RESUMEN
BACKGROUND: Colombia, which hosts over 3 million of the Venezuelan diaspora, is lauded for its progressive approach to social integration, including providing migrants access to its universal health coverage system. However, barriers to healthcare persist for both migrant and host populations, with poorly understood disparities in healthcare-seeking behaviors and associated costs. This is the first study to link healthcare-seeking behaviors with costs for Venezuelan migrants in Colombia, encompassing costs of missing work or usual activities due to healthcare events. METHODS: We use self-reported survey data from Venezuelan migrants and Colombians living in Colombia (September-November 2020) to compare healthcare-seeking behaviors and cost variables by nationality using two-sampled t-tests or Chi-square tests (X2). The International Classification of Diseases was used to compare reported household illnesses for both populations. Average health service direct costs were estimated using the Colombian Government's Suficiencia database and self-reported out-of-pocket (OOP) payments for laboratory and pharmacy services. Indirect costs were calculated by multiplying self-reported days of missed work or usual activities with estimated income levels, derived by matching characteristics using the Gran Enquesta Integrada de Hogares database. We calculate economic burdens for both populations, combining self-reported healthcare-seeking behaviors and estimated healthcare service unit costs across six healthcare-seeking behavior categories. RESULTS: Despite similar disease profiles, Venezuelan migrants are 21.3% more likely to forego formal care than Colombians, with 746.3% more Venezuelans reporting lack of health insurance as their primary reason. Venezuelan women and uninsured report the greatest difficulties in accessing health services, with accessing medications becoming more difficult for Venezuelan women during the COVID-19 pandemic. Colombians cost the health system more per treated illness event (US$40) than Venezuelans (US$26) in our sample, over a thirty-day period. Venezuelans incur higher costs for emergency department visits (123.5% more) and laboratory/ pharmacy OOP payments (24.7% more). CONCLUSIONS: While Colombians and Venezuelans share similar disease burdens, significant differences exist in access, cost, and health-seeking behaviors. Increasing Venezuelan health insurance enrollment and tackling accessibility barriers are crucial for ensuring healthcare equity and effectively integrating the migrant population. Findings suggest that improving migrant access to primary healthcare would produce savings in Colombian healthcare expenditures.
Asunto(s)
Aceptación de la Atención de Salud , Migrantes , Adolescente , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto Joven , Colombia , Costos de la Atención en Salud , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Pueblos Sudamericanos , Venezuela/etnologíaRESUMEN
In Mexico, the economically active population aged over 50 years has been increasing in recent years. Due to their age, these workers may experience health deterioration and require some form of care. However, only formal employment is associated with better access to health services and pensions. At the same time, these workers may also need to care for children, sick partners or dependent older adults, which limits their time available for employment. This study examined the association between disability, receiving and providing care and access to health services, and economic activity among adults aged 50 to 69 in Mexico in 2015 and 2018. Multilevel modeling was conducted using data from the Mexican Health and Aging Study (MHAS). The MHAS is a longitudinal panel study of adults aged 50 years and older. The study sample included data from 8,831 observations from 2015 and 10,445 observations from 2018. Those living with some degree of disability and receiving care were found to be less likely to be economically active than those living with disability and not receiving care. Similarly, individuals who care for someone were also found to be less likely to be employed. Furthermore, the data suggested that individuals without access to health services were more likely to be economically active. For individuals aged 50 to 69 years, health and care issues were factors that limited economic activity status. In family-oriented societies with weak welfare states, the right to health is partial for the population and care is traditionally the responsibility of women, which exacerbates gender inequalities and has a differential impact on paid work for men and women.
Asunto(s)
Cuidadores , Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Factores Socioeconómicos , Humanos , México , Masculino , Femenino , Anciano , Persona de Mediana Edad , Personas con Discapacidad/estadística & datos numéricos , Cuidadores/economía , Cuidadores/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Estudios Longitudinales , Empleo/estadística & datos numéricos , Estado de Salud , Factores SociodemográficosRESUMEN
This cross-sectional study investigates whether there are associations between inflation, economic policy changes, and retirees' access to medicines in Argentina.
Asunto(s)
Medicamentos Esenciales , Argentina , Humanos , Anciano , Masculino , Femenino , Medicamentos Esenciales/economía , Medicamentos Esenciales/provisión & distribución , Jubilación/economía , Inflación Económica , Persona de Mediana Edad , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Estudios TransversalesRESUMEN
BACKGROUND: Telemedicine, a method of healthcare service delivery bridging geographic distances between patients and providers, has gained prominence. This modality is particularly advantageous for outpatient consultations, addressing inherent barriers of travel time and cost. OBJECTIVE: We aim to describe economical outcomes towards the implementation of a multidisciplinary telemedicine service in a high-complexity hospital in Latin America, from the perspective of patients. DESIGN: A cross-sectional study was conducted, analysing the institutional data obtained over a period of 9 months, between April 2020 and December 2020. SETTING: A high-complexity teaching hospital located in Cali, Colombia. PARTICIPANTS: Individuals who received care via telemedicine. The population was categorised into three groups based on their place of residence: Cali, Valle del Cauca excluding Cali and Outside of Valle del Cauca. OUTCOME MEASURES: Travel distance, time, fuel and public round-trip cost savings, and potential loss of productivity were estimated from the patient's perspective. RESULTS: A total of 62 258 teleconsultations were analysed. Telemedicine led to a total distance savings of 4 514 903 km, and 132 886 hours. The estimated cost savings were US$680 822 for private transportation and US$1 087 821 for public transportation. Patients in the Outside of Valle del Cauca group experienced an estimated average time savings of 21.2 hours, translating to an average fuel savings of US$149.02 or an average savings of US$156.62 in public transportation costs. Areas with exclusive air access achieved a mean cost savings of US$362.9 per teleconsultation, specifically related to transportation costs. CONCLUSION: Telemedicine emerges as a powerful tool for achieving substantial travel savings for patients, especially in regions confronting geographical and socioeconomic obstacles. These findings underscore the potential of telemedicine to bridge healthcare accessibility gaps in low-income and middle-income countries, calling for further investment and expansion of telemedicine services in such areas.
Asunto(s)
Hospitales de Enseñanza , Telemedicina , Humanos , Colombia , Estudios Transversales , Telemedicina/economía , Telemedicina/métodos , Femenino , Masculino , Persona de Mediana Edad , Adulto , Anciano , Ahorro de Costo , Accesibilidad a los Servicios de Salud/economía , Adolescente , Adulto Joven , Viaje/economíaRESUMEN
Problem: The coronavirus disease 2019 (COVID-19) pandemic has highlighted global disparities in accessing essential health products, demonstrating the critical need for low- and middle-income countries to develop local production and innovation capabilities. Approach: The health economic-industrial complex approach changed the values that guided innovation and industrial policies in Brazil. The approach directed health production and innovation to universal access; the health ministry led a whole-of-government approach; and public procurement was strategically applied to stimulate productive public and private investments. The institutional, technological and productive capacities built up by the health economic-industrial complex allowed the country to quickly establish local COVID-19 vaccines production and guarantee access for the population. Local setting: Brazil has a universal health system that guarantees access to health for its 215 million population. Relevant changes: Public policies and actions, based on the health economic-industrial complex, guided investment projects in line with health demands, strengthened local producers, and increased autonomy in the production of health products in areas of greater technological dependence. During the COVID-19 pandemic, the country was able to rapidly scale up local vaccine production. By August 2021, Brazil had produced 74.8% (151 463 502/202 437 516) of the vaccine doses used in the country. Lessons learnt: The Brazilian example shows that low- and middle-income countries can build systemic development policies that increase their capability to produce and innovate in concert with universal health systems. This increased capacity can guarantee access to health products and supplies that are critical during global health emergencies.
Asunto(s)
Vacunas contra la COVID-19 , COVID-19 , Accesibilidad a los Servicios de Salud , Brasil , Humanos , COVID-19/epidemiología , COVID-19/economía , Accesibilidad a los Servicios de Salud/economía , Vacunas contra la COVID-19/economía , Vacunas contra la COVID-19/provisión & distribución , SARS-CoV-2 , Atención de Salud Universal , PandemiasRESUMEN
Pay-for-performance (P4P) schemes have been shown to have mixed effects on health care outcomes. A challenge in interpreting this evidence is that P4P is often considered a homogenous intervention, when in practice schemes vary widely in their design. Our study contributes to this literature by providing a detailed depiction of incentive design across municipalities within a national P4P scheme in Brazil [Primary Care Access and Quality (PMAQ)] and exploring the association of alternative design typologies with the performance of primary health care providers. We carried out a nation-wide survey of municipal health managers to characterize the scheme design, based on the size of the bonus, the providers incentivized and the frequency of payment. Using OLS regressions and controlling for municipality characteristics, we examined whether each design feature was associated with better family health team (FHT) performance. To capture potential interactions between design features, we used cluster analysis to group municipalities into five design typologies and then examined associations with quality of care. A majority of the municipalities included in our study used some of the PMAQ funds to provide bonuses to FHT workers, while the remaining municipalities spent the funds in the traditional way using input-based budgets. Frequent bonus payments (monthly) and higher size bonus allocations (share of 20-80%) were strongly associated with better team performance, while who within a team was eligible to receive bonuses did not in isolation appear to influence performance. The cluster analysis showed what combinations of design features were associated with better performance. The PMAQ score in the 'large bonus/many workers/high-frequency' cluster was 8.44 points higher than the 'no bonus' cluster, equivalent to a difference of 21.7% in the mean PMAQ score. Evidence from our study shows how design features can potentially influence health provider performance, informing the design of more effective P4P schemes.
Asunto(s)
Atención Primaria de Salud , Reembolso de Incentivo , Brasil , Humanos , Atención Primaria de Salud/economía , Calidad de la Atención de Salud , Accesibilidad a los Servicios de Salud/economíaRESUMEN
INTRODUCTION: Neuromyelitis optica spectrum disorder (NMOSD) is a rare but severe neuroimmunological condition associated with a significant financial burden. NMOSD is also associated with increased health care utilization, including neurology outpatient visits, magnetic resonance imaging (MRI) use, long-term medication, among others. We aimed to evaluate real-world patient experiences in access to care and NMOSD burden in an Argentinean cohort. METHODS: This cross-sectional study used a self-administered survey and was conducted in Argentina (2022). Patients with NMOSD were divided into three groups: private health insurance (PHI), social health insurance (SHI), and public health insurance (PHI, Ministry of Public Health). Differences in access and health care barriers were assessed. RESULTS: One hundred patients with NMOSD (74 women) with a mean age at diagnosis of 38.7 years were included. Their EDSS was 2.8 and they were followed for 5.2 years. Of them, 51%, 11%, and 13% were employed (full-time: 57.5%), currently unemployed and retired by NMOSD, respectively. 55% of them visited between 2-3 specialists before NMOSD diagnosis. Aquaporin-4-antibody and/or myelin oligodendrocyte glycoprotein-antibody testing was requested in 91% (health insurance covered this partially in 15.3% and 32.9% of the time the test was entirely paid by patient/family). Patients with NMOSD receiving private medical care reported greater access to MRI, outpatient visits, and fewer issues to obtain NMOSD medications compared to those treated at public institutions. A longer mean time to MRI and neurology visit was found in the PHI group when compared with the other two subgroups. Regression analysis showed that private insurance (OR=3.84, p=0.01) was the only independent factor associated with appropriate access to NMOSD medications in Argentina. CONCLUSION: These findings suggest that barriers to access and utilization of NMOSD care services in Argentina are common. NMOSD patients experienced problems to receive NMOSD medication properly, especially those from the public sector.
Asunto(s)
Acuaporina 4 , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Neuromielitis Óptica , Femenino , Humanos , Acuaporina 4/inmunología , Argentina/epidemiología , Autoanticuerpos , Costo de Enfermedad , Estudios Transversales , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/economía , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Imagen por Resonancia Magnética/economía , Neuromielitis Óptica/diagnóstico por imagen , Neuromielitis Óptica/economía , Neuromielitis Óptica/epidemiología , Neuromielitis Óptica/inmunología , Evaluación de Necesidades , Masculino , AdultoRESUMEN
OBJECTIVE: To test the association of material deprivation and the utilization of vision care services for young children. STUDY DESIGN: We conducted a population-based, repeated measures cohort study using linked health and administrative datasets. All children born in Ontario in 2010 eligible for provincial health insurance were followed from birth until their seventh birthday. The main exposure was neighborhood-level material deprivation quintile, a proxy for socioeconomic status. The primary outcome was receipt of a comprehensive eye examination (not to include a vision screening) by age 7 years from an eye care professional, or family physician. RESULTS: Of 128 091 children included, female children represented 48.7% of the cohort, 74.4% lived in major urban areas, and 16.2% lived in families receiving income assistance. Only 65% (n = 82 833) had at least 1 comprehensive eye examination, with the lowest uptake (56.9%; n = 31 911) in the most deprived and the highest uptake (70.5%; n =19 860) in the least deprived quintiles. After adjusting for clinical and demographic variables, children living in the least materially deprived quintile had a higher odds of receiving a comprehensive eye examination (aOR 1.43; 95% CI 1.36, 1.51) compared with children in the most materially deprived areas. CONCLUSIONS: Uptake of comprehensive eye examinations is poor, especially for children living in the most materially deprived neighborhoods. Strategies to improve uptake and reduce inequities are warranted.
Asunto(s)
Utilización de Instalaciones y Servicios/economía , Accesibilidad a los Servicios de Salud/economía , Disparidades en Atención de Salud/economía , Clase Social , Trastornos de la Visión/diagnóstico , Pruebas de Visión/economía , Niño , Preescolar , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Lactante , Estudios Longitudinales , Masculino , Ontario , Pruebas de Visión/estadística & datos numéricosRESUMEN
Allogeneic hematopoietic cell transplantation (allo-HCT) is a highly complex, costly procedure for patients with oncologic, hematologic, genetic, and immunologic diseases. Demographics and socioeconomic status as well as donor availability and type of health care system are important factors that influence access to and outcomes following allo-HCT. The last decade has seen an increase in the numbers of allo-HCTs and teams all over the world, with no signs of saturation. More than 80 000 procedures are being performed annually, with 1 million allo-HCTs estimated to take place by the end of 2024. Many factors have contributed to this, including increased numbers of eligible patients (older adults with or without comorbidities) and available donors (unrelated and haploidentical), improved supportive care, and decreased early and late post-HCT mortalities. This increase is also directly linked to macro- and microeconomic indicators that affect health care both regionally and globally. Despite this global increase in the number of allo-HCTs and transplant centers, there is an enormous need for increased access to and improved outcomes following allo-HCT in resource-constrained countries. The reduction of poverty, global economic changes, greater access to information, exchange of technologies, and use of artificial intelligence, mobile health, and telehealth are certainly creating unprecedented opportunities to establish collaborations and share experiences and thus increase patient access to allo-HCT. A specific research agenda to address issues of allo-HCT in resource-constrained settings is urgently warranted.
Asunto(s)
Trasplante de Células Madre Hematopoyéticas , Selección de Donante , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trasplante de Células Madre Hematopoyéticas/economía , Trasplante de Células Madre Hematopoyéticas/estadística & datos numéricos , Humanos , Internacionalidad , Factores Socioeconómicos , Trasplante Homólogo/economía , Trasplante Homólogo/estadística & datos numéricosRESUMEN
INTRODUCTION: Systemic arterial hypertension (SAH), a global public health problem and the primary risk factor for cardiovascular diseases, has a significant financial impact on health systems. In Brazil, the prevalence of SAH is 23.7%, which caused 203,000 deaths and 3.9 million DALYs in 2015. OBJECTIVE: To estimate the cost of SAH and circulatory system diseases attributable to SAH from the perspective of the Brazilian public health system in 2019. METHODS: A prevalence-based cost-of-illness was conducted using a top-down approach. The population attributable risk (PAR) was used to estimate the proportion of circulatory system diseases attributable to SAH. The direct medical costs were obtained from official Ministry of Health of Brazil records and literature parameters, including the three levels of care (primary, secondary, and tertiary). Deterministic univariate analyses were also conducted. RESULTS: The total cost of SAH and the proportion of circulatory system diseases attributable to SAH was Int$ 581,135,374.73, varying between Int$ 501,553,022.21 and Int$ 776,183,338.06. In terms only of SAH costs at all healthcare levels (Int$ 493,776,445.89), 97.3% were incurred in primary care, especially for antihypertensive drugs provided free of charge by the Brazilian public health system (Int$ 363,888,540.14). Stroke accounted for the highest cost attributable to SAH and the third highest PAR, representing 47% of the total cost of circulatory diseases attributable to SAH. Prevalence was the parameter that most affected sensitivity analyses, accounting for 36% of all the cost variation. CONCLUSION: Our results show that the main Brazilian strategy to combat SAH was implemented in primary care, namely access to free antihypertensive drugs and multiprofessional teams, acting jointly to promote care and prevent and control SAH.
Asunto(s)
Antihipertensivos/uso terapéutico , Enfermedades Cardiovasculares/economía , Enfermedades Cardiovasculares/epidemiología , Hipertensión/economía , Antihipertensivos/economía , Brasil/epidemiología , Enfermedades Cardiovasculares/etiología , Costo de Enfermedad , Accesibilidad a los Servicios de Salud/economía , Humanos , Hipertensión/complicaciones , Hipertensión/tratamiento farmacológico , Hipertensión/epidemiología , Prevalencia , Atención Primaria de Salud , Salud Pública , Medición de RiesgoAsunto(s)
Países en Desarrollo , Costos de la Atención en Salud , Accesibilidad a los Servicios de Salud/economía , Terapia por Inhalación de Oxígeno/economía , Terapia por Inhalación de Oxígeno/instrumentación , Humanos , Hiperoxia/etiología , Renta , Incubadoras para Lactantes/economía , Recién Nacido , Terapia por Inhalación de Oxígeno/efectos adversosAsunto(s)
Infecciones por VIH/epidemiología , Accesibilidad a los Servicios de Salud/ética , Disparidades en Atención de Salud/ética , Grupos de Población/psicología , Poblaciones Vulnerables/psicología , Fármacos Anti-VIH/provisión & distribución , Fármacos Anti-VIH/uso terapéutico , Terapia Antirretroviral Altamente Activa , COVID-19/epidemiología , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/psicología , Infecciones por VIH/transmisión , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Disparidades en Atención de Salud/economía , Humanos , Perú/epidemiología , Estigma SocialRESUMEN
OBJECTIVE: To assess the impact of geographic access to surgical center on readmission risk and burden in children after congenital heart surgery. STUDY DESIGN: Children <6 years old at discharge after congenital heart surgery (Risk Adjustment for Congenital Heart Surgery-1 score 2-6) were identified using Pediatric Health Information System data (46 hospitals, 2004-2015). Residential distance from the surgery center, calculated using ZIP code centroids, was categorized as <15, 15-29, 30-59, 60-119, and ≥120 miles. Rurality was defined using rural-urban commuting area codes. Geographic risk factors for unplanned readmissions to the surgical center and associated burden (total hospital length of stay [LOS], costs, and complications) were analyzed using multivariable regression. RESULTS: Among 59 696 eligible children, 19 355 (32%) had ≥1 unplanned readmission. The median LOS was 9 days (IQR 22) across the entire cohort. In those readmitted, median total costs were $31 559 (IQR $90 176). Distance from the center was inversely related but rurality was positively related to readmission risk. Among those readmitted, increased distance was associated with longer LOS, more complications, and greater costs. Compared with urban patients, highly rural patients were more likely to have an unplanned readmission but had fewer average readmission days. CONCLUSIONS: Geographic measures of access differentially affect readmission to the surgery center. Increased distance from the center was associated with fewer unplanned readmissions but more complications. Among those readmitted, the most isolated patients had the greatest readmission costs. Understanding the contribution of geographic access will aid in developing strategies to improve care delivery to this population.
Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Cardiopatías Congénitas/cirugía , Hospitales Pediátricos/provisión & distribución , Readmisión del Paciente/estadística & datos numéricos , Centros de Atención Terciaria/provisión & distribución , Niño , Preescolar , Femenino , Costos de la Atención en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Cardiopatías Congénitas/economía , Hospitales Pediátricos/economía , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Readmisión del Paciente/economía , Análisis de Regresión , Estudios Retrospectivos , Salud Rural/economía , Salud Rural/estadística & datos numéricos , Servicios de Salud Rural/economía , Servicios de Salud Rural/provisión & distribución , Centros de Atención Terciaria/economía , Estados Unidos , Salud Urbana/economía , Salud Urbana/estadística & datos numéricos , Servicios Urbanos de Salud/economía , Servicios Urbanos de Salud/provisión & distribuciónAsunto(s)
Neoplasias del Ano/diagnóstico , COVID-19 , Neoplasias Colorrectales/diagnóstico , Detección Precoz del Cáncer/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Ano/economía , Neoplasias del Ano/epidemiología , Neoplasias del Ano/patología , Brasil/epidemiología , Neoplasias Colorrectales/economía , Neoplasias Colorrectales/epidemiología , Neoplasias Colorrectales/patología , Estudios Transversales , Detección Precoz del Cáncer/economía , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Masculino , Pacientes no Asegurados/estadística & datos numéricos , Persona de Mediana Edad , Estadificación de Neoplasias , Derivación y Consulta/economía , Derivación y Consulta/tendenciasRESUMEN
Based on survey data of the income distribution and living conditions of urban and rural residents collected by the China Economic Monitoring and Analysis Center in 2014, we investigated the mechanisms related to informal credit constraints on farmer health and then empirically analyzed the impacts of such constraints. Results showed that, in general, informal credit constraints significantly negatively impact farmer health. Compared with farmers whose credit was not informally constrained, the probability of farmers who faced informal credit constraints describing their self-rated health as "very good" fell by 6.64%. After controlling for endogenous problems, this proportion rose to 28.87%. Correspondingly, the probability of describing self-rated health as "very bad" increased by 0.45%. After controlling for endogenous problems, this proportion rose to 0.81%. The robustness test showed that our conclusions are strongly robust. Informal credit constraints significantly positively impacted the number of days of illness in 2013 in the sample of farmers, which means farmers who suffered from informal credit constraints required more sick days than those who did not experience informal credit constraints in 2013. As far as we know, this is the first study on the impact of informal credit constraints on Chinese farmer health.(AU)
Com base nos dados da pesquisa sobre a distribuição de renda e as condições de vida dos residentes urbanos e rurais coletados pelo Centro de Análise e Monitoramento Econômico da China em 2014, investigamos os mecanismos relacionados às restrições informais de crédito à saúde dos agricultores e, em seguida, analisamos empiricamente os impactos dessas restrições. Os resultados mostram que, em geral, as restrições informais de crédito afetam significativamente a saúde dos agricultores. Em comparação com os agricultores cujo crédito não foi informalmente restrito, a probabilidade de agricultores que enfrentaram restrições informais de crédito que descrevem sua auto-avaliação de saúde como "muito boa" caiu 6,64%. Após o controle de problemas endógenos, essa proporção subiu para 28,87%. Da mesma forma, a probabilidade de descrever a auto-avaliação de saúde como muito ruim aumentou 0,45%. Após o controle de problemas endógenos, essa proporção subiu para 0,81%. O teste de robustez mostrou que nossas conclusões são fortemente robustas. As restrições informais de crédito impactaram significativamente o número de dias de doença em 2013 na amostra de agricultores, o que significa que os agricultores que sofreram restrições informais de crédito permaneceram mais dias doentes do que aqueles que não tiveram restrições informais de crédito em 2013. Tanto quanto sabemos, este é o primeiro estudo sobre o impacto das restrições informais ao crédito na saúde dos agricultores chineses.(AU)
Asunto(s)
Humanos , Accesibilidad a los Servicios de Salud/economía , Equidad en el Acceso a los Servicios de Salud , Pobreza/etnología , AgricultoresRESUMEN
Based on survey data of the income distribution and living conditions of urban and rural residents collected by the China Economic Monitoring and Analysis Center in 2014, we investigated the mechanisms related to informal credit constraints on farmer health and then empirically analyzed the impacts of such constraints. Results showed that, in general, informal credit constraints significantly negatively impact farmer health. Compared with farmers whose credit was not informally constrained, the probability of farmers who faced informal credit constraints describing their self-rated health as "very good" fell by 6.64%. After controlling for endogenous problems, this proportion rose to 28.87%. Correspondingly, the probability of describing self-rated health as "very bad" increased by 0.45%. After controlling for endogenous problems, this proportion rose to 0.81%. The robustness test showed that our conclusions are strongly robust. Informal credit constraints significantly positively impacted the number of days of illness in 2013 in the sample of farmers, which means farmers who suffered from informal credit constraints required more sick days than those who did not experience informal credit constraints in 2013. As far as we know, this is the first study on the impact of informal credit constraints on Chinese farmer health.
Com base nos dados da pesquisa sobre a distribuição de renda e as condições de vida dos residentes urbanos e rurais coletados pelo Centro de Análise e Monitoramento Econômico da China em 2014, investigamos os mecanismos relacionados às restrições informais de crédito à saúde dos agricultores e, em seguida, analisamos empiricamente os impactos dessas restrições. Os resultados mostram que, em geral, as restrições informais de crédito afetam significativamente a saúde dos agricultores. Em comparação com os agricultores cujo crédito não foi informalmente restrito, a probabilidade de agricultores que enfrentaram restrições informais de crédito que descrevem sua auto-avaliação de saúde como "muito boa" caiu 6,64%. Após o controle de problemas endógenos, essa proporção subiu para 28,87%. Da mesma forma, a probabilidade de descrever a auto-avaliação de saúde como muito ruim aumentou 0,45%. Após o controle de problemas endógenos, essa proporção subiu para 0,81%. O teste de robustez mostrou que nossas conclusões são fortemente robustas. As restrições informais de crédito impactaram significativamente o número de dias de doença em 2013 na amostra de agricultores, o que significa que os agricultores que sofreram restrições informais de crédito permaneceram mais dias doentes do que aqueles que não tiveram restrições informais de crédito em 2013. Tanto quanto sabemos, este é o primeiro estudo sobre o impacto das restrições informais ao crédito na saúde dos agricultores chineses.
Asunto(s)
Humanos , Accesibilidad a los Servicios de Salud/economía , Equidad en el Acceso a los Servicios de Salud , Agricultores , Pobreza/etnologíaRESUMEN
OBJECTIVES: Pediatric patients are at higher risk of nonadherence to immunosuppressive medication after kidney transplant and the resulting adverse outcomes. Factors associated with nonadherence vary, which follow an epidemiological framework and according to health system patterns. The Brazilian public health system covers all costs of kidney transplant, including immunosuppressive medications. We aimed to assess the prevalence and correlates of nonadherence to immunosuppressive medications in a pediatric kidney transplant population who received free access to immunosuppressive medications within the health care system. MATERIALS AND METHODS: In this single-center crosssectional study, we studied a convenience sample of 156 outpatients (< 18 years old) who were a minimum of 4 weeks posttransplant. Implementation nonadherence to immunosuppressive medications was measured by the 4 questions of the Basel Assessment of Adherence to Immunosuppressive Medications Scale. Multilevel correlates to non - adherence (patient, micro, and macro levels) were assessed. RESULTS: In our patient population, 61% were males, mean age was 13.6 ± 3.1 years, 77% were adolescents, and 84% received organs from deceased donors. We found that 33% were nonadherent to immuno - suppressive medications, mainly in timing (25%) and taking (10.9%) dimensions. Being an adolescent (odds ratio: 2.66; CI, 1.02-6.96), religion other than Catholic or Protestant (odds ratio: 4.33; CI, 1.13-16.67), and family income higher than 4 reference wages (odds ratio: 3.50; CI, 1.14-10.75) were factors associated with nonadherence. CONCLUSIONS: In our patient population of mostly adolescents, one-third displayed nonadherence to immunosuppressants. Unexpectedly, a higher economic profile, potentially representing better previous access to health care, was independently associated with nonadherence. This result highlights the need for identifying specific correlates to non - adherence before designing interventions.
Asunto(s)
Rechazo de Injerto/prevención & control , Supervivencia de Injerto/efectos de los fármacos , Inmunosupresores/uso terapéutico , Trasplante de Riñón , Cumplimiento de la Medicación , Adolescente , Conducta del Adolescente , Factores de Edad , Brasil , Niño , Conducta Infantil , Preescolar , Estudios Transversales , Costos de los Medicamentos , Femenino , Rechazo de Injerto/economía , Rechazo de Injerto/inmunología , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/economía , Humanos , Inmunosupresores/efectos adversos , Inmunosupresores/economía , Trasplante de Riñón/efectos adversos , Trasplante de Riñón/economía , Masculino , Factores Socioeconómicos , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Técnicas Reproductivas , Justicia Social , Brasil/epidemiología , Epidemias , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Disparidades en el Estado de Salud , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Recién Nacido , Seguro de Salud/economía , Seguro de Salud/ética , Seguro de Salud/legislación & jurisprudencia , Legislación como Asunto/tendencias , Masculino , Embarazo , Técnicas Reproductivas/economía , Técnicas Reproductivas/ética , Técnicas Reproductivas/legislación & jurisprudencia , Factores de Riesgo , Justicia Social/ética , Justicia Social/legislación & jurisprudencia , Justicia Social/tendencias , Factores SocioeconómicosRESUMEN
BACKGROUND: In 2007 Uruguay began a reform in the health sector towards the construction of a National Integrated Health System (SNIS), based on public insurance with private and public provision. The main objective of the reform was to universalize access to health services. METHODS: Data comes from the first National Health Survey conducted in 2014 and available since 2016. Concentration indices are calculated for different indicators of use and access to medical services, for the population 18 years of age and older, and for different subgroups (age, sex, region and type of coverage). The indices are decomposed into need and non-need variables and the contribution of each of them to total inequality is analyzed. Horizontal inequity is calculated. RESULTS: Results show pro-rich inequality for medical consultations, medical analysis, medication use and non-access due to costs. Type of health coverage is the variable that explains most of the inequality: private coverage is pro-rich while public coverage is pro-poor. Income does not appear as significant to explain inequality, except for access issues. From the population subgroups' analysis, there is no evidence of inequality for the group of 60 years old or more. On the other hand, studies such as Pap Smear and prostate, which may be associated with preventive studies,, shows pro-rich inequality and, in both cases, the main contribution is given by income. CONCLUSIONS: The analysis of health inequity shows pro-rich inequity in medical consultations, medical analysis, medication use and lack of access due to costs. The type of health coverage explains these inequalities; in particular, private coverage is pro-rich. These results suggest that the type of health coverage are capturing the income factor, since higher income individuals will be more likely to be treated in the private system.