with significant personal, social and economic costs. Estimates of the resulting lost productivity provide an important societal perspective on the impact of the problem. Understanding where these economic costs fall is relevant for policy. AIMS: We estimated the value of lost productivity to the economy from workplace bullying in the public and private sectors in Ireland. METHODS: We used nationally representative survey data and multivariable negative binomial regression to estimate the independent effect of workplace bullying on days absent from work. We applied the human capital approach to derive an estimate of the annual value of lost productivity due to bullying by sector and overall, in 2017. RESULTS: Bullying was independently associated with an extra 1.00 (95% CI: 0.38-1.62) days absent from work over a 4-week period. This differed for public and private sector employees: 0.69 (95% CI: -0.12 to 1.50) versus 1.45 (95% CI: 0.50-2.40) days respectively. Applying official data, we estimated the associated annual value of lost productivity to be €51.8 million in the public sector, €187.6 million in the private sector and €239.3 million overall. CONCLUSIONS: The economic value of lost productivity from workplace bullying in Ireland is significant. Although bullying is more prevalent in the public sector, it has a larger effect on absence in the private sector. Given this, along with the greater overall share of employees, productivity losses from bullying are considerably larger in the private sector in Ireland.


Assuntos
Bullying/estatística & dados numéricos , Eficiência Organizacional/economia , Setor Privado/economia , Setor Público/economia , Local de Trabalho/economia , Adulto , Feminino , Humanos , Irlanda/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Local de Trabalho/psicologia
11.
Am J Clin Nutr ; 111(6): 1278-1285, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32412583

RESUMO

BACKGROUND: Many lower-income communities in the United States lack a full-line grocery store. There is evidence that the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) increases the availability of healthy foods in stores. One national discount variety store chain (DVS) that is often located in low-income neighborhoods became an authorized WIC vendor in 8 pilot stores. OBJECTIVES: The objective of this study was to evaluate how implementing WIC in DVS pilot stores affected sales of healthy, WIC-eligible foods. METHODS: We used DVS sales data and difference-in-differences regression to evaluate how WIC authorization affected sales of WIC-eligible foods in 8 DVS pilot stores, compared with 8 matched comparison stores. RESULTS: DVS added 18 new WIC-approved foods to become an authorized vendor. Results indicate that becoming a WIC vendor significantly increased sales of healthy, WIC-eligible foods that DVS carried before authorization. WIC implementation in DVS led to a 31-unit increase in sales of the original WIC foods per week on average (P < 0.01). Lower socioeconomic status, assessed using a summary measure, is associated with increased sales of WIC foods. Yet sales of non-WIC eligible foods (e.g., salty snack foods, candy bars, soda, and processed meats) were not affected by WIC authorization. CONCLUSIONS: Encouraging DVS stores to become WIC-authorized vendors has the potential to modestly increase DVS sales and the availability of healthy foods in low-income neighborhoods. If WIC authorization is financially viable for small-format variety stores, encouraging similar small-format variety stores to become WIC-authorized has the potential to improve food access.


Assuntos
Assistência Alimentar/economia , Abastecimento de Alimentos/economia , Alimentos/economia , Setor Privado/economia , Comércio/legislação & jurisprudência , Feminino , Assistência Alimentar/legislação & jurisprudência , Abastecimento de Alimentos/legislação & jurisprudência , Promoção da Saúde/economia , Humanos , Masculino , Pobreza , Autorização Prévia , Setor Privado/legislação & jurisprudência , Estados Unidos
12.
BMC Health Serv Res ; 20(1): 290, 2020 Apr 07.
Artigo em Inglês | MEDLINE | ID: mdl-32264964

RESUMO

BACKGROUND: South Africa's divided healthcare system is believed to be inequitable as the population serviced by each sector and the treatment received differs while annual healthcare expenditure is similar. The appropriateness of treatment received and in particular the cost of the same treatment between the sectors remains debatable and raises concerns around equitable healthcare. Colorectal cancer places considerable pressure on the funders, yet treatment utilization data and the associated costs of non-communicable diseases, in particular colorectal cancer, are limited for South Africa. Resources need to be appropriately managed while ensuring equitable healthcare is provided regardless of where the patient is able to receive their treatment. Therefore the aim of this study was to determine the cost of colorectal cancer treatment in a privately insured patient population in order to compare the costs and utilization to a previously published public sector patient cohort. METHODS: Private sector costs were determined using de-identified claim-based data for all newly diagnosed CRC patients between 2012 and 2014. The costs obtained from this patient cohort were compared to previously published public sector data for the same period. The costs compared were costs incurred by the relevant sector funder and didn't include out-of-pocket costs. RESULTS: The comparison shows private sector patients gain access to more of the approved regimens (12 vs. 4) but the same regimens are more costly, for example CAPOX costs approximately €150 more per cycle. The cost difference between 5FU and capecitabine monotherapy is less than €30 per cycle however, irinotecan is cheaper in comparison to oxaliplatin in the private sector (FOLFOX approx. €500 vs. FOLFIRI aprox. €460). Administrative costs account for up to 45% of total costs compared to the previously published data of these costs totaling < 15% of the full treatment cost in South Africa's public healthcare system. CONCLUSION: This comparison highlights the disparities between sectors while illustrating the need for further research to improve resource management to attain equitable healthcare.


Assuntos
Neoplasias Colorretais/economia , Neoplasias Colorretais/terapia , Custos de Cuidados de Saúde/estatística & dados numéricos , Setor Privado/economia , Setor Público/economia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , África do Sul , Adulto Jovem
13.
Ophthalmology ; 127(4): 445-455, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32067797

RESUMO

PURPOSE: To identify temporal and geographic trends in private equity (PE)-backed acquisitions of ophthalmology and optometry practices in the United States. DESIGN: A cross-sectional study using private equity acquisition and investment data from January 1, 2012, through October 20, 2019. PARTICIPANTS: A total of 228 PE acquisitions of ophthalmology and optometry practices in the United States between 2012 and 2019. METHODS: Acquisition and financial investment data were compiled from 6 financial databases, 4 industry news outlets, and publicly available press releases from PE firms or platform companies. MAIN OUTCOME MEASURES: Yearly trends in ophthalmology and optometry acquisitions, including number of total acquisitions, clinical locations, and providers of acquired practices as well as subsequent sales, median holding period, geographic footprint, and financing status of each platform company. RESULTS: A total of 228 practices associated with 1466 clinical locations and 2146 ophthalmologists or optometrists were acquired by 29 PE-backed platform companies. Of these acquisitions, 127, 9, and 92 were comprehensive or multispecialty, retina, and optometry practices, respectively. Acquisitions increased rapidly between 2012 and 2019: 42 practices were acquired between 2012 and 2016 compared to 186 from 2017 through 2019. Financing rounds of platform companies paralleled temporal acquisition trends. Three platform companies, comprising 60% of platforms formed before 2016, were subsequently sold or recapitalized to new PE investors by the end of this study period with a median holding period of 3.5 years. In terms of geographic distribution, acquisitions occurred in 40 states with most PE firms developing multistate platform companies. New York and California were the 2 states with the greatest number of PE acquisitions with 22 and 19, respectively. CONCLUSIONS: Private equity-backed acquisitions of ophthalmology and optometry practices have increased rapidly since 2012, with some platform companies having already been sold or recapitalized to new investors. Additionally, private equity-backed platform companies have developed both regionally focused and multistate models of add-on acquisitions. Future research should assess the impact of PE investment on patient, provider, and practice metrics, including health outcomes, expenditures, procedural volume, and staff employment.


Assuntos
Administração Financeira/tendências , Oftalmologia/tendências , Optometria/tendências , Setor Privado/tendências , Prática Profissional/tendências , Estudos Transversais , Bases de Dados Factuais , Administração Financeira/economia , Geografia , Humanos , Oftalmologistas/estatística & dados numéricos , Oftalmologia/economia , Optometristas/estatística & dados numéricos , Optometria/economia , Setor Privado/economia , Estados Unidos
14.
World Neurosurg ; 135: e716-e722, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899389

RESUMO

BACKGROUND: Anterior lumbar interbody fusion (ALIF) is a commonly performed surgical procedure for the management of degenerative lumbar spine pathologic entities. Despite an increasing number of ALIFs performed nationally, to the best of our knowledge, no study has evaluated the costs associated with the 90-day episode of care postoperatively. METHODS: The 2007-2016 Humana Administrative Claims data set, a national database of commercial and Medicare Advantage (MA) beneficiaries, was queried using Current Procedural Terminology code 22558 for patients who had undergone single-level ALIF. The 90-day costs were defined using the following categories: facility, surgeon, anesthesia, other hospitalization costs and services, radiology, office visits, physical therapy/rehabilitation, emergency department visits, and readmissions. RESULTS: A total of 365 ALIF procedures (MA, n = 244; commercial, n = 121) were included in the analysis. The average 90-day cost of single-level ALIF was $25,568 and $51,741 for the MA and commercial enrollees, respectively. The major proportion of 90-day costs was attributable to facility reimbursement (74%-76%), followed by surgeon costs (9%-11%). Postacute care (i.e., office visits and physical therapy/rehabilitation) was not a major driver of the 90-day costs, consisting of only 0.7%-1.3% of the total 90-day reimbursement. Of patients who had required readmission, the costs of the readmission increased the average 90-day costs by 65%-66%. CONCLUSIONS: Facility costs were the major drivers of a stipulated 90-day reimbursement for patients undergoing single-level ALIF. Health policy makers and providers can use these data to better understand the distribution of costs in a stipulated bundled-payment model for ALIFs and allow them to identify areas in which cost reduction strategies can be performed.


Assuntos
Degeneração do Disco Intervertebral/cirurgia , Vértebras Lombares/cirurgia , Fusão Vertebral/métodos , Custos e Análise de Custo , Assistência à Saúde/economia , Cuidado Periódico , Instalações de Saúde/economia , Custos Hospitalares , Humanos , Degeneração do Disco Intervertebral/economia , Medicare/economia , Readmissão do Paciente/economia , Setor Privado/economia , Estudos Retrospectivos , Fusão Vertebral/economia , Cirurgiões/economia , Estados Unidos
15.
Inquiry ; 56: 46958019887572, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31823665

RESUMO

The aim of this study was to evaluate the availability, price, and affordability of essential noncommunicable disease (NCD) medicines in Nepal. A cross-sectional survey was conducted in Nepal in 2015 using World Health Organization/Health Action International (WHO/HAI) methodology. We collected data on the availability and price of 60 essential NCD medicines from medicine distribution outlets in both the public and private health care sectors in 6 regions. Essential NCD medicines were more available in the private sector (78%) than the public sector (60%). Furosemide tablets were the cheapest (NPR 0.6/10 tablets) and streptokinase injections were the most expensive (NPR 2200/vial) drugs. There was no significant difference (P > .05) in availability and affordability of essential NCD medicines across the 6 survey areas. Treating selected NCD conditions with medicines was generally affordable, with 1 month of treatment costing no more than a day's wage of the lowest paid unskilled government worker. The lower availability of NCD medicines in the public sector limits the effectiveness of the government's policy of providing free health services at public facilities. Although NCD medicines were generally affordable, future health policy should aim to ensure improved equitable access to NCD medicines, particularly in public facilities.


Assuntos
Medicamentos Essenciais/economia , Honorários Farmacêuticos/estatística & dados numéricos , Acesso aos Serviços de Saúde/economia , Doenças não Transmissíveis/economia , Estudos Transversais , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Nepal , Doenças não Transmissíveis/terapia , Preparações Farmacêuticas/economia , Setor Privado/economia , Setor Público/economia
16.
J Glob Oncol ; 5: 1-17, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31860377

RESUMO

PURPOSE: The population of Chile has aged, and in 2017, cancer became the leading cause of death. Since 2005, a national health program has expanded coverage of drugs for 13 types of cancer and related palliative care. We describe the trends in public and private oncology drug expenditures in Chile and consider how increasing expenditures might be addressed. METHODS: We analyzed total quarterly drug expenditures for 131 oncology drugs from quarter (Q)3 2012 until Q1 2017, including public and private insurance payments and patient out-of-pocket spending. The data were analyzed by drug-mix, sources of funding, growth, and intellectual property status. The Laspeyres Price Index was used to analyze expenditure growth. RESULTS: We found 131 oncology drugs associated with 87,129 observations. Spending on drugs rose 120% from the first period, spanning from the first 3 quarters (Q3, Q4, Q1 2012-2013) to the last period (Q3, Q4, Q1 2016-2017), corresponding to an annualized rate of 19.2% and totaling US$398 million (in 2017 dollars). The public sector accounted for 84.2% of spending, which included 50 drugs in the official treatment protocols, whereas private insurance accounted for 7.3% in on-protocol drugs. The remaining 8.5% was paid out of pocket. In the public sector, more than 90% of growth resulted from increased use. Seven drugs, including 3 with nonexpired patents, accounted for 50% of total expenditures. CONCLUSION: Increased use and access enabled by expanded public expenditures drove most of the growth in oncology drug expenditures. However, the rate of public expenditure growth may be fiscally unsustainable. Policies are urgently needed to promote the use of generic drugs, the appropriate mix of on-protocol versus off-protocol drugs, and the curbing of off-label prescribing.


Assuntos
Antineoplásicos/economia , Assistência à Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Neoplasias/economia , Setor Privado/economia , Setor Público/economia , Idoso , Antineoplásicos/uso terapêutico , Chile , Financiamento Governamental , Financiamento Pessoal/economia , Gastos em Saúde , Humanos , Programas Nacionais de Saúde/organização & administração
17.
PLoS One ; 14(12): e0226169, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31834889

RESUMO

OBJECTIVES: To explore availability, prices and affordability of essential medicines for diabetes and hypertension treatment in private pharmacies in three provinces of Zambia. METHODS: A cross-sectional survey was conducted in 99 pharmacies across three Zambian provinces. Methods were based on a standardized methodology by the World Health Organization and Health Action International. Availability was analysed as mean availability per pharmacy and individual medicine. Median prices were compared to international reference prices and differences in price between medicine forms (original brand or generic product) were computed. Affordability was assessed as number of days' salaries required to purchase a standard treatment course using the absolute poverty line and mean per capita provincial household income as standard. An analysis identifying medicines considered both available and affordable was conducted. RESULTS: Two antidiabetics and nine antihypertensives had high-level availability (≥80%) in all provinces; availability levels for the remaining surveyed antidiabetics and antihypertensives were largely found below 50%. Availability further varied markedly across medicines and medicine forms. Prices for most medicines were higher than international reference prices and great price variations were found between pharmacies, medicines and medicine forms. Compared to original brand products, purchase of generics was associated with price savings for patients between 21.54% and 96.47%. No medicine was affordable against the absolute poverty line and only between four and eleven using mean per capita provincial incomes. Seven generics in Copperbelt/Lusaka and two in Central province were highly available and affordable. CONCLUSIONS: The study showed that the majority of surveyed antidiabetic and antihypertensive medicines was inadequately available (<80%). In addition, most prices were higher than their international reference prices and that treatment with these medicines was largely unaffordable against the set affordability thresholds. Underlying reasons for the findings should be explored as a basis for targeted policy initiatives.


Assuntos
Anti-Hipertensivos/provisão & distribução , Comércio/economia , Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hipoglicemiantes/provisão & distribução , Farmácias/economia , Setor Privado/economia , Anti-Hipertensivos/economia , Custos e Análise de Custo , Estudos Transversais , Diabetes Mellitus/tratamento farmacológico , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Medicamentos Essenciais/economia , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/economia , Hipertensão/epidemiologia , Hipoglicemiantes/economia , Zâmbia/epidemiologia
18.
Ciênc. Saúde Colet ; 24(12): 4579-4586, dez. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1055763

RESUMO

Resumen El presente artículo indaga sobre la participación popular en salud en barrios de la periferia de La Plata (Argentina) en un contexto de vaciamiento de las políticas sociales de acuerdo a las normativas neoliberales que rigen con fuerza creciente en el país y en el continente. En este marco de crisis económica que afecta particularmente a la salud pública, los movimientos sociales se organizan para defenderla, al mismo tiempo que resisten el empobrecimiento cotidiano y construyen alternativas de salud popular y colectiva. El trabajo, sostenido en una investigación etnográfica, se propone reconstruir los modos en que los sujetos reconfiguran los modos de pensar la salud y la participación política en la vida cotidiana de los territorios a través de distintas tácticas y estrategias de cuidado y construcción político-comunitarias.


Abstract This article investigates the popular participation in health in neighborhoods of the periphery of La Plata (Argentina) in a context of emptying of social policies according to the neo-liberal regulations that govern with increasing force in the country and in the continent. In this framework of economic crisis that especially affects public health, social movements are organized to defend, while resisting daily impoverishment and building popular and collective health alternatives. The work, sustained in an ethnographic investigation, aims to reconstruct the ways in which the subjects reconfigure the ways of thinking about health and political participation in the daily life of the territories through different tactics and strategies of care and community-political construction.


Assuntos
Humanos , Política , Justiça Social , Características de Residência , Saúde Pública , Participação da Comunidade/métodos , Recessão Econômica , Argentina , Setor Público/economia , Setor Público/organização & administração , Setor Privado/economia , Pesquisa Qualitativa , Direito à Saúde/tendências , Promoção da Saúde/métodos , Acesso aos Serviços de Saúde , Seguro Saúde/economia , Seguro Saúde/organização & administração , Antropologia Cultural , Programas Nacionais de Saúde/organização & administração
19.
New Bioeth ; 25(4): 349-358, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31702479

RESUMO

The use of human biological materials (HBMs) involves a number of issues from both an ethical and a legal point of view. In recent decades, the purposes for which this material has been used have increased. The development of therapeutic products has led to the configuration of a market in which products have acquired an economic value. As soon as the private sector crosses the threshold of access to the use of human cells and tissues, a conflict may arise between the altruistic principles motivating the act of donation and the profit-making objectives . When donated material emerges from the public management setting and becomes a source of profit, the instrument of informed consent may not adequately protect the dignity of the donors. In the era of medical biotechnology revolution, any use of the donated material must be justified and consistent with the values motivating the act of donation.


Assuntos
Altruísmo , Bancos de Espécimes Biológicos , Mercantilização , Consentimento Livre e Esclarecido , Setor Privado , Doadores de Tecidos , Obtenção de Tecidos e Órgãos , Bancos de Espécimes Biológicos/economia , Bancos de Espécimes Biológicos/ética , Biotecnologia , União Europeia , Objetivos , Humanos , Pessoalidade , Setor Privado/economia , Setor Privado/ética , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/ética
20.
Cien Saude Colet ; 24(12): 4579-4586, 2019 Dec.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-31778507

RESUMO

This article investigates the popular participation in health in neighborhoods of the periphery of La Plata (Argentina) in a context of emptying of social policies according to the neo-liberal regulations that govern with increasing force in the country and in the continent. In this framework of economic crisis that especially affects public health, social movements are organized to defend, while resisting daily impoverishment and building popular and collective health alternatives. The work, sustained in an ethnographic investigation, aims to reconstruct the ways in which the subjects reconfigure the ways of thinking about health and political participation in the daily life of the territories through different tactics and strategies of care and community-political construction.


Assuntos
Participação da Comunidade/métodos , Recessão Econômica , Política , Saúde Pública , Características de Residência , Justiça Social , Antropologia Cultural , Argentina , Promoção da Saúde/métodos , Acesso aos Serviços de Saúde , Humanos , Seguro Saúde/economia , Seguro Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Setor Privado/economia , Setor Público/economia , Setor Público/organização & administração , Pesquisa Qualitativa , Direito à Saúde/tendências
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