RESUMO
BACKGROUND: The Family Health Strategy (FHS) became consolidated as a primary care model and gatekeeper for the Unified Health System (Sistema Único de Saúde, SUS) in the Brazil and it is considered one of the largest primary health care programmes in the world. Its rapid expansion allowed the SUS to meet the changing health care needs of the population remote localities of Brazilian municipalities. METHODS: In the present study, exploratory data analysis was performed using modelling to provide a general overview of the study and to delineate possible structural characteristics of the cross-sectional time-series data. Panel regression methods were used to assess the association between FHS coverage and ambulatory care-sensitive hospitalizations (ACSH rates) in the municipalities of Pará, in the Brazilian Amazon, from 2008 to 2017. RESULTS: The results showed strong evidence for the association between FHS coverage and ACSH rates, including reductions of 22% in preventable hospitalizations and 15% in hospital expenses that were directly linked to the 40% increase in FHS population coverage during the evaluated period. This expansion of primary care has mainly benefitted areas that are difficult to access and populations that were previously deprived of health care in the vast Amazon territory. CONCLUSIONS: The findings of this study show that the increase of the expansion of primary care reduces the preventable hospitalization and the hospital expenses. This reinforces the need for public protection of the health of populations at risk and the positive impacts of primary care in the Brazilian Amazon.
Assuntos
Programas Governamentais/estatística & dados numéricos , Assistência Médica/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Criança , Estudos Transversais , Saúde da Família , Humanos , Fatores SocioeconômicosRESUMO
OBJECTIVES: To evaluate the trends and hospital variation in the use of pharmacologic restraint among pediatric mental health visits in the emergency department (ED). STUDY DESIGN: We examined ED visits with a mental health diagnosis in patients aged 3-21 years at children's hospital EDs from 2009 to 2019. We calculated the frequency of pharmacologic restraint use and determined visit characteristics associated with restraint use. We calculated cumulative percent change for visits with restraints and for all mental health visits. We used logistic regression to test trends over time and evaluate hospital variation in the frequency of restraint use. RESULTS: We identified 389 885 mental health ED visits (54.9% female, median age 14.3 years) and 13 643 (3.5%) visits with pharmacologic restraint use. Characteristics associated with pharmacologic restraint use were late adolescent age (18-21 years), male sex, Black race, non-Latino ethnicity, public insurance, and admission to the hospital (P < .001). During the study period, both mental health ED visits increased by 268% and mental health ED visits with pharmacologic restraint use increased by 370%. The rate of pharmacologic restraint in this patient population remained constant. Hospital use of pharmacologic restraint for mental health visits varied significantly across hospitals (1.6%-11.8%, P < .001). CONCLUSIONS: Pediatric mental health ED visits with and without pharmacologic restraint are increasing over time. In addition, the overall number of pharmacologic restraint use has increased threefold. Significant hospital variation in pharmacologic restraint use signifies an opportunity for standardization of care and restraint reduction.
Assuntos
Antipsicóticos/administração & dosagem , Serviço Hospitalar de Emergência , Hospitais Pediátricos , Serviços de Saúde Mental , Adolescente , Fatores Etários , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Injeções Intramusculares , Injeções Intravenosas , Masculino , Assistência Médica/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Fatores Raciais , Fatores Sexuais , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Since its beginning in Wuhan, China, in December 2019, the disease caused by COVID-19 has reached more than 27 million confirmed cases and more than 880 thousand deaths worldwide by early September 2020. Although it is known that some of these deaths may have been influenced by the overload of health systems, the world medical literature lacks data on deaths due to COVID-19 in patients who have not received medical assistance. We conducted a retrospective transversal study to report the clinical and epidemiological profile of the first 200 consecutive cases of home deaths without medical assistance caused by COVID-19 diagnosed by verbal autopsy and real-time PCR in samples of postmortem nasopharyngeal swabs, in the state of Ceara, in Northeastern Brazil. The data show a slightly increased prevalence of cases in males (57%) and an average age of 76.8 years. Previous comorbidities were reported in 85.5% of cases, the most common being cardiovascular disease (45%), neurological disease (30%), and diabetes (29%). The main symptoms reported were dyspnea (79%), fever (75.5%), cough (69%), and fatigue (42.5%). The average time between the onset of illness and death was 7.3 days, being statistically shorter in patients who had previous comorbidities (P = 0.0215). This is the first study to evidence the clinical and epidemiological characteristics of COVID-19 home deaths without medical assistance, which may represent a considerable portion of the pandemic burden, especially in the context of health system overload.
Assuntos
COVID-19/epidemiologia , COVID-19/mortalidade , Morte , Assistência Médica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Autopsia , Brasil/epidemiologia , Comorbidade , Tosse , Diabetes Mellitus , Feminino , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: Effective health system interventions may help address the disproportionate burden of diabetes in low- and middle-income countries (LMICs). We assessed the impact of health system interventions to improve outcomes for adults with type 2 diabetes in LMICs. METHODS AND FINDINGS: We searched Ovid MEDLINE, Cochrane Library, EMBASE, African Index Medicus, LILACS, and Global Index Medicus from inception of each database through February 24, 2020. We included randomized controlled trials (RCTs) of health system interventions targeting adults with type 2 diabetes in LMICs. Eligible studies reported at least 1 of the following outcomes: glycemic change, mortality, quality of life, or cost-effectiveness. We conducted a meta-analysis for the glycemic outcome of hemoglobin A1c (HbA1c). GRADE and Cochrane Effective Practice and Organisation of Care methods were used to assess risk of bias for the glycemic outcome and to prepare a summary of findings table. Of the 12,921 references identified in searches, we included 39 studies in the narrative review of which 19 were cluster RCTs and 20 were individual RCTs. The greatest number of studies were conducted in the East Asia and Pacific region (n = 20) followed by South Asia (n = 7). There were 21,080 total participants enrolled across included studies and 10,060 total participants in the meta-analysis of HbA1c when accounting for the design effect of cluster RCTs. Non-glycemic outcomes of mortality, health-related quality of life, and cost-effectiveness had sparse data availability that precluded quantitative pooling. In the meta-analysis of HbA1c from 35 of the included studies, the mean difference was -0.46% (95% CI -0.60% to -0.31%, I2 87.8%, p < 0.001) overall, -0.37% (95% CI -0.64% to -0.10%, I2 60.0%, n = 7, p = 0.020) in multicomponent clinic-based interventions, -0.87% (-1.20% to -0.53%, I2 91.0%, n = 13, p < 0.001) in pharmacist task-sharing studies, and -0.27% (-0.50% to -0.04%, I2 64.1%, n = 7, p = 0.010) in trials of diabetes education or support alone. Other types of interventions had few included studies. Eight studies were at low risk of bias for the summary assessment of glycemic control, 15 studies were at unclear risk, and 16 studies were at high risk. The certainty of evidence for glycemic control by subgroup was moderate for multicomponent clinic-based interventions but was low or very low for other intervention types. Limitations include the lack of consensus definitions for health system interventions, differences in the quality of underlying studies, and sparse data availability for non-glycemic outcomes. CONCLUSIONS: In this meta-analysis, we found that health system interventions for type 2 diabetes may be effective in improving glycemic control in LMICs, but few studies are available from rural areas or low- or lower-middle-income countries. Multicomponent clinic-based interventions had the strongest evidence for glycemic benefit among intervention types. Further research is needed to assess non-glycemic outcomes and to study implementation in rural and low-income settings.
Assuntos
Planejamento em Saúde Comunitária , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Educação em Saúde/estatística & dados numéricos , Adulto , Ásia , Planejamento em Saúde Comunitária/economia , Programas Governamentais/estatística & dados numéricos , Educação em Saúde/economia , Humanos , Assistência Médica/estatística & dados numéricos , Qualidade de VidaRESUMO
This article aims to provide an overview of the territorial distribution of health training supply and to identify the strategies for strengthening regionalization adopted by teaching institutions that offer health courses and the changes in the regional surroundings as a function of these institutions. This is a descriptive-exploratory multiple-case study conducted at the national level in Brazil from December 2015 to September 2016. The study analyzed secondary data on health training supply and interviewed 68 administrators of undergraduate health courses, whose commentary was submitted to content analysis. There was an increase in health training institutions in smaller regions and municipalities (counties), although such institutions were still concentrated mainly in more socioeconomically developed regions. Policies have been implemented for access and enrollment in higher education from the perspective of promoting provision and professional retention in the region where the health course is located. The university's presence promotes regional development and has the potential to strengthen health regionalization.
Este artigo objetiva descrever o panorama de distribuição territorial da oferta de formação em saúde, bem como identificar as estratégias para o fortalecimento da regionalização adotadas pelas instituições de ensino que ofertam cursos de saúde e as mudanças verificadas no entorno regional em função dessas instituições. Trata-se de estudo descritivo-exploratório, do tipo estudo de casos múltiplos, desenvolvido em âmbito nacional no período de dezembro de 2015 a setembro de 2016. Foram analisados dados secundários de oferta de formação em saúde e foram entrevistados 68 gestores de ensino de cursos de graduação em saúde, cujos depoimentos foram submetidos a análise de conteúdo. Percebe-se um aumento de equipamentos para formação em saúde em regiões e municípios de menor porte, não obstante a concentração em locais com maior desenvolvimento socioeconômico. Políticas de acesso ao ensino superior de estudantes vêm sendo empreendidas, na perspectiva de promover a provisão e fixação profissional do entorno onde se localizam os cursos da saúde. Constata-se que a presença da universidade promove desenvolvimento regional e tem potencial para o fortalecimento da regionalização da saúde.
El objetivo de este artículo es describir el panorama de la distribución territorial, en cuanto a la oferta de formación en salud, e identificar estrategias para el fortalecimiento de la regionalización, adoptadas por las instituciones de enseñanza que ofrecen cursos de salud, además de analizar los cambios verificados en el entorno regional, en función de estas instituciones. Se trata de un estudio descriptivo-exploratorio, de casos múltiples, desarrollado en el ámbito nacional de Brasil durante el período de diciembre de 2015 a septiembre de 2016. Se analizaron datos secundarios de oferta de formación en salud, y se entrevistaron a 68 gestores de enseñanza de cursos de grado en salud, cuyas declaraciones fueron sometidas a análisis de contenido. Se percibe un aumento de equipamientos para la formación en salud en regiones y municipios de menor porte, pese a la concentración en lugares con mayor desarrollo socioeconómico. Se están emprendiendo políticas de acceso e ingreso en la enseñanza superior de estudiantes, desde la perspectiva de promover la provisión y emplazamiento del profesional en el entorno donde se localizan los cursos de salud. Se constata que la presencia de la universidad promueve el desarrollo regional y tiene potencial para el fortalecimiento de la regionalización de la salud.
Assuntos
Educação de Graduação em Medicina/organização & administração , Educação em Enfermagem/organização & administração , Mão de Obra em Saúde/organização & administração , Assistência Médica/organização & administração , Programas Nacionais de Saúde/organização & administração , Regionalização da Saúde/organização & administração , Brasil , Centros Comunitários de Saúde/organização & administração , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Educação de Graduação em Medicina/estatística & dados numéricos , Educação em Enfermagem/estatística & dados numéricos , Ocupações em Saúde/educação , Ocupações em Saúde/estatística & dados numéricos , Política de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Assistência Médica/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Médicos/provisão & distribuição , Regionalização da Saúde/estatística & dados numéricos , Características de Residência , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
More than one in four Brazilians have private health insurance (PHI), even thought it covers mostly the same procedures as the Brazilian Unified National Health System (SUS). This literature review included articles and monographs published since 1990 about the utilization of SUS by privately insured individuals. Considering outpatient care and hospitalization, privately insured people in Brazil use SUS in approximately 13% of the times they receive health care, and approximately 7% of people receiving care paid by SUS are privately insured; these findings vary depending on the type of service studied and on study methods. Utilization of SUS is more frequent in less developed regions, by people with more restricted PHI plans and by people with worse health status. Privately insured people report the limitations of PHI plans as their reasons for resorting to SUS. Sometimes, beneficiaries of PHI plans owned by nonprofit hospitals (which also provide health care financed by SUS) have easier access to care than uninsured people financed by SUS. Anecdotally, privately insured people are satisfied with SUS, but not to the point of adopting SUS as their preferred source of care. In short, for privately insured people, SUS only plays a secondary role in their health care. Despite PHI taking over part of the SUS's health care demand, PHI represents a restriction of the universal, equitable character of the SUS.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Brasil , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/tendências , Assistência Médica/estatística & dados numéricos , Assistência Médica/tendências , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/tendências , Saúde PúblicaRESUMO
Resumo: Este artigo objetiva descrever o panorama de distribuição territorial da oferta de formação em saúde, bem como identificar as estratégias para o fortalecimento da regionalização adotadas pelas instituições de ensino que ofertam cursos de saúde e as mudanças verificadas no entorno regional em função dessas instituições. Trata-se de estudo descritivo-exploratório, do tipo estudo de casos múltiplos, desenvolvido em âmbito nacional no período de dezembro de 2015 a setembro de 2016. Foram analisados dados secundários de oferta de formação em saúde e foram entrevistados 68 gestores de ensino de cursos de graduação em saúde, cujos depoimentos foram submetidos a análise de conteúdo. Percebe-se um aumento de equipamentos para formação em saúde em regiões e municípios de menor porte, não obstante a concentração em locais com maior desenvolvimento socioeconômico. Políticas de acesso ao ensino superior de estudantes vêm sendo empreendidas, na perspectiva de promover a provisão e fixação profissional do entorno onde se localizam os cursos da saúde. Constata-se que a presença da universidade promove desenvolvimento regional e tem potencial para o fortalecimento da regionalização da saúde.
Abstract: This article aims to provide an overview of the territorial distribution of health training supply and to identify the strategies for strengthening regionalization adopted by teaching institutions that offer health courses and the changes in the regional surroundings as a function of these institutions. This is a descriptive-exploratory multiple-case study conducted at the national level in Brazil from December 2015 to September 2016. The study analyzed secondary data on health training supply and interviewed 68 administrators of undergraduate health courses, whose commentary was submitted to content analysis. There was an increase in health training institutions in smaller regions and municipalities (counties), although such institutions were still concentrated mainly in more socioeconomically developed regions. Policies have been implemented for access and enrollment in higher education from the perspective of promoting provision and professional retention in the region where the health course is located. The university's presence promotes regional development and has the potential to strengthen health regionalization.
Resumen: El objetivo de este artículo es describir el panorama de la distribución territorial, en cuanto a la oferta de formación en salud, e identificar estrategias para el fortalecimiento de la regionalización, adoptadas por las instituciones de enseñanza que ofrecen cursos de salud, además de analizar los cambios verificados en el entorno regional, en función de estas instituciones. Se trata de un estudio descriptivo-exploratorio, de casos múltiples, desarrollado en el ámbito nacional de Brasil durante el período de diciembre de 2015 a septiembre de 2016. Se analizaron datos secundarios de oferta de formación en salud, y se entrevistaron a 68 gestores de enseñanza de cursos de grado en salud, cuyas declaraciones fueron sometidas a análisis de contenido. Se percibe un aumento de equipamientos para la formación en salud en regiones y municipios de menor porte, pese a la concentración en lugares con mayor desarrollo socioeconómico. Se están emprendiendo políticas de acceso e ingreso en la enseñanza superior de estudiantes, desde la perspectiva de promover la provisión y emplazamiento del profesional en el entorno donde se localizan los cursos de salud. Se constata que la presencia de la universidad promueve el desarrollo regional y tiene potencial para el fortalecimiento de la regionalización de la salud.
Assuntos
Humanos , Regionalização da Saúde/organização & administração , Educação de Graduação em Medicina/organização & administração , Educação em Enfermagem/organização & administração , Mão de Obra em Saúde/organização & administração , Assistência Médica/organização & administração , Programas Nacionais de Saúde/organização & administração , Médicos/provisão & distribuição , Regionalização da Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Brasil , Características de Residência , Inquéritos e Questionários , Centros Comunitários de Saúde/organização & administração , Atenção à Saúde/organização & administração , Atenção à Saúde/estatística & dados numéricos , Educação de Graduação em Medicina/estatística & dados numéricos , Educação em Enfermagem/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Ocupações em Saúde/educação , Ocupações em Saúde/estatística & dados numéricos , Política de Saúde , Assistência Médica/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricosRESUMO
Abstract: More than one in four Brazilians have private health insurance (PHI), even thought it covers mostly the same procedures as the Brazilian Unified National Health System (SUS). This literature review included articles and monographs published since 1990 about the utilization of SUS by privately insured individuals. Considering outpatient care and hospitalization, privately insured people in Brazil use SUS in approximately 13% of the times they receive health care, and approximately 7% of people receiving care paid by SUS are privately insured; these findings vary depending on the type of service studied and on study methods. Utilization of SUS is more frequent in less developed regions, by people with more restricted PHI plans and by people with worse health status. Privately insured people report the limitations of PHI plans as their reasons for resorting to SUS. Sometimes, beneficiaries of PHI plans owned by nonprofit hospitals (which also provide health care financed by SUS) have easier access to care than uninsured people financed by SUS. Anecdotally, privately insured people are satisfied with SUS, but not to the point of adopting SUS as their preferred source of care. In short, for privately insured people, SUS only plays a secondary role in their health care. Despite PHI taking over part of the SUS's health care demand, PHI represents a restriction of the universal, equitable character of the SUS.
Resumo: Mais de um em cada quatro brasileiros têm planos de saúde, apesar de estes planos cobrirem majoritariamente os mesmos procedimentos do Sistema Único de Saúde (SUS). Esta revisão da literatura incluiu artigos e monografias publicados desde 1990 sobre a utilização do SUS por indivíduos com plano de saúde. Ao considerar conjuntamente a assistência ambulatorial e hospitalar, os brasileiros com planos de saúde utilizam o SUS em aproximadamente 13% das vezes em que recebem cuidados; aproximadamente 7% das pessoas que recebem cuidados pagos pelo SUS dispõem de planos de saúde (os achados variam de acordo com o tipo de serviço analisado e com os detalhes metodológicos dos estudos). O aumento da utilização do SUS está associado a: regiões menos desenvolvidas do país, planos de saúde com pior cobertura e pessoas com pior saúde. Os brasileiros com plano de saúde citam as limitações dos planos como o motivo pelo qual recorrem ao SUS. Em alguns casos os beneficiários de planos de saúde comercializados por hospitais filantrópicos (os quais também prestam assistência financiada pelo SUS) relatam acesso mais fácil à assistência financiada pelo SUS, comparado com aqueles sem plano de saúde. Pessoas com plano de saúde eventualmente citam a satisfação com a utilização do SUS, mas não a ponto do SUS se tornar a fonte de assistência preferida. Em resumo, para os brasileiros com plano de saúde, o SUS desempenha papel secundário no financiamento dos cuidados de saúde. Embora os planos de saúde pareçam deslocar parte da demanda por assistência para fora do SUS, esses mesmos planos tendem a restringir o caráter universal e equitativo do SUS.
Resumen: Más de uno de cada cuatro brasileños tiene un seguro de salud privado (PHI), a pesar de que estos últimos cubren en su mayoría los mismos procedimientos que en el Sistema Unificado de Salud (SUS). Esta revisión de la literatura incluyó artículos y monografías publicadas desde 1990 sobre la utilización del SUS por parte de personas aseguradas mediante el sistema privado. Considerando atención ambulatoria junto a hospitalización, la población con seguro médico privado en Brasil utiliza el SUS aproximadamente un 13% de las veces que reciben atención médica; además, aproximadamente un 7% de la gente que recibe atención médica pagada a través del SUS tiene seguro privado. Los resultados varían con el tipo de servicio estudiado y con los detalles de los métodos de estudio. La frecuencia de utilización del SUS es mayor en las regiones menos desarrolladas, por parte de la población con planes de seguros de salud más limitados, y personas con peor salud. Las personas con seguros privados identifican las limitaciones de sus planes PHI como la razón por la que usan el SUS. Algunas veces, los beneficiarios de los planes PHI de hospitales sin fines de lucro (que también proveen servicios de salud financiados por el SUS) cuentan con un acceso más sencillo a los cuidados de salud sufragados por el SUS que las personas sin seguro. Anecdóticamente, la población con seguro de salud privado está satisfecha con la utilización que hacen del SUS, pero no hasta el extremo de que el SUS se trasforme en su principal vía para recibir servicios médicos. En resumen, para la población con seguro privado, el SUS juega un papel secundario en la financiación de la asistencia a sus cuidados de salud. Pese a que el PHI parece desviar del SUS parte de la demanda de cuidados de salud, el PHI representa una restricción del carácter universal y equitativo del SUS.
Assuntos
Humanos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Brasil , Saúde Pública , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/tendências , Assistência Médica/tendências , Assistência Médica/estatística & dados numéricos , Programas Nacionais de Saúde/tendênciasAssuntos
Fármacos Anti-HIV , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/economia , Fármacos Anti-HIV/provisão & distribuição , Infecções por HIV/epidemiologia , Humanos , Assistência Médica/organização & administração , Assistência Médica/estatística & dados numéricos , México , Educação de Pacientes como Assunto , Vigilância da População , Avaliação de Programas e Projetos de Saúde , Previdência Social/organização & administração , Previdência Social/estatística & dados numéricosAssuntos
Humanos , Infecções por HIV/tratamento farmacológico , Fármacos Anti-HIV , Fármacos Anti-HIV/administração & dosagem , Fármacos Anti-HIV/economia , Previdência Social/organização & administração , Previdência Social/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Infecções por HIV/epidemiologia , Vigilância da População , Educação de Pacientes como Assunto , Assistência Médica/organização & administração , Assistência Médica/estatística & dados numéricos , MéxicoRESUMO
Aimed at covering the large fraction of workers in the informal sector without access to a social security program, the Mexican public health insurance program Seguro Popular began in 2002 and now reaches more than 50 million individuals. We estimate impacts of Seguro Popular for the population aged 50 and older on a set of indicators related to health care including utilization, diagnostic/preventive tests, and treatment conditional on being ill. Using the longitudinal Mexican Health and Aging Study over the period 2001-2012, we conduct before and after difference-in-difference matching impact estimators. Our results suggest large and important effects of the Program on utilization and diagnostic tests. We find overall smaller effects on the probability of being in treatment for individuals with chronic diseases, but these effects are concentrated in rural areas with relatively more health services versus rural areas with lower levels of health services. These results suggest that, to the extent that health services become more available in rural areas lacking services, effects of health insurance may increase.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Idoso , Técnicas e Procedimentos Diagnósticos/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Masculino , Assistência Médica/estatística & dados numéricos , México , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
Latinos are the largest growing population and have the highest fertility rates in the US. In response, this study assessed if late initiation of or no prenatal care (PNC) mediated the relationship among adverse birth outcomes and interactions between immigrant and insurance status. This study used cross-sectional data (2002-2004) limited to 109,399 women of Mexican ethnicity who had singleton births in the San Joaquin Valley, California. We conducted hierarchical mediation analyses. US-born Mexican women who used private or public insurance for PNC were more likely to have infants born at low-birth weight and premature compared to Mexican first generation immigrant women. Nonetheless, initiation of late or no PNC positively mediated the relationship between infants born premature to Mexican first generation immigrant women who used public insurance (ab/se(ab) = 2.123, p = .034). Findings from this study support acculturation theory and the need for multilevel approaches to address PNC among women of Mexican ethnicity.
Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Americanos Mexicanos/estatística & dados numéricos , Nascimento Prematuro/etnologia , Cuidado Pré-Natal/estatística & dados numéricos , Aculturação , Adulto , California/epidemiologia , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Assistência Médica/estatística & dados numéricos , Gravidez , Resultado da Gravidez/etnologiaRESUMO
OBJECTIVE: The primary objectives of this study were to measure and compare health insurance coverage between nonelderly Puerto Rican adults in cohabiting same-sex relationships and their counterparts in cohabiting different-sex relationships. METHODS: This study used data from the 2008-2014 Puerto Rican Community Survey on nonelderly adults (18-64 years) in cohabiting same-sex (n=274) and different-sex (n=58,128) relationships. Multinomial logistic regression models estimated differences in primary source of health insurance while controlling for key demographic and socioeconomic characteristics. RESULTS: Compared with men in different-sex relationships, men in same-sex relationships were less likely to have employer-sponsored insurance (ESI). Women in same-sex relationships were less likely than others to have ESI, insurance purchased directly from an insurer, and public health insurance after controlling for socio-demographic factors. CONCLUSIONS: Employment-based discrimination and policy barriers may have prevented same-sex couples from enjoying the full benefits associated with marriage and cohabitation in Puerto Rico, including employer-sponsored health insurance.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Homossexualidade/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Casamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Assistência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Porto Rico/etnologia , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In Brazil, health is fundamental human right guaranteed by the Constitution of 1988, which created the Brazilian Universal Health System (Sistema Único de Saúde - SUS). The SUS provides medications for outpatient care via policy of pharmaceutical assistance (PA) programmes. Despite the advances in PA policies which include the improvement in access to medications, there has been a significant increase in lawsuits related to health products and services. This study aimed to characterize the medication processes filed between 2010 and 2014 against the Secretary of State for Health of São Paulo (State Health Department of São Paulo - SES/SP), in Brazil, following PA policies. METHODS: This descriptive study used secondary data on medication lawsuits filed against the SES/SP between 2010 and 2014. The data source was the S-Codes computerized system. RESULTS: In the period evaluated, the number of lawsuits filed concerning health-related products increased approximately 63%; requests for medications were predominant. Approximately 30% of the medications involved in court proceedings were supplied via PA programmes. With regard to medications supplied via specialized component, 81.3% were prescribed in disagreement with the protocols published by the Ministry of Health. Insulin glargine was the most requested medication (6.3%), followed by insulin aspart (3.3%). Because there is no scientific evidence that either of these medicines is superior for the treatment of diabetes, neither of them has been incorporated into the SUS by the National Commission for Technology Incorporation. The judicial data showed that most of the lawsuits involved normal proceedings (i.e., individual demands), were filed by private lawyers, and named the State of São Paulo as the sole defendant, demonstrating the individual nature of these claims. The data indicate inequality in the distribution between the number of cases and lawyers and the number of lawsuits and prescribers, evidencing the concentration of lawyers and physicians in filing lawsuits. CONCLUSION: The judicialization of health in the State of São Paulo with the characteristics presented herein is a threat to the SUS.
Assuntos
Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Legislação de Medicamentos , Medicamentos sob Prescrição/provisão & distribuição , Assistência Ambulatorial , Brasil , Dissidências e Disputas/legislação & jurisprudência , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Serviços de Saúde/legislação & jurisprudência , Serviços de Saúde/estatística & dados numéricos , Direitos Humanos , Humanos , Advogados/legislação & jurisprudência , Advogados/estatística & dados numéricos , Assistência Médica/legislação & jurisprudência , Assistência Médica/estatística & dados numéricos , Médicos/legislação & jurisprudência , Médicos/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , Fatores SocioeconômicosRESUMO
The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.
Assuntos
Seguro Saúde/estatística & dados numéricos , Mortalidade Materna , Assistência Médica/estatística & dados numéricos , Pré-Eclâmpsia/mortalidade , Complicações na Gravidez/mortalidade , Sepse/mortalidade , Hemorragia Uterina/mortalidade , Adulto , Estudos de Casos e Controles , Colômbia/epidemiologia , Feminino , Humanos , Serviços de Saúde Materna/economia , Gravidez , Fatores de Risco , Fatores SocioeconômicosRESUMO
OBJECTIVE: To assess the impact of socioeconomic status (SES) on pediatric appendicitis outcomes using the validated Agency for Healthcare Research and Quality (AHRQ) SES Index and incorporating block-group data. STUDY DESIGN: We reviewed all patients <18 years old who underwent appendectomy for acute appendicitis from 2009-2013 at our institution. Patient addresses were geocoded and linked to 2010 US Census SES block-group data to determine composite AHRQ SES Index scores based on 7 publically reported SES variables. The primary outcome was appendiceal perforation, and the impact of SES scores, age, race, and insurance status on perforation rates were assessed through regression analyses. RESULTS: Of 1501 patients, 510 (34%) had perforated appendicitis. On bivariate analysis, components of the SES Index associated with an increased perforation rate included lower household income, lower percentage of adults with college education, and higher percentage of adults with <12th grade education (all P < .05). On multivariate analysis, age ≤ 10 years (OR 1.7, 95% CI 1.4-2.2) and public insurance (OR 1.5, 95% CI 1.2-2.0) were associated with increased odds of perforation. CONCLUSIONS: This study used the AHRQ SES scoring system to evaluate SES and its influence on appendiceal perforation. Among our cohort of pediatric patients, the risk of perforation was multifactorial, and younger age and public insurance were stronger predictors of perforation than SES.
Assuntos
Apendicectomia , Apendicite/cirurgia , Classe Social , Adolescente , Fatores Etários , Apendicite/epidemiologia , Censos , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Assistência Médica/estatística & dados numéricos , Análise Multivariada , Readmissão do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Infecção da Ferida Cirúrgica , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: Obesity can be considered a global public health problem that affects virtually all countries worldwide and results in greater use of healthcare services and higher healthcare costs. We aimed to describe average monthly household medicine expenses according to source of funding, public or private, and to estimate the influence of the presence of obese residents in households on total medicine expenses. METHODS: This study was based on data from the 2008-2009 Brazilian Household Budget Survey, with a representative population sample of 55,970 households as study units. Information on nutritional status and medicines acquired and their cost in the past 30 days were analyzed. A two-part model was employed to assess the influence of obesity on medicine expenses, with monthly household medicine expenses per capita as outcome, presence of obese in the household as explanatory variable, and adjustment for confounding variables. RESULTS: Out-of-pocket expenses on medicines were always higher than the cost of medicines obtained through the public sector, and 32 % of households had at least one obese as resident. Monthly household expenses on medicines per capita in households with obese was US$ 20.40, 16 % higher than in households with no obese. An adjusted model confirmed that the presence of obese in the households increased medicine expenses. CONCLUSION: Obesity is associated with additional medicine expenses, increasing the negative impact on household budgets and public expenditure.
Assuntos
Honorários Farmacêuticos/estatística & dados numéricos , Financiamento Pessoal/estatística & dados numéricos , Assistência Médica/estatística & dados numéricos , Obesidade/epidemiologia , Adolescente , Adulto , Idoso , Brasil , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Características de Residência , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto JovemRESUMO
Resumen: El objetivo fue identificar si formas de pago y regímenes de aseguramiento están asociados con la mortalidad materna y morbilidad obstétrica extrema. Estudio de casos y controles de base hospitalaria en dos regiones de Colombia, 2009-2011. Los datos se obtuvieron de la historia clínica de cada gestante. Se utilizó regresión logística no condicional. El resultado fue: 1.011 pacientes, 337 casos y 674 controles. Ningún componente de calidad fue estadísticamente significativo en ambas regiones. En Bogotá, el riesgo de complicación obstétrica, significativamente mayor en Régimen Contributivo que en Subsidiado y no aseguradas; Antioquia, aunque hubo asociaciones similares, no estadísticamente significativas. Diferencias en morbilidad por régimen de pago no estadísticamente significativas en Antioquia ni Bogotá. Factores asociados a la morbimortalidad materna diferentes, según la población estudiada, lo que sugiere la necesidad de estudios locales para identificar factores determinantes propios y tomar decisiones pertinentes.
Abstract: The study aimed to identify whether payment forms and insurance schemes are associated with severe obstetric complications and maternal mortality. A hospital-based case-control study was conducted in two regions of Colombia, 2009-2011. Data were obtained from each woman's clinical history. Unconditional logistic regression was used. The sample included 1,011 patients: 337 cases and 674 controls. No quality component was statistically significant in either region. In Bogotá, the risk of obstetric complications was significantly higher in the contributive insurance scheme than in subsidized coverage or uninsured; Antioquia showed similar associations, but not statistically significant. Differences in maternal morbidity according to payment scheme were not statistically significant in either Antioquia or Bogotá. Factors associated with maternal morbidity and mortality differed according to the study population, suggesting the need for local studies to identify determinants and make appropriate decisions.
Resumo: O presente estudo objetiva identificar se as formas de pagamento e regimes de seguros de saúde estão associados com a mortalidade materna e morbidade materna grave. Trata-se de um estudo caso-controle de base hospitalar em duas regiões da Colômbia entre 2009-2011. Os dados foram obtidos através da história clínica de cada gestante. Foi utilizada a regressão logística não condicionada. A mostra incluiu 1.011 pacientes: 337 casos e 674 controles. Nenhum componente de qualidade foi estatisticamente significativo em ambas as regiões. Em Bogotá, o risco de complicações obstétricas foi significativamente maior no Regime Contributivo do que no Subsidiado e em mulheres sem seguro de saúde. Em Antioquia, embora existam associações similares, não foram estatisticamente significativas. Tanto em Antioquia quanto em Bogotá não se encontraram diferenças significativas de morbilidade por regime de pagamento. Foram encontrados diferentes fatores associados à morbimortalidade materna, segundo a população estudada, o que sugere a necessidade de estudos locais para identificar fatores determinantes próprios e tomar decisões adequadas neste contexto.
Assuntos
Humanos , Feminino , Gravidez , Adulto , Pré-Eclâmpsia/mortalidade , Complicações na Gravidez/mortalidade , Hemorragia Uterina/mortalidade , Mortalidade Materna , Sepse/mortalidade , Seguro Saúde/estatística & dados numéricos , Assistência Médica/estatística & dados numéricos , Fatores Socioeconômicos , Estudos de Casos e Controles , Fatores de Risco , Colômbia/epidemiologia , Serviços de Saúde Materna/economiaRESUMO
OBJECTIVE: To compare the self-perceived health, use of health services and unmet need for health care (UNHC) among immigrants and native populations of Southeast Spain. MATERIALS AND METHODS: Cross-sectional study of two representative samples of 1150 immigrants, and 1303 native participants from the National Health Survey. A single database was created with specific weights for each sample, and prevalence ratios (PR) were estimated by multivariate regression. RESULTS: Moroccans, Ecuadorians and Eastern Europeans (EE) reported poorer health than the native population (PRs [CI95%]: 2.45 [1.91-3.15]; 1.51 [1.28-1.79] and 1.44 [1.08-1.93], respectively). Immigrants made greater use of emergencies that natives (except for EE) and had lower use of medication. Moroccan showed the greatest difference in the frequency of UNHC (PR [CI95%]:12.20 [5.25 - 28.37]), mainly because of working limitations (46%). CONCLUSIONS: The health status and use of health services among immigrants differ significantly from those of natives. Results highlight the higher frequency of UNHC among immigrants, especially high in Moroccans.