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Colombia is among the countries with the most robust financial protection against personal health spending in the world, with out-of-pocket spending ranking lowest across OECD countries. We investigate the evolution, distribution, and persistence of health spending by age group, sex, health care setting, health condition and geographic region for over 19 million users of Colombia's health system between 2013 and 2021 (contributory scheme). We use average patient-level expenditure data from the Health-Promoting Entities of the Ministry of Health and Social Protection. We applied multivariate statistical techniques such as multiple correspondence analysis, factor maps and correlations. For both sexes, average health expenditure increases gradually with age until 60 years, accelerating thereafter abruptly. Health conditions with the highest percentage of expenditure were those related to neoplasms, blood diseases, circulatory system, pregnancy, puerperium and perinatal period. We found that home-based care in Amazonía-Orinoquía is almost non-existent, and that outpatient care represents a high proportion in all age groups (over 65%) compared to the other regions. There is a strong persistence of expenditure from one year to the next (i.e. they can provide relevant information for prediction), especially in areas with a larger supply of health services such as Bogotá-Cundinamarca. To the authors' knowledge, this is the most comprehensive and detailed micro-analysis of health spending that has been developed for a Latin American country to date.
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Gastos en Salud , Colombia , Humanos , Gastos en Salud/estadística & datos numéricos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Adolescente , Preescolar , Adulto Joven , Lactante , Niño , Recién NacidoRESUMEN
OBJECTIVES: Although catastrophic health spending is the main measure for assessing financial healthcare protection, it varies considerably in methodological and empirical terms, which hinders comparison between studies. The aim of this study was to measure the prevalence of catastrophic health spending in Brazil in 2003, 2009, and 2018, its associated factors, and disparities in prevalence distribution according to socioeconomic status. STUDY DESIGN: This was a time series study. METHODS: Data from the Household Budget Surveys were used. Prevalence of catastrophic health spending was measured as a percentage of the budget and ability to pay, considering thresholds of 10, 25, and 40%. It was determined whether household, family, and household head characteristics influence the likelihood of incurring catastrophic health spending. Households were stratified by income deciles, consumption, and wealth score. RESULTS: There was an increase in prevalence of catastrophic health spending between 2003 and 2009 in Brazil and a slight reduction in 2018. The wealth score showed more pronounced distributional effects between the poor and the rich, with the former being the most affected by catastrophic health spending. Consumption showed greater percentage variations in the prevalence of catastrophic health spending. The prevalence of catastrophic health spending was positively associated with the presence of older adults, age and female household head, rural area, receipt of government benefits, and some degree of food insecurity. CONCLUSIONS: The poorest families are most affected by catastrophic health spending in Brazil, requiring more effective and equitable policies to mitigate financial risk.
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The rise in obesity and related chronic noncommunicable diseases (NCDs) during recent decades in Brazil has been associated with increases in the financial burden and risk of impoverishment due to out-of-pocket (OOP) health expenditure. Thus, this study investigated trends and predictors associated with impoverishment due to health expenditure, in the population of São Paulo city, Brazil, between 2003 and 2015. Household data from the São Paulo Health Survey (n = 5475) were used to estimate impoverishment linked to OOP health expenses, using the three thresholds of International Poverty Lines (IPLs) defined by the World Bank at 1.90, 3.20, and 5.50 dollars per capita per day purchasing power parity (PPP) in 2011. The results indicated a high incidence of impoverishment due to OOP disbursements for health care throughout the period, predominantly concentrated among low-income individuals. Lifestyle choices referring to leisure-time physical activity (OR = 0.766 at $3.20 IPL, and OR = 0.789 at $5.50 IPL) were linked to reduction in the risk for impoverishment due to OOP health expenditures whilst there were increases in the probability of impoverishment due to cardiometabolic risk factors referring to obesity (OR = 1.588 at $3.20 IPL, and OR = 1.633 at $5.50 IPL), and diagnosis of cardiovascular diseases (OR = 2.268 at $1.90 IPL, OR = 1.967 at $3.20 IPL, and OR = 1.936 at $5.50 IPL). Diagnosis of type 2 diabetes mellitus was associated with an increase in the probability of impoverishment at only the $1.90 IPL (OR = 2.506), whilst coefficients for high blood pressure presented lack of significance in the models. Health policies should focus on interventions for prevention of obesity to ensure the financial protection of the population in São Paulo city, Brazil, especially targeting modifiable lifestyle choices like promotion of physical activity and reduction of tobacco use.
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Factores de Riesgo Cardiometabólico , Gastos en Salud , Estilo de Vida , Humanos , Brasil/epidemiología , Gastos en Salud/estadística & datos numéricos , Adulto , Persona de Mediana Edad , Femenino , Masculino , Adulto Joven , Pobreza/estadística & datos numéricos , Adolescente , Anciano , Factores de Riesgo , Obesidad/epidemiología , Obesidad/economíaRESUMEN
Safe drinking water availability is a concern in Haiti. Public systems have limited coverage and reliability. Private wells and local water sources are often of unknown or poor quality. Public health events, such as the 2010 cholera outbreak, demonstrate vulnerability to water contamination. To address these concerns, a drinking water laboratory was established at the Campus Henri Christophe in Limonade, a branch of the State University of Haiti, to meet water testing demands from local clients such as for-profit kiosks, institutions, industries, and municipal water systems. This study assessed the financial viability of a university-based drinking water laboratory in Haiti by calculating Internal Rate of Return and Net Present Value. Sensitivity analysis was used to identify the range of conditions under which laboratory revenues would cover operating costs. To achieve an acceptable profitability level, the laboratory must perform microbiological testing for routine monitoring samples and test an average of five samples per day. Price-based incentives for new clients have relatively small impacts on profitability. Finally, international and Haitian inflation cause some variation in profitability. These economic factors will be among the key drivers of laboratory operation costs. The results underscore the main factors that must be considered to make the laboratory successful and the importance of strategic marketing for laboratory managers to encourage clients to regularly test drinking water and emphasize microbiological testing.
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BACKGROUND: Complementary and alternative (CAM) cancer treatment is often expensive and not covered by insurance. As a result, many people turn to crowdfunding to access this treatment. OBJECTIVE: The aim of this study is to identify the rationales of patients with cancer seeking CAM treatment abroad by looking specifically at crowdfunding campaigns to support CAM cancer treatment in Tijuana, Mexico. METHODS: We scraped the GoFundMe.com and GiveSendGo.com crowdfunding platforms for campaigns referencing CAM cancer clinics in Tijuana, initiated between January 1, 2022, and February 28, 2023. The authors created a coding framework to identify rationales for seeking CAM treatment in Tijuana. To supplement campaign metadata, we coded the beneficiary's cancer stage, type, age, specific treatment sought, whether the beneficiary died, gender, and race. RESULTS: Patients sought CAM cancer treatment in Tijuana because the (1) treatment offers the greatest efficacy (29.9%); (2) treatment offered domestically was not curative (23.2%); (3) the clinic treats the whole person, and addresses the spiritual dimension of the person (20.1%); (4) treatments are nontoxic, natural, or less invasive (18.2%); and (5) clinic offers the newest technology (8.5%). Campaigns raised US $5,275,268.37 and most campaign beneficiaries were women (69.7%) or White individuals (71.1%). CONCLUSIONS: These campaigns spread problematic misinformation about the likely efficacy of CAM treatments, funnel money and endorsements to CAM clinics in Tijuana, and leave many campaigners short of the money needed to pay for CAM treatments while costing beneficiaries and their loved one's time, privacy, and dignity. This study affirms that Tijuana, Mexico, is a very popular destination for CAM cancer treatment.
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OBJECTIVE: To evaluate the extent of payments from medical device and pharmaceutical companies to editorial board members of leading otolaryngology journals. METHODS: Editorial board members of the top 10 otolaryngology journals from Google Scholar rankings were identified in this cross-sectional study. Payments between 2017 and 2022 were identified via the Open Payments Database from the Centers for Medicare and Medicaid Services. All payment data was adjusted for inflation in 2022 US dollars. Descriptive analyses were performed and journal websites were evaluated for individual editor disclosures. RESULTS: Out of 581 board members, 306 (53 %) received industry payments between 2017 and 2022, median journal percentage 55 % (interquartile range: 26.5 %-73.5 %). A sum of $45.8 million was paid out between 2017 and 2022, comprising $32.0 million in associated research funding, $1.2 million in research payments, $1.4 million in ownership and investment interests, and $11.2 million in general payments. The largest general payments were made out for "services other than consulting and speaking" ($3.9 million), "consulting" ($3.8 million), "travel and lodging" ($0.99 million), "education" ($0.87 million), "royalty or license" ($0.56 million), and "food and beverage" ($0.55 million). Individual editor disclosures were only available for International Forum of Allergy and Rhinology (9 % of all included editors). CONCLUSIONS: Industry payments to editors of otolaryngology journals are not uncommon. We highlight the need for improved reporting of individual editor disclosures for transparency to journal readers and for minimizing biased editorial decisions.
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This article investigates the intersection between innovation, Health 4.0, and financial management in the healthcare industry, emphasizing the importance of operational efficiency and quality of care. The study aims to analyze how financial management processes in healthcare relate to Health 4.0 and enhance care quality. It begins with a thorough theoretical grounding, proposing a framework that connects Health 4.0 with financial management practices. A systematic review of the literature was conducted, identifying trends, challenges, and opportunities in the financial management of Health 4.0. The results highlight selected articles on responsible innovation, Health 4.0 technologies, investments in health, hospital efficiency, performance forecasting, and high-cost patient management. These articles were clustered into "Data Analysis and Machine Learning in Healthcare" and "Health Management and Sustainability," providing a categorized understanding of the topics. The study reveals that Health 4.0 offers significant opportunities for process efficiency and cost reduction without compromising service quality. It highlights strategic advantages in addressing contemporary healthcare challenges by optimizing processes, improving financial projections, and incorporating advanced technologies efficiently. The successful implementation of Health 4.0 can lead to substantial improvements in service quality, adding value to patients and driving local economic development. This article offers valuable insights for healthcare professionals and managers, emphasizing the transformative potential of Health 4.0 and outlining strategies for its effective implementation. The clustering of articles provides a clearer understanding of current research in Health 4.0, contributing significantly to the field and guiding future research directions.
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BACKGROUND: The impact of social determinants of health in allogeneic transplant recipients in low- and middle-income countries is poorly described. This observational study analyzes the impact of place of residence, referring institution, and transplant cost coverage (out-of-pocket vs government-funded vs private insurance) on outcomes after allogeneic hematopoietic stem cell transplantation (alloHSCT) in two of Mexico's largest public and private institutions. AIM: To evaluate the impact of social determinants of health and their relationship with outcomes among allogeneic transplant recipients in Mexico. METHODS: In this retrospective cohort study, we included adolescents and adults ≥ 16 years who received a matched sibling or haploidentical transplant from 2015-2022. Participants were selected without regard to their diagnosis and were sourced from both a private clinic and a public University Hospital in Mexico. Three payment groups were compared: Out-of-pocket (OOP), private insurance, and a federal Universal healthcare program "Seguro Popular". Outcomes were compared between referred and institution-diagnosed patients, and between residents of Nuevo Leon and out-of-state. Primary outcomes included overall survival (OS), categorized by residence, referral, and payment source. Secondary outcomes encompassed early mortality, event-free-survival, graft-versus-host-relapse-free survival, and non-relapse-mortality (NRM). Statistical analyses employed appropriate tests, Kaplan-Meier method, and Cox proportional hazard regression modeling. Statistical software included SPSS and R with tidycmprsk library. RESULTS: Our primary outcome was overall survival. We included 287 patients, n = 164 who lived out of state (57.1%), and n = 129 referred from another institution (44.9%). The most frequent payment source was OOP (n = 139, 48.4%), followed by private insurance (n = 75, 26.1%) and universal coverage (n = 73, 25.4%). No differences in OS, event-free-survival, NRM, or graft-versus-host-relapse-free survival were observed for patients diagnosed locally vs in another institution, nor patients who lived in-state vs out-of-state. Patients who covered transplant costs through private insurance had the best outcomes with improved OS (median not reached) and 2-year cumulative incidence of NRM of 14% than patients who covered costs OOP (Median OS and 2-year NRM of 32%) or through a universal healthcare program active during the study period (OS and 2-year NRM of 19%) (P = 0.024 and P = 0.002, respectively). In a multivariate analysis, payment source and disease risk index were the only factors associated with overall survival. CONCLUSION: In this Latin-American multicenter study, the site of residence or referral for alloHSCT did not impact outcomes. However, access to healthcare coverage for alloHSCT was associated with improved OS and reduced NRM.
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Resumen Introducción: la preocupación por las finanzas es una de las principales causas de estrés financiero, especialmente en grupos poblacionales con ingresos y trabajos inestables. El objetivo de este artículo fue determinar si las actitudes austera y hedonista hacia el endeudamiento se relacionan directamente con el estrés financiero e indirectamente a través de las actitudes de compra planificada e impulsiva en adultos emergentes. Método: el diseño fue transversal, con un alcance correlacional-explicativo. Se aplicaron escalas de autorreporte en formato en línea a una muestra conformada por 624 adultos emergentes (63.1 % mujeres). El promedio de edad fue 20.44 (DE = 3.35). Resultados: el análisis de ecuaciones estructurales reveló que las actitudes austeras se vinculan directamente con el estrés financiero, y también indirectamente a través de la compra planificada. En cuanto a las actitudes hedonistas, se encontró una asociación directa con la compra impulsiva, pero no con el estrés financiero. Conclusiones: el estrés financiero aumenta cuando los adultos emergentes tienen actitudes de compra más austeras y planificadas. Por lo tanto, tales actitudes pueden presionarlos a hacer un uso más eficiente del dinero. Sería interesante en futuros estudios tener muestras de otros rangos etarios que permitan comparar la evidencia encontrada para contribuir al desarrollo de estrategias de educación financiera basadas en la evidencia científica.
Abstract Introduction: Worry about finances is one of the main causes of financial stress, especially in population groups with unstable income and jobs. This article aimed to determine whether austere and hedonistic debt attitudes are directly related to financial stress and indirectly through planned and impulsive buying attitudes in emerging adults. Method: The design was cross-sectional, with a correlational-explanatory scope. Self-report scales were answered online by a sample of 624 emerging adults (63.1 % women) with an average age of 20.44 (SD = 3.35). Results: Structural equation modeling analysis revealed that austere attitudes are directly linked to financial stress, and indirectly through planned purchases. Regarding hedonistic attitudes, a direct association with impulsive buying was found, but no relationship with financial stress was observed. Conclusion: Financial stress increases when emerging adults have more austere and planned purchasing attitudes, therefore, they may feel pressure to make more efficient use of money. It would be interesting in future studies to have samples from other age ranges that allow comparing the evidence found to contribute to the development of Financial Education strategies based on scientific evidence.
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Resume Objective: The objective of this research is to establish a relationship between the theory of multiple intelligences with the management and use of credit cards, including risk, patience, and economic education. This will allow the establishment of a line of marketing and consumption contextualized to the types of intelligence. Method: The design is observational-correlational, and this analysis was done using structural equation modeling (SEM). There were 498 participants in the study. Results: We found there was a positive relationship between the logical-mathematical and personal intelligences (intra and inter) with the management of patience, risk conditions, and tendency toward indebtedness. In the conceptual review, no studies were found that relate the present variables. In the same sense, the present work helps the marketing processes and product design better fit the profile of the user and/or buyer. Conclusion: Finally, it sheds light on the construction of public policy for the management of marketing and financial education.
Resumen Objetivo: El objetivo de esta investigación es establecer una relación entre la teoría de las inteligencias múltiples y la gestión y el uso de tarjetas de crédito, incluyendo el riesgo, la paciencia y la educación económica. Esto permitirá establecer una línea de marketing y consumo contextualizada a los tipos de inteligencia. Método: El diseño es observacional-correlacional, y este análisis se llevó a cabo utilizando el modelado de ecuaciones estructurales (SEM). Hubo 498 participantes en el estudio. Resultados: Encontramos que había una relación positiva entre las inteligencias lógico-matemáticas y personales (intra e inter) con la gestión de la paciencia, las condiciones de riesgo y una tendencia hacia el endeudamiento. En la revisión conceptual, no se encontraron estudios relacionados con las variables actuales. En el mismo sentido, el presente trabajo ayuda a que los procesos de marketing y el diseño de productos se ajusten mejor al perfil del usuario y/o comprador. Conclusión: Finalmente, arroja luz sobre el desarrollo de políticas públicas para la gestión del marketing y la educación financiera.
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Prescription drug costs within oncology remain a challenge for many patients with cancer. The Mark Cuban Cost Plus Drug Company (MCCPDC) launched in 2022, aiming to provide transparently priced medications at reduced costs. In this study, we sought to describe the potential impact of MCCPDC on Medicare Part-D oncology spending related to cancer-directed (nâ =â 7) and supportive care (nâ =â 26) drugs. We extracted data for drug-specific Part-D claims and spending for 2021. Using 90-count purchases from MCCPDC, we found potential Part-D savings of $857.8 million (91% savings) across the 7 cancer-directed drugs and $28.7 million (67% savings) across 21/26 (5/26 did not demonstrate savings) supportive care drugs. Collectively, our findings support that alternative purchasing models like MCCPDC may promote substantial health care savings.
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Antineoplásicos , Medicare Part D , Neoplasias , Medicamentos bajo Prescripción , Medicamentos bajo Prescripción/economía , Antineoplásicos/economía , Antineoplásicos/uso terapéutico , Neoplasias/tratamiento farmacológico , Ahorro de CostoRESUMEN
Background and Objectives: Little is known about patients' and caregivers' experiences with atopic dermatitis (AD) in Argentina, so a survey was administered to learn more. Materials and Methods: A 53-item anonymous survey was administered in Spanish to adult AD patients (n = 334) and caregivers (n = 339) of pediatric AD patients in Argentina (total n = 673). Demographics, healthcare provider information, financial burden, disease severity, disease burden, level of disease-specific education, and experience with shared physician/patient decision making were collected. Linear and logistic regression models were used for statistical comparisons. Results: Survey respondents were overwhelmingly female (90.8%), as was the overall patient population (72.8%). Patients were seen mostly by healthcare specialists (66.8% dermatologists, 13.5% pediatricians, 7.7% allergists, and 7.2% general practitioners). Only 2.8% of respondents reported no symptoms, while 33.3%, 52.4%, and 11.5% reported mild, moderate, and severe AD disease, respectively. Anxiety/depression and pain/discomfort were the most impactful on respondents' quality of life. Caregivers of children with moderate to severe AD and adult patients with severe AD reported a significant financial burden, including using savings or not purchasing food or other essentials to afford medical care. Few people reported receiving disease-specific education or having their own treatment priorities taken into consideration. For adult patients, receiving disease education and being asked about treatment priorities were associated with higher treatment satisfaction and AD control. Discussion: Mental health, pain/discomfort, and financial worries are the most important burdens for adult AD patients and caregivers of children with AD in Argentina. We recommend prioritizing disease-specific education and shared decision making to improve AD care in Argentina.
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Cuidadores , Costo de Enfermedad , Dermatitis Atópica , Humanos , Femenino , Dermatitis Atópica/psicología , Dermatitis Atópica/terapia , Argentina , Cuidadores/psicología , Cuidadores/estadística & datos numéricos , Masculino , Adulto , Encuestas y Cuestionarios , Persona de Mediana Edad , Calidad de Vida/psicología , Adolescente , Niño , Índice de Severidad de la EnfermedadRESUMEN
Ovarian cancer is considered the most fatal and costly gynecologic cancer. Although personalized therapies have improved ovarian cancer prognosis, they have resulted in increased financial toxicity concerns among this population. This study evaluated financial toxicity in patients with advanced ovarian cancer. Using secondary data from a study of barriers to palliative care, financial toxicity (FT) was measured through the Comprehensive Score for Financial Toxicity scale. Univariate and bivariate analyses were used to assess the relationship between selected demographic (i.e., age, race, ethnicity, education, place of birth, insurance type, yearly household income, employment status) and treatment-specific variables (i.e., years since diagnosis, surgery, chemotherapy, radiation, hormonal and targeted therapy) with clinically relevant financial toxicity. Characteristics were compared using Fisher's exact or chi squared tests. A total of 38 participants with advanced ovarian cancer were included in this study; 24% (n = 9) reported clinically significant FT. Income (p = .001), place of birth (p = .048) and employment status (p = .001) were related to FT. Study findings highlight that advanced ovarian cancer patients experience high FT, particularly those with low income, who are not able to work and were born outside the US. Further research using larger datasets and more representative samples is needed to inform intervention development and implementation.
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Estrés Financiero , Renta , Neoplasias Ováricas , Humanos , Femenino , Neoplasias Ováricas/terapia , Neoplasias Ováricas/patología , Persona de Mediana Edad , Anciano , Estrés Financiero/psicología , Renta/estadística & datos numéricos , Cuidados Paliativos , Factores Socioeconómicos , Empleo/estadística & datos numéricos , Adulto , Anciano de 80 o más Años , Factores SociodemográficosRESUMEN
The issue of financial inclusion considers access to and use of quality financial services by household members and different types of companies around the world, allowing us to reach the opportunities that the globalized world offers us. The objective of this research was to identify the socioeconomic factors that determined the inclusion of households in the financial system in Peru in the period of 2021. A quantitative approach was considered, which was non-experimental with a descriptive and correlational design and in which 81,441 pieces of data were obtained from the National Household Survey (ENAHO) of the National Institute of Statistics and Informatics, applying a logit binomial regression. It was determined that 47.02% of households were included in the financial system; 61.93% of those surveyed had their residence in the urban area; on average, respondents had incomplete secondary education; the age of the respondents on average was from 25 to 44 years; the average economic income of the household was less than $251 per month; 72.18% were represented by men as heads of the household and the rest by women; most of the respondents had a cohabiting marital status; the social conditions showed that 23.82% were in the group of being poor; and the majority of households did not have a property title. The determinants of financial inclusion in Peruvian households for 2021 were the area of residence, educational level, age of the respondent, economic income, gender of the respondent, marital status, social status, and property title.
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Introducción. La deuda económica durante la residencia en cirugía general puede afectar el desempeño profesional, las decisiones de vida y el bienestar psicológico. La información disponible en Colombia es limitada. El objetivo de este estudio fue cuantificar la deuda económica del residente de cirugía general, identificar los factores asociados y evaluar su efecto en el bienestar psicológico. Métodos. Estudio de corte transversal analítico. Se invitó a 380 residentes a diligenciar una encuesta sobre los aspectos relacionados con su deuda económica y se utilizó el WHO-index para evaluar su bienestar psicológico. Resultados. Un total de 259 residentes participaron en el estudio (67,6 %). El 56 % posee una deuda económica promedio de COP $88.000.000 ((US$21.826)). Un alto nivel de endeudamiento se relacionó con el año de residencia, el tipo de institución (privada) y la solicitud de préstamos. Se identificó algún trastorno mental en 14,7 % y un bajo nivel de bienestar psicológico en 56,4 % de los participantes. No se identificó ninguna asociación entre una elevada deuda económica y el bajo bienestar psicológico. Conclusiones. La deuda económica tiene un efecto sobre los residentes. El endeudamiento de los residentes de cirugía en Colombia es altamente prevalente, y no se correlaciona con un pobre bienestar psicológico. La autodeterminación favorece el bienestar psicológico en el posgrado en cirugía general. Existe la necesidad de educación financiera en los residentes. Se requieren nuevos estudios que evalúen las causas del pobre bienestar psicológico.
Introduction. Financial debt during surgery residency can affect professional performance, life decisions, and psychological well-being. The information available in Colombia is limited. The objective of this study is to quantify the financial debt of the general surgery resident, identify the associated factors and evaluate their effect on psychological well-being. Methods. A cross-sectional study was carried out. A total of 380 residents were invited to complete a survey on aspects related to their financial debt, and the WHO-index to evaluate their psychological well-being. Results. A total of 259 residents participated in the study (67.6%). 56% have an average economic debt of $88,000,000 COP (US$21,826). High debt was related to level of residence, type of institution (private), and loan application. Some mental disorder was identified in 14.7% and a low level of psychological well-being in 56.4% of the participants. No association was identified between high financial debt and low psychological well-being. Conclusions. Economic debt has an effect on residents. Financial debt among surgical residents in Colombia is highly prevalent; however, it does not correlate with poor psychological well-being. Self-determination favors psychological well-being in the postgraduate course in general surgery. Likewise, the need for financial education in residents is imminent. New studies are required that thoroughly evaluate the causes of poor well-being.
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Humanos , Cirugía General , Economía , Bienestar Psicológico , Apoyo a la Formación Profesional , Educación de Postgrado en MedicinaRESUMEN
Predictors of health across the life-course do not maintain the same significance in very late life and the role of financial strain in health outcomes of very old adults remain unclear. Data from adults aged 74 + in waves 5 and 7 of the Hispanic Established Population for the Epidemiological Study of the Elderly (n = 772) study was used to evaluate the role of financial strain on the health of older Mexican Americans who have the highest poverty rate of any racial or ethnic group in the United States. We evaluate the association between episodic (one wave) and persistent financial strain (two waves), with follow-up health outcomes (self-rated health, ADL (limitations in activities of daily living)/IADL (limitations in instrumental activities of daily living) disability, and depressive symptoms). Adults with persistent strain were twice as likely to experience depressive symptoms and three times more likely to experience IADL limitations than the unstrained. Our findings highlight the role of stress proliferation and allostatic load processes leading to deteriorated health over time.
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Actividades Cotidianas , Depresión , Estado de Salud , Americanos Mexicanos , Humanos , Masculino , Anciano , Femenino , Americanos Mexicanos/estadística & datos numéricos , Americanos Mexicanos/psicología , Actividades Cotidianas/psicología , Anciano de 80 o más Años , Depresión/epidemiología , Depresión/etnología , Depresión/psicología , Estados Unidos/epidemiología , Estados Unidos/etnología , Estrés Financiero/etnología , Estrés Financiero/psicologíaRESUMEN
OBJECTIVES: Non-small cell lung cancer (NSCLC) is Argentina's first cause of cancer death. Most patients have an advanced stage at diagnosis, with poor expected survival. This study aimed to characterize the health-related quality of life (HRQOL) and economic impact of patients treated in the private healthcare sector and compare it with that of the public sector. METHODS: We undertook an observational cross-sectional study that extended a previous study to a referral private center in Argentina. Outcomes included the EuroQol EQ-5D-3L (to assess HRQOL), Comprehensive Score for Financial Toxicity (financial toxicity instrument), Work Productivity and Activity Impairment - General Health (to assess productivity loss), and out-of-pocket expenses in adults diagnosed of NSCLC. RESULTS: We included 30 consecutive patients from a private healthcare center (July 2021 to March 2022), totaling 131 patients (n = 101 from previous public study). The whole sample had low quality of life and relevant economic impact. Patients in the private healthcare sector showed lower disease severity and higher educational level and household income. In addition, private healthcare system patients showed higher utility (0.77 vs 0.73; P < .05) and lower impairment of daily activities (41% vs 59%; P = .01). Private health system patients also showed lower financial toxicity as measured by the Comprehensive Score for Financial Toxicity score (23.9 vs 20.14; P < .05) but showed no differences when financial toxicity was assessed as a dichotomic variable. CONCLUSIONS: Although patients with NSCLC treated in a private healthcare center in Argentina showed a relevant HRQOL and economic impact, this impact was smaller than the one observed in publicly funded hospitals.
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Neoplasias Pulmonares , Sector Privado , Sector Público , Calidad de Vida , Humanos , Calidad de Vida/psicología , Argentina/epidemiología , Masculino , Femenino , Estudios Transversales , Persona de Mediana Edad , Sector Privado/estadística & datos numéricos , Sector Privado/economía , Neoplasias Pulmonares/economía , Neoplasias Pulmonares/epidemiología , Sector Público/economía , Sector Público/estadística & datos numéricos , Anciano , Gastos en Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Costo de Enfermedad , Carcinoma de Pulmón de Células no Pequeñas/economía , Carcinoma de Pulmón de Células no Pequeñas/epidemiología , AdultoRESUMEN
The Colombian health system has made a deep transition into managed competition since a major reform in 1993. A market for insurers was created, the consumer has free choice of insurer and a national-level equalisation fund distributes revenues via a per-capita payment. Fully subsidised insurance for the poor and informal, and a comprehensive standardised benefit package for subsidised and contributory schemes (both schemes covering 98 per cent of the population), has led to a low level of out-of-pocket expenses and high financial protection, as well as to reduced gaps in equity in access. The preconditions for managed competition are largely met, but improving health care providers' organisation towards integrated care, to enable them to deliver more value, is a necessary step to achieve the expected results of managed competition in terms of efficiency and quality. Although the current system is likely to be reformed in the coming months, the nature and extent of those reforms are not defined yet, so our analysis is based on the current system.
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BACKGROUND: Healthcare-associated infections (HAIs) have a significant impact on patients' morbidity and mortality, and have a detrimental financial impact on the healthcare system. Various strategies exist to prevent HAIs, but economic evaluations are needed to determine which are most appropriate. AIM: To present the financial impact of a nationwide project on HAI prevention in intensive care units (ICUs) using a quality improvement (QI) approach. METHODS: A health economic evaluation assessed the financial results of the QI initiative 'Saúde em Nossas Mãos' (SNM), implemented in Brazil between January 2018 and December 2020. Among 116 participating institutions, 13 (11.2%) fully reported the aggregate cost and stratified patients (with vs without HAIs) in the pre-intervention and post-intervention periods. Average cost (AC) was calculated for each analysed HAI: central-line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infections (CAUTIs). The absorption model and time-driven activity-based costing were used for cost estimations. The numbers of infections that the project could have prevented during its implementation were estimated to demonstrate the financial impact of the SNM initiative. RESULTS: The aggregated ACs calculated for each HAI from these 13 ICUs - US$8480 for CLABSIs, US$10,039 for VAP, and US$7464 for CAUTIs - were extrapolated to the total number of HAIs prevented by the project (1727 CLABSIs, 3797 VAP and 2150 CAUTIs). The overall savings of the SNM as of December 2020 were estimated at US$68.8 million, with an estimated return on investment (ROI) of 765%. CONCLUSION: Reporting accurate financial data on HAI prevention strategies is still challenging in Brazil. These results suggest that a national QI initiative to prevent HAIs in critical care settings is a feasible and value-based approach, reducing financial waste and yielding a significant ROI for the healthcare system.
Asunto(s)
Infecciones Relacionadas con Catéteres , Infección Hospitalaria , Neumonía Asociada al Ventilador , Infecciones Urinarias , Humanos , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/prevención & control , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Unidades de Cuidados Intensivos , Neumonía Asociada al Ventilador/epidemiología , Neumonía Asociada al Ventilador/prevención & control , Infecciones Urinarias/prevención & control , Atención a la SaludRESUMEN
Resumo Estabelecido em 2019, o Programa Previne Brasil (PPB), atual modelo de financiamento de custeio da Atenção Primária à Saúde (APS) do Ministério da Saúde, é composto por quatro critérios de pagamentos. Estes, com exceção do incentivo financeiro com base em critério populacional, são variáveis e relacionados ao desempenho municipal no alcance de indicadores da APS. O objetivo desse estudo foi de verificar a tendência de disponibilidade de recursos da APS em uma capital brasileira. Trata-se de um estudo quantitativo, analítico, de corte longitudinal, realizado a partir de informações secundárias de transferências intergovernamentais. As análises foram realizadas no programa R, com nível de significância do valor de p<0,05. Os resultados demonstraram que os repasses financeiros para custeio tiveram uma tendência significativa de aumento, considerando o período como um todo. A capitação ponderada foi o critério que mais impactou o bloco de custeio, permanecendo estável; o pagamento por desempenho e as ações estratégicas indicaram tendência de flutuação significativa nos pagamentos mensais.
Abstract Established in 2019, the Previne Brasil Program (PPB), the current PHC financing model under the Ministry of Health, comprises four payment criteria. Except for the population-based financial incentive, these criteria vary and are linked to municipal performance in achieving PHC indicators. This study aimed to assess the trend in the availability of PHC funds in a Brazilian capital. This quantitative, analytical, longitudinal study was based on secondary information from intergovernmental transfers. Analyses were conducted using the R program, with a significance level set at p<0.05. Considering the entire period, the results revealed a significant upward trend in costing financial transfers. Weighted capitation was the criterion that most impacted the costing block and remained stable, whereas pay-for-performance and strategic actions indicated a significant fluctuation trend in monthly payments.
Resumen Establecido en 2019, el Programa Previne Brasil (PPB), actual modelo de financiación de los costos de la Atención Primaria de Salud (APS) del Ministerio de Salud, está compuesto por cuatro criterios de pagos. Estos, con excepción del incentivo financiero basado en el criterio poblacional, son variables y están relacionados con el desempeño municipal en el alcance de indicadores de la APS. El objetivo de este estudio fue verificar la tendencia de disponibilidad de recursos de la APS en una capital brasileña. Se trata de un estudio cuantitativo, analítico, de corte longitudinal, realizado a partir de información secundaria de transferencias intergubernamentales. Los análisis se realizaron en el programa R, con un nivel de significancia del valor de p<0,05. Los resultados demostraron que las transferencias financieras para costos tuvieron una tendencia significativa de aumento, considerando el período como un todo. La capitación ponderada fue el criterio que más impactó el bloque de costos, permaneciendo estable; el pago por desempeño y las acciones estratégicas indicaron una tendencia de fluctuación significativa en los pagos mensuales.