Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 14 de 14
Filtrar
1.
J Surg Res ; 283: 127-136, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36403406

RESUMO

INTRODUCTION: The Lancet Commission on Global Surgery indicators for monitoring anesthetic and surgical care allow the identification of access barriers, evaluate the safety of surgeries, facilitate planning, and assess changes over time. The primary objective was to measure these indicators in all health facilities of a Peruvian region in 2020. METHODS: This was an ambispective observational study to measure the anesthetic and surgical care indicators in Piura, a region in Peru, between January 2020 and June 2021. Public and private health facilities in the Piura region that performed surgical care or had specialists from any surgical specialty participated in the study. Data were collected from all regional health facilities that provided surgical care to estimate the density of surgical workforce. Likewise, the percentage of the population with access to an operating room within 2 h was estimated using georeferenced tools. Finally, a public database was accessed to determine the surgical volume, the percentage of the regional population protected with health insurance. RESULTS: In 2020, 88.4% of the inhabitants of this Peruvian region had access to timely essential surgery. There were 18.4 surgical specialists and 1174 surgeries per 100,000 populations, and 91% of the population had health insurance. In addition, there was a rate of 2.1 working operating rooms per 100,000 inhabitants in 2021. CONCLUSIONS: This Peruvian region presented an increasing trend with respect to the population's access to essential and timely surgical care, and health insurance coverage. However, the workforce distribution was inequitable among the provinces of the region, the surgical volume was reduced, and timely access was hindered because of the SARS-CoV-2 pandemic.


Assuntos
Anestésicos , COVID-19 , Especialidades Cirúrgicas , Humanos , Peru , SARS-CoV-2 , Acessibilidade aos Serviços de Saúde
2.
Cancer Invest ; 40(8): 680-692, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35731734

RESUMO

We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.


Assuntos
Carcinoma de Células Escamosas , Neoplasias de Cabeça e Pescoço , Neoplasias Bucais , Neoplasias Orofaríngeas , Brasil/epidemiologia , Carcinoma de Células Escamosas/patologia , Atenção à Saúde , Humanos , Neoplasias Bucais/patologia , Neoplasias Orofaríngeas/terapia , Prognóstico , Estudos Retrospectivos , Carcinoma de Células Escamosas de Cabeça e Pescoço/terapia
3.
Rev. méd. Chile ; 150(1): 70-77, ene. 2022. tab
Artigo em Espanhol | LILACS | ID: biblio-1389620

RESUMO

BACKGROUND: In Chile, an eventual implementation of a plan with universal health coverage is a challenge. The already implemented explicit health guarantees plan (GES) could be a benchmark. For this reason, it is important to obtain information about the results of its implementation. AIM: To identify the social determinants of health that influence the access to GES. MATERIAL AND METHODS: The National Socioeconomic Characterization Survey performed in 2017 was used as a data source. The beneficiaries of 20 diseases covered by GES and inquired in the survey were considered for the present study. RESULTS: People with the higher probability of access to GES plan belong to the lowest income quintiles, are nationals, live in the central-southern metropolitan Santiago, have lower education, have a public health insurance program (FONASA) and are aged mostly over 60 years. The diseases with the highest probability of access to the program are primary arterial hypertension, type 1 and type 2 diabetes mellitus, acute myocardial infarction, moderate and severe bronchial asthma, breast cancer, colon cancer, and bipolar disorder. CONCLUSIONS: The access probability to the GES program is in line with the epidemiological profile of the Chilean population, and with a greater social vulnerability.


Assuntos
Humanos , Idoso , Determinantes Sociais da Saúde , Acessibilidade aos Serviços de Saúde , Programas Nacionais de Saúde/organização & administração , Fatores Socioeconômicos , Chile , Cobertura Universal do Seguro de Saúde/organização & administração
4.
J. bras. nefrol ; 43(3): 417-421, July-Sept. 2021. tab, graf
Artigo em Inglês, Português | LILACS | ID: biblio-1340121

RESUMO

Abstract Introduction: Hypertension (HTN) is a public health problem. The prevalence and mortality rates are significantly higher in middle and low-income countries, such as Peru. This study aimed to determine the trend of mortality attributable to HTN for the 2005-2016 period in Peru. Methods: We conducted a secondary analysis based on death certificates provided by the Ministry of Health. We applied linear regression models to test the HTN mortality rate trend. Results: The age-standardized HTN mortality per 100,000 inhabitants decreased from 14.43 for the 2005 to 2010 period to 11.12 for the 2011 to 2016 period. The coast was the natural region with the highest decrease in mortality rate. Moreover, Tumbes, Callao, and Lambayeque were regions with the highest decline in mortality rate. Conclusion: The age-standardized mortality attributable to HTN decreased in Peru, with variations in both natural and political regions of the country.


Resumo Introdução: A hipertensão arterial (HA) é um problema de saúde pública. As taxas de prevalência e mortalidade são significativamente mais altas em países de média e baixa renda, como o Peru. O objetivo do estudo foi determinar a tendência de mortalidade atribuível à HA para o período de 2005-2016 no Peru. Métodos: Realizamos uma análise secundária com base em atestados de óbito fornecidos pelo Ministério da Saúde. Aplicamos modelos de regressão linear para testar a tendência da taxa de mortalidade por HA. Resultados: A mortalidade por HA padronizada para idade por 100.000 habitantes diminuiu de 14,43 no período de 2005 a 2010 para 11,12 no período de 2011 a 2016. O litoral foi a região natural com maior queda na taxa de mortalidade. Além disso, Tumbes, Callao e Lambayeque foram as regiões com maior declínio na taxa de mortalidade. Conclusão: A mortalidade padronizada para idade atribuível à HA diminuiu no Peru, com variações tanto em regiões naturais como políticas do país.


Assuntos
Humanos , Pobreza , Hipertensão/epidemiologia , Peru/epidemiologia , Modelos Lineares , Prevalência
5.
Artigo em Inglês | MEDLINE | ID: mdl-33353250

RESUMO

Very few studies exist of legal interventions (national laws) for essential medicines as part of universal health coverage in middle-income countries, or how the effect of these laws is measured. This study aims to critically assess whether laws related to universal health coverage use five objectives of public health law to promote medicines affordability and financing, and to understand how access to medicines achieved through these laws is measured. This comparative case study of five middle-income countries (Ecuador, Ghana, Philippines, South Africa, Ukraine) uses a public health law framework to guide the content analysis of national laws and the scoping review of empirical evidence for measuring access to medicines. Sixty laws were included. All countries write into national law: (a) health equity objectives, (b) remedies for users/patients and sanctions for some stakeholders, (c) economic policies and regulatory objectives for financing (except South Africa), pricing, and benefits selection (except South Africa), (d) information dissemination objectives (ex. for medicines prices (except Ghana)), and (e) public health infrastructure. The 17 studies included in the scoping review evaluate laws with economic policy and regulatory objectives (n = 14 articles), health equity (n = 10), information dissemination (n = 3), infrastructure (n = 2), and sanctions (n = 1) (not mutually exclusive). Cross-sectional descriptive designs (n = 8 articles) and time series analyses (n = 5) were the most frequent designs. Change in patients' spending on medicines was the most frequent outcome measure (n = 5). Although legal interventions for pharmaceuticals in middle-income countries commonly use all objectives of public health law, the intended and unintended effects of economic policies and regulation are most frequently investigated.


Assuntos
Diabetes Mellitus Tipo 2 , Cobertura Universal do Seguro de Saúde , Adulto , Estudos Transversais , Países em Desenvolvimento , Equador , Gana , Reforma dos Serviços de Saúde , Acessibilidade aos Serviços de Saúde , Humanos , Estudos Longitudinais , Filipinas , Saúde Pública , Estudos Retrospectivos , África do Sul , Ucrânia
6.
J Prev Med Public Health ; 53(4): 266-274, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32752596

RESUMO

OBJECTIVES: Describe out-of-pocket payment (OOP) and the proportion of Peruvian households with catastrophic health expenditure (CHE) and evaluate changes in socioeconomic inequalities in CHE between 2008 and 2017. METHODS: We used data from the 2008 and 2017 National Household Surveys on Living and Poverty Conditions (ENAHO in Spanish), which are based on probabilistic stratified, multistage and independent sampling of areas. OOP was converted into constant dollars of 2017. A household with CHE was assumed when the proportion between OOP and payment capacity was ≥0.40. OOP was described by median and interquartile range while CHE was described by weighted proportions and 95% confidence intervals (CIs). To estimate the socioeconomic inequality in CHE we computed the Erreygers concentration index. RESULTS: The median OOP reduced from 205.8 US dollars to 158.7 US dollars between 2008 and 2017. The proportion of CHE decreased from 4.9% (95% CI, 4.5 to 5.2) in 2008 to 3.7% (95% CI, 3.4 to 4.0) in 2017. Comparison of socioeconomic inequality of CHE showed no differences between 2008 and 2017, except for rural households in which CHE was less concentrated in richer households (p<0.05) and in households located on the rest of the coast, showing an increase in the concentration of CHE in richer households (p<0.05). CONCLUSIONS: Although OOP and CHE reduced between 2008 and 2017, there is still socioeconomic inequality in the burden of CHE across different subpopulations. To reverse this situation, access to health resources and health services should be promoted and guaranteed to all populations.


Assuntos
Doença Catastrófica/economia , Financiamento Pessoal/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , População Rural/estatística & dados numéricos , Características da Família , Humanos , Seguro Saúde/economia , Peru , Pobreza/estatística & dados numéricos , Fatores Socioeconômicos
7.
Medwave ; 20(2): e7833, 2020 Mar 19.
Artigo em Espanhol | MEDLINE | ID: mdl-32225131

RESUMO

BACKGROUND: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. OBJECTIVE: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. METHODS: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. RESULTS: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). CONCLUSIONS: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.


INTRODUCCIÓN: El gasto de bolsillo en medicamentos e insumos puede afectar financieramente los hogares. OBJETIVO: Determinar el gasto de bolsillo en medicamentos e insumos en Perú y las características de la población con mayor gasto de este tipo en los años 2007 y 2016. MÉTODOS: Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza 2007 y 2016. Se determinó la media y mediana del gasto de bolsillo en medicamentos e insumos en dólares americanos para la población general, y según la presencia de factores descritos en la literatura como asociados al gasto de bolsillo en medicamentos e insumos. RESULTADOS: Se incluyeron datos de 92 148 encuestados en 2007 y de 130 296 en 2016. En 2007, se encontró una mediana de 3,19 (rango intercuartílico: 0,96 a 7,99) y una media de 8,14 (intervalo de confianza 95%: 7,80 a 8,49) para el gasto de bolsillo en medicamentos. En 2016, la mediana y media de este gasto fueron de 3,55 (rango intercuartílico: 1,48 a 8,88) y 9,68 (intervalo de confianza 95%: 9,37 a 9,99), respectivamente. Para 2016, se encontró un mayor gasto de bolsillo en medicamentos en mujeres, menores de cinco y mayores de 60 años; personas de mayor nivel educativo; tener seguro privado o de las fuerzas armadas; vivir en la región costa y en zona urbana; tener una enfermedad crónica; y ser de los quintiles de gasto per cápita más altos. Entre 2007 y 2016, se incrementó significativamente (p < 0,05) el gasto de bolsillo en medicamentos e insumos en los menores de cinco años (p < 0,001), personas no aseguradas (p < 0,001), asegurados en el Seguro Integral de Salud (p < 0,001) o a las fuerzas armadas, para el área urbana y rural (p < 0,001, ambos), y en personas sin enfermedades crónicas (p < 0,001). CONCLUSIONES: Se obtuvo el gasto de bolsillo en medicamentos e insumos en población peruana en 2007 y 2016, encontrándose un incremento del mismo entre los años de estudio, existiendo grupos poblacionales con mayor gasto y con aumentos significativos. Se requiere profundizar el estudio de factores asociados al gasto de bolsillo en medicamentos en grupos de mayor vulnerabilidad económico frente al gasto directo en salud en Perú.


Assuntos
Custos de Medicamentos , Financiamento Pessoal , Gastos em Saúde , Adolescente , Adulto , Criança , Estudos Transversais , Características da Família , Feminino , Financiamento Pessoal/economia , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Pobreza , Adulto Jovem
8.
Medwave ; 20(2): e7833, 31-03-2020.
Artigo em Inglês, Espanhol | LILACS | ID: biblio-1096503

RESUMO

INTRODUCCIÓN: El gasto de bolsillo en medicamentos e insumos puede afectar financieramente los hogares. Objetivo: Determinar el gasto de bolsillo en medicamentos e insumos en Perú y las características de la población con mayor gasto de este tipo en los años 2007 y 2016. MÉTODOS: Estudio transversal analítico de la Encuesta Nacional de Hogares sobre Condiciones de Vida y Pobreza 2007 y 2016. Se determinó la media y mediana del gasto de bolsillo en medicamentos e insumos en dólares americanos para la población general, y según la presencia de factores descritos en la literatura como asociados al gasto de bolsillo en medicamentos e insumos. RESULTADOS: Se incluyeron datos de 92 148 encuestados en 2007 y de 130 296 en 2016. En 2007, se encontró una mediana de 3,19 (rango intercuartílico: 0,96 a 7,99) y una media de 8,14 (intervalo de confianza 95%: 7,80 a 8,49) para el gasto de bolsillo en medicamentos. En 2016, la mediana y media de este gasto fueron de 3,55 (rango intercuartílico: 1,48 a 8,88) y 9,68 (intervalo de confianza 95%: 9,37 a 9,99), respectivamente. Para 2016, se encontró un mayor gasto de bolsillo en medicamentos en mujeres, menores de cinco y mayores de 60 años; personas de mayor nivel educativo; tener seguro privado o de las fuerzas armadas; vivir en la región costa y en zona urbana; tener una enfermedad crónica; y ser de los quintiles de gasto per cápita más altos. Entre 2007 y 2016, se incrementó significativamente (p < 0,05) el gasto de bolsillo en medicamentos e insumos en los menores de cinco años (p < 0,001), personas no aseguradas (p < 0,001), asegurados en el Seguro Integral de Salud (p < 0,001) o a las fuerzas armadas, para el área urbana y rural (p < 0,001, ambos), y en personas sin enfermedades crónicas (p < 0,001). CONCLUSIONES: Se obtuvo el gasto de bolsillo en medicamentos e insumos en población peruana en 2007 y 2016, encontrándose un incremento del mismo entre los años de estudio, existiendo grupos poblacionales con mayor gasto y con aumentos significativos. Se requiere profundizar el estudio de factores asociados al gasto de bolsillo en medicamentos en grupos de mayor vulnerabilidad económico frente al gasto directo en salud en Perú.


BACKGROUND: Out-of-pocket spending on medicines and supplies can lead to a heavy financial burden in households. OBJECTIVE: To determine the out-of-pocket spending on medicines and supplies in Peru and the population groups with the highest out-of-pocket spending on medicines and supplies in 2007 and 2016. METHODS: We conducted an analytical cross-sectional study of the Peruvian National Household Survey on Living and Poverty Conditions for the years 2007 and 2016. Mean and median out-of-pocket spending on medicines and supplies are reported in USD for the general population, and according to the presence or not of factors described in the literature as associated with out-of-pocket spending on medicines and supplies. RESULTS: 92 148 and 130 296 participants from 2007 and 2016 were included. In 2007, a median of 3.19 (interquartile range: 0.96 to 7.99) and an average of 8.14 (95% confidence interval: 7.80 to 8.49) were found for the out-of-pocket spending on medicines and supplies. In 2016, the median and mean out-of-pocket spending on medicines and supplies were 3.55 (interquartile range: 1.48 to 8.88) and 9.68 (95% confidence interval: 9.37 to 9.99), respectively. For 2016, higher out-of-pocket spending on medicines and supplies was found in women, children under five and over 60 years of age, people of higher educational level, having private or armed forces insurance, living in the coastal region, and being in one of the highest per capita quintile of expenditure. Between 2007 and 2016, the out-of-pocket spending on medicines and supplies was significantly increased in children under five (p < 0.001), uninsured persons (p < 0.001), insured to the Seguro Integral de Salud (p < 0.001) or the Armed Forces (p = 0.035), for the urban and rural area (both p < 0.001), and in people without chronic diseases (p < 0.001). CONCLUSIONS: An increase in out-of-pocket spending on medicines and supplies was found in the study period. There were population groups with significant increases in out-of-pocket spending on medicines and supplies. It is necessary to explore further the factors associated with out-of-pocket spending on medicines and supplies in groups of greater economic vulnerability regarding direct health spending in Peru.


Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Custos de Medicamentos , Gastos em Saúde/estatística & dados numéricos , Financiamento Pessoal/economia , Peru , Pobreza , Características da Família , Estudos Transversais
9.
Rev. Bras. Med. Fam. Comunidade (Online) ; 15(42): 2561, 20200210. tab
Artigo em Português | LILACS | ID: biblio-1282585

RESUMO

Introdução: O aumento contínuo do número de processos de judicialização da saúde, a relevância epidemiológica do diabetes mellitus tipo 2 (DM2), a escassez de recursos utilizados para monitorar os investimentos dos processos judiciais e do seu alto custo para a saúde pública, diante disso torna-se necessário estudos que analisem o perfil da judicialização dos antidiabéticos, que é a principal classe de medicamentos alvo dos processos judiciais. Objetivo: Analisar se os pacientes com DM2 atendidos via judicial, foram acompanhados e monitorados no Sistema Único de Saúde (SUS) antes e após os processos judiciais. Além de analisar o perfil de medicamentos judicializados para tratamento da DM2. Métodos: Trata-se de um estudo longitudinal retrospectivo, que utilizou dados secundários, prontuários e arquivos de processos judiciais, de 56 pacientes com DM2 que adquiriram pelo menos um de seus medicamentos por meio da judicialização, no ano de 2019, em um município mineiro. Os dados foram analisados 12 meses antes e 12 meses após a judicialização. Resultados: Dentre as 56 ações judiciais, 39% se concentraram em apenas três unidades de saúde do município. Somente 30 pacientes (53%) antes e 29 (51%) após a judicialização tiveram consultas no SUS. Além disso, apenas 15 (26%) e 13 (23%) pacientes, respectivamente antes e após a judicialização, apresentaram algum exame laboratorial realizado pelo SUS. As insulinas Levemir Flex Pen® (13%), Novo Rapid® (11%) e Lantus® (7%) foram os medicamentos mais judicializados. Conclusão: Observou-se que apesar do SUS prover o insumo terapêutico de elevado custo por meio de uma porta de entrada não convencional, não há monitorização clínica e laboratorial para avaliação da efetividade do uso da tecnologia, conforme recomendam os protocolos clínicos e dispositivos legais brasileiros sobre acesso a medicamentos.


Introducción: El aumento continuo en el número de procesos de judicialización de la salud, la relevancia epidemiológica de la diabetes mellitus tipo 2 (DM2), la escasez de recursos utilizados para monitorear las inversiones en procesos judiciales y de su alto costo para la salud pública, se vuelven necesarios estudios que analicen el perfil de la judicialización de los antidiabéticos, que es la principal clase de medicamentos a las que se dirigen los procesos judiciales. Objetivo: Analizar si los pacientes con DM2 atendidos vía judicial, fueron acompañados y monitoreados en el Sistema Único de Salud (SUS) antes y después de los procesos judiciales. Además de analizar el perfil de las drogas legalizadas para el tratamiento de la DM2. Métodos: Se trata de un estudio retrospectivo longitudinal, que utilizó datos secundarios, registros médicos y archivos de demandas, de 56 pacientes con DM2 que adquirieron al menos uno de sus medicamentos a través de la judicialización, en el año 2019, en un municipio de Minas Gerais. Los datos fueron analizados 12 meses antes y 12 meses después de la judicialización. Resultados: Entre las 56 acciones judiciales, el 39% se concentró en solo tres unidades de salud en el municipio. Solo 30 pacientes (53%) antes y 29 (51%) después de la judicialización tuvieron consultas en el SUS. Además, solo 15 (26%) y 13 (23%) pacientes, respectivamente antes y después de la judicialización, se sometieron a pruebas de laboratorio realizadas por el SUS. Las insulinas Levemir Flex Pen® (13.0%), Novo Rapid® (11%) y Lantus® (7%) fueron los medicamentos más judicializadas. Conclusión: Se observó que a pesar de que el SUS proporciona un recurso terapéutico de alto costo a través de una puerta de entrada no convencional, no hay monitoreo clínico y laboratorial para la evaluación de la efectividad del uso de la tecnología, según lo recomendado por los protocolos clínicos y dispositivos legales brasileros sobre el acceso a medicamentos.


Introduction: The continuous increase in the number of health judicialization processes, the epidemiological relevance of type 2 diabetes mellitus (DM2), the scarcity of resources used to monitor the investments of lawsuits, and their high cost to public health, that said there is a need for studies that analyze the profile of the judicialization of antidiabetics, which is the main class of drugs targeted by lawsuits. Objective: To analyze whether patients with DM2 attended by judicial system, are followed up and monitored in Brazilian Public Health System (SUS) before and after judicial proceedings. In addition to analyzing the profile of drugs legalized for the treatment of DM2. Methods: A retrospective observational study, which secondary database, medical records and judicial files, was conducted with 56 patients with DM2 who have acquired at least one of their medicines through lawsuits, in 2019, in a city in Minas Gerais. The data were analyzed 12 months before and 12 months after judicialization process. Results: Among the 56 lawsuits, 39% were concentrated in only three health units. Only 30 patients (53%) before and 29 (51%) after judicialization had appointments in SUS. Furthermore, only 15 (26%) and 13 (23%) patients, respectively before and after judicialization, had some laboratory test performed by SUS. The insulins Levemir Flex Pen® (13%), Novo Rapid® (11%), and Lantus® (7%) were the most judicialized drugs. Conclusion: It was observed that despite the SUS providing the high-cost therapeutic input through an unconventional gateway, there is no clinical and laboratory monitoring to evaluate the effectiveness of the technology, as recommended by clinical protocols and Brazilian laws about access to medicines.


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Assistência Farmacêutica , Acesso à Informação , Diabetes Mellitus Tipo 2 , Judicialização da Saúde , Cobertura Universal do Seguro de Saúde
10.
Asian Pac J Cancer Prev ; 20(6): 1857-1864, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31244310

RESUMO

Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic limitations and the geographical distribution and quality of the mammography machines. This study evaluated access to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions, states and the Federal District in 2016. The number of mammography machines required for breast cancer screening was calculated and compared to the number of machines available. The expected number of mammograms was compared with the actual number performed. Machines were georeferenced based on their location and the municipal seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed, representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60 km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion: These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the SUS is not associated with the number of machines available or with the geographical location of the equipment but rather with the insufficient number of mammograms performed.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/tendências , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Neoplasias da Mama/epidemiologia , Detecção Precoce de Câncer/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Pessoa de Meia-Idade , Prognóstico
11.
Rev. Fac. Med. Hum ; 19(3): 75-80, July-Sep,2019.
Artigo em Inglês, Espanhol | LILACS-Express | LILACS | ID: biblio-1025595

RESUMO

La política del Aseguramiento Universal en Salud estableció que el acceso a los servicios de salud se realizara por medio de la intermediación financiera de seguros de salud, estableciendo para ello cuatro ejes de "reforma": plan de beneficios, financiamiento y pagos, focalización de subsidios, prestación de servicios y regulación. La política del Aseguramiento Universal en Salud se basó en la teoría de los cuasimercados donde la intención del Estado es evitar ser el proveedor de recursos y el proveedor de servicios al mismo tiempo; en lugar de ello, busca convertirse en el proveedor primario de fondos para una variedad de proveedores del sector privado, público y no lucrativos, todos operando en competencia unos contra otro.A 10 años de su implementación en nuestro país se analizan los avances de implementación en los ejes de reforma que planteó la política del Aseguramiento Universal en Salud.


The policy of the Universal Health Insurance established that access to health services will be carried out through the financial intermediation of health insurance, establishing for this four axes of "reform": plan of benefits, financing and payments, targeting of subsidies, service provision and regulation.The policy of the Universal Health Insurance was based on the theory of quasi-markets where the intention of the State is to avoid being the provider of resources and the service provider at the same time; instead, it seeks to become the primary provider of funds to a variety of private, public and nonprofit providers, all operating in competition against each other.Ten years after its implementation in our country, the progress made in the implementation of the reform axis proposed by the Universal Health Insurance policy is analyzed.

12.
Ciênc. cuid. saúde ; 18(3): e47115, 2019-03-23.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1120317

RESUMO

Objective: To analyze universal access to health from the social representations of users about the Unified Health System, in the city of Rio de Janeiro, Brazil. Method:A quantitative-qualitative study, based on the Theory of Social Representations, in its procedural approach. Data collection was performed in 2010, through a semi-structured interview. The data were analyzed using Alceste 4.7 software. Results:104 users of the health system participated, most of them women, income up to a minimum wage and residents from Rio de Janeiro. Two textual sets were evidenced in the lexical analysis: "The process of evaluation of the health system: the experience of users" and "The health system: structure and purpose". Conclusion:Health service users have builtthe experience of a system in permanent construction that lacks, in some situations, financial resources, basic and essential routinely actions, but that actualize the universality of social classes and different levels of complexities of care.


Objetivo: Analisar o acesso universal à saúde a partir das representações sociais dos usuários acerca do Sistema Único de Saúde, no município do Rio de Janeiro, Brasil. Método: Estudo com abordagem quanti-qualitativa, pautado na Teoria das Representações Sociais, em sua abordagem processual. A coleta de dados foi realizada em 2010, por meio de entrevista semiestruturada. Os dados foram analisados com auxílio do software Alceste 4.7. Resultados: Participaram 104 usuários do sistema de saúde, sendo a maioria mulheres, renda de até um salário mínimo e residentes no município do Rio de Janeiro. Foram evidenciados na análise lexical, dois conjuntos textuais: "O processo de avaliação do sistema de saúde: a experiência dos usuários" e "O sistema de Saúde: estrutura e finalidade". Conclusão:Os usuários dos serviços de saúde vêm acumulando a experiência de um sistema em permanente construção que carece, em algumas situações, de insumos e ações essenciais, rotineiras e básicas, mas que efetiva a universalidade perpassando classes sociais e distintos níveis de complexidades de assistência.


Assuntos
Humanos , Masculino , Feminino , Acesso Universal aos Serviços de Saúde , Organização e Administração , Classe Social , Sistema Único de Saúde , Saúde , Enfermagem em Saúde Comunitária , Cobertura Universal do Seguro de Saúde , Recursos Humanos , Universalização da Saúde , Estresse Financeiro , Representação Social , Recursos em Saúde , Serviços de Saúde , Hospitais
13.
Rev Med Inst Mex Seguro Soc ; 57(5): 307-313, 2019 Sep 02.
Artigo em Espanhol | MEDLINE | ID: mdl-32568486

RESUMO

BACKGROUND: dropout is considered a problem because attention is interrupted, causing in many cases, complications and important sequelae. The prevalence and factors associated with outpatient referral (DECE) in a national hospital in Peru, 2014-2015, were evaluated. METHODS: analytical cross-sectional design. The DECE is that medical appointment by external office that was not specified. Demographic factors related to the medical appointment were collected. To assess the factors associated with DECE, a generalized linear model of the Poisson family with robust standard errors (crude and adjusted) was used. RESULTS: Of 592160 medical appointments granted, the prevalence of DECE was 20.2%. The average age was 51.10 ± 23.23 years and 59.6% were women. The factors associated with a greater probability of DECE were: being a woman, being under 18 years of age or adult, programming schedule, type of patient of the service and the hospital; and have more than 15 days of deferral in the appointment. CONCLUSIONS: Conclusions: One out of every five patients did not make an appointment in the outpatient clinic. There were demographic and health system factors associated with a higher prevalence of DECE, which could be considered to propose strategies to reduce it.


INTRODUCCIÓN: se considera la deserción un problema debido a que interrumpe la atención, ocasionando, en muchos casos, complicaciones y secuelas importantes. Se planteó valorar la prevalencia y los factores asociados a la deserción en consulta externa (DECE) en un hospital nacional de Perú, 2014-2015. MÉTODOS: diseño transversal analítico. La DECE es aquella cita médica por consultorio externo que no fue concretada. Se recolectaron factores demográficos y relacionados a la cita médica. Para valorar los factores asociados a la DECE se utilizó un modelo lineal generalizado de la familia Poisson con errores estándares robustos (crudo y ajustado). Se reporta como medida de asociación a la razón de prevalencias (RP) con sus IC95%. RESULTADOS: de 592 160 citas médicas otorgadas, la prevalencia de DECE fue de 20.2%. La edad promedio fue 51.1 ± 23.2 años, y el 59.6% fueron mujeres. Los factores asociados a una mayor probabilidad de DECE fueron: ser mujer, ser menor de 18 años de edad, horario de programación (tarde), tipo de paciente (continuador y de reingreso) del servicio y del hospital y tener más de 15 días de diferimiento en la cita. En contraste, los factores que disminuyeron la probabilidad de DECE fueron: tener cita adicional, horario de programación (noche) y si fueron horas extras u horas de régimen de prestaciones complementarias de trabajo. CONCLUSIONES: uno de cada cinco pacientes no concretó su cita en consulta externa. Se evidenciaron factores demográficos y del sistema de salud asociados a una mayor prevalencia de DECE que podrían ser tomados en cuenta para plantear estrategias para disminuirla.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Agendamento de Consultas , Pacientes Desistentes do Tratamento/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Peru , Distribuição de Poisson , Fatores Sexuais , Previdência Social/estatística & dados numéricos
14.
Rev. méd. Chile ; 147(1): 103-106, 2019.
Artigo em Espanhol | LILACS | ID: biblio-991379

RESUMO

Health care raises structural issues in a democratic society, such as the role assigned to the central government in the management of health risk and the redistributive consequences generated by the implementation of social insurance. These are often cause of strong political controversy. This paper examines the United States of America health reform, popularly known as "ObamaCare". Its three main elements, namely individual mandate, creation of new health insurance exchanges, and the expansion of Medicaid, generated a redistribution of health risks in the insurance market of that country after almost a century of frustrated legislative efforts to guarantee minimum universal coverage. The article proposes that a change of this magnitude in the United States will produce effects in a forthcoming parliamentary discussion on the health reform in Chile, which still maintains a highly deregulated private health system.


Assuntos
Humanos , Reforma dos Serviços de Saúde/normas , Cobertura Universal do Seguro de Saúde/normas , Patient Protection and Affordable Care Act/normas , Estados Unidos , Chile , Medicaid/normas
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA