RESUMO
Differing from previous studies ignoring the nonlinear features, this study employs both the linear and nonlinear Granger causality tests to examine the complex causal relationship between health care expenditure and economic growth among 15 Organisation for Economic Co-operation and Development (OECD) and 5 major developing countries. Some interesting findings can be obtained as follows: (1) For Australia, Austria, and UK, linear and nonlinear Granger causality does not exist between them. A unidirectional linear or nonlinear causality running from economic growth to health care expenditure can be found for Ireland, Korea, Portugal, and India. For these seven countries, health or fiscal policy related to health spending will not have an impact on economic growth; (2) For Belgium, Norway, and Mexico, only a unidirectional linear causality runs from health care expenditure to economic growth, while bidirectional linear causality can be found for Canada, Finland, Iceland, New Zealand, Spain, Brazil, and South Africa. Especially for the US, China, and Japan, a unidirectional nonlinear causality exists from health spending to economic growth. To improve the quality of national health, life quality and happiness, these 13 countries should actively look to optimise policy related to health care expenditure, such as by enhancing the efficiency of health costs to promote sustainable economic development.
Assuntos
Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Desenvolvimento Econômico , Produto Interno Bruto/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Austrália , Áustria , Bélgica , Brasil , Canadá , China , Finlândia , Humanos , Islândia , Índia , Irlanda , Japão , México , Nova Zelândia , Noruega , Organização para a Cooperação e Desenvolvimento Econômico , Portugal , República da Coreia , África do Sul , EspanhaRESUMO
Diabetes is associated with a significant burden globally. The costs of diabetes-related hospitalizations are unknown in most developing countries. The aim of this study was to estimate the total number and economic burden of hospitalizations attributable to diabetes mellitus (DM) and its complications in adults from the perspective of the Brazilian Public Health System in 2014. Data sources included the National Health Survey (NHS) and National database of Hospitalizations (SIH). We considered diabetes, its microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular complications (coronary heart disease, cerebrovascular disease, and peripheral arterial disease), respiratory and urinary tract infections, as well as selected cancers. Assuming that DM patients are hospitalized for these conditions more frequently that non-DM individuals, we estimated the etiological fraction of each condition related to DM, using the attributable risk methodology. We present number, average cost per case, and overall costs of hospitalizations attributable to DM in Brazil in 2014, stratified by condition, state of the country, gender and age group. In 2014, a total of 313,273 hospitalizations due to diabetes in adults were reported in Brazil (4.6% of total adult hospitalization), totaling (international dollar) Int$264.9 million. The average cost of an adult hospitalization due to diabetes was Int$845, 19% higher than hospitalization without DM. Hospitalizations due to cardiovascular diseases related to diabetes accounted for the higher proportion of costs (47.9%), followed by microvascular complications (25.4%) and DM per se (18.1%). Understanding the costs of diabetes and its major complications is crucial to raise awareness and to support the decision-making process on policy implementation, also allowing the assessment of prevention and control strategies.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Hospitalização/economia , Adolescente , Adulto , Brasil , Doenças Cardiovasculares/economia , Custos e Análise de Custo , Bases de Dados Factuais , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Doenças Respiratórias/economia , Doenças Urológicas/economia , Adulto JovemRESUMO
The aim of this study was to estimate the annual costs for the treatment of diabetic foot disease (DFD) in Brazil. We conducted a cost-of-illness study of DFD in 2014, while considering the Brazilian Public Healthcare System (SUS) perspective. Direct medical costs of outpatient management and inpatient care were considered. For outpatient costs, a panel of experts was convened from which utilization of healthcare services for the management of DFD was obtained. When considering the range of syndromes included in the DFD spectrum, we developed four well-defined hypothetical DFD cases: (1) peripheral neuropathy without ulcer, (2) non-infected foot ulcer, (3) infected foot ulcer, and (4) clinical management of amputated patients. Quantities of each healthcare service was then multiplied by their respective unit costs obtained from national price listings. We then developed a decision analytic tree to estimate nationwide costs of DFD in Brazil, while taking into the account the estimated cost per case and considering epidemiologic parameters obtained from a national survey, secondary data, and the literature. For inpatient care, ICD10 codes related to DFD were identified and costs of hospitalizations due to osteomyelitis, amputations, and other selected DFD related conditions were obtained from a nationwide hospitalization database. Direct medical costs of DFD in Brazil was estimated considering the 2014 purchasing power parity (PPP) (1 Int$ = 1.748 BRL). We estimated that the annual direct medical costs of DFD in 2014 was Int$ 361 million, which denotes 0.31% of public health expenses for this period. Of the total, Int$ 27.7 million (13%) was for inpatient, and Int$ 333.5 million (87%) for outpatient care. Despite using different methodologies to estimate outpatient and inpatient costs related to DFD, this is the first study to assess the overall economic burden of DFD in Brazil, while considering all of its syndromes and both outpatients and inpatients. Although we have various reasons to believe that the hospital costs are underestimated, the estimated DFD burden is significant. As such, public health preventive strategies to reduce DFD related morbidity and mortality and costs are of utmost importance.
Assuntos
Amputação Cirúrgica/economia , Efeitos Psicossociais da Doença , Pé Diabético/economia , Hospitalização/economia , Medicina Preventiva/organização & administração , Saúde Pública , Adulto , Amputação Cirúrgica/estatística & dados numéricos , Brasil/epidemiologia , Bases de Dados Factuais , Pé Diabético/epidemiologia , Pé Diabético/terapia , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Saúde Pública/economia , Adulto JovemRESUMO
A inatividade física é um dos maiores desafios à saúde pública devido à sua associação com doenças crônicas e ao impacto econômico sobre o sistema público de saúde. Entretanto, a prática de caminhada pode auxiliar a amenizar esses problemas. Objetivo Verificar se existem associações entre prática de caminhada no lazer, presença de fatores de risco e gastos relacionados ao uso de serviços de saúde em usuários do sistema público de saúde brasileiro. Metodologia A amostra foi composta por 963 adultos. A prática de caminhada foi avaliada a partir de questionário de Baecke. Gasto com tratamento/ano foi avaliado pela demanda por serviços registrados nos prontuários clínicos. Resultados Prática de caminhada como atividade física de lazer foi referida por 64,4% dos participantes. Os grupos de maior prática de caminhada apresentaram menores valores para idade, IMC, CC e gastos com medicamentos. Indivíduos inseridos na categoria de maior envolvimento apresentaram 41% menos chances de estarem inserido no grupo de maior gasto total (OR=0.59; IC95% 0.39-0.89). Conclusão Verificou-se que a prática de caminhada como atividade física de lazer foi a mais frequente para a maioria dos usuários do SUS, a qual foi associada a menores gastos com medicamentos e no total.
Physical inactivity is a major public health challenge due to its association with chronic diseases and the resulting economic impact on the public healthcare system. However, walking can help alleviate these problems. Aim To verify associations between walking during leisure-time, risk factors and health care expenditure among users of the Brazilian public health care system. Methods The sample consisted of 963 adults. Walking was evaluated using the Baecke questionnaire. The total expenditure per year was evaluated through the demand for health care services, verified in the medical records of each participant. Results Walking was reported as a physical activity during leisure-time by 64.4% of the participants. The group with the highest engagement in walking was younger and presented lower values for BMI, WC and expenditure on medication. Participants inserted in the category of higher involvement in walking were 41% less likely to be inserted into the group with higher total expenditure (OR = 0:59; 95% CI 0.39-0.89). Conclusion It was found that walking was the most frequent leisure-time physical activity reported by users of the Brazilian health care system and was associated with lower total and medication expenditure.
Assuntos
Humanos , Masculino , Feminino , Adulto , Caminhada , Gastos em Saúde , Brasil , Estudos Transversais , Estudos RetrospectivosRESUMO
Este documento tiene como marco la protección social en salud. Su objeto es precisar indicadores y conceptos de la economía de la salud que permiten estudiar y proponer políticas y arreglos institucionales para que las personas sean protegidas financieramente al momento de acudir a instituciones o prestadores de salud. El texto se divide en dos secciones: la una, con indicadores macrofinancieros (vinculando a la macroeconomía con las reglas globales del financiamiento de la salud); y, la otra, de carácter microfinanciero referido al impacto en la equidad de los gastos de bolsillo. Se presenta un cuadro original del autor identificando el gasto total en salud de Chile: la suma del gasto público (aportes fiscales más cotizaciones obligatorias a la Seguridad Social) y el gasto privado (cotizaciones voluntarias a seguros incluyendo Isapres más gastos de bolsillo) y se examinan diversos indicadores financieros tales como: Gasto per cápita total en salud; Índice general de precios, Índice de precios de salud y tipo de cambio promedio; Gasto del gobierno en salud como proporción del total de gastos en salud; porcentaje del presupuesto de salud del gobierno dedicado a la consulta ambulatoria / la atención hospitalaria; Gasto de bolsillo como proporción del gasto en salud .La segunda sección se refiere a la equidad en las cotizaciones; la composición del gasto de bolsillo en salud por quintil; y el acceso a medicamentos.
The background of this paper is the concept of health protection. The article aims to define both concepts and indicators of health economics, in order to develop and propose health policies to protect persons financially at the point of demand health services. The article is organized in two sections: The first one oriented to macroeconomic issues; and the second to microeconomic ones. Global information about the current public and private health care expenditures en Chile is provided.