Antonio Carlos Coelho Campino

Household catastrophic health expenditures: A comparative analysis of twelve Latin American and Caribbean Countries

OBJECTIVE Compare patterns of catastrophic health expenditures in 12 countries in Latin America and the Caribbean. MATERIAL AND METHODS Prevalence of catastrophic expenses was estimated uniformly at the household level using household surveys. Two types of prevalence indicators were used based on out-of-pocket health expense: a) relative to an international poverty line, and b) relative to the households ability to pay net of their food basket. Ratios of catastrophic expenditures were estimated across subgroups defined by economic and social variables. RESULTS The percent of households with catastrophic health expenditures ranged from 1 to 25% in the twelve countries. In general, rural residence, lowest quintile of income, presence of older adults, and lack of health insurance in the household are associated with higher propensity of catastrophic health expenditures. However, there is vast heterogeneity by country. CONCLUSIONS Cross national studies may serve to examine how health systems contribute to the social protection of Latin American households.

Analysis of the evolution and determinants of income-related inequalities in the Brazilian health system, 1998 - 2008

OBJECTIVE To analyze the evolution and determinants of income-related inequalities in the Brazilian health system between 1998 and 2008. METHODS Data from the National Household Sampling Surveys of 1998, 2003, and 2008 were used to analyze inequalities in health and health care. Health was measured by self-reported health status, physical limitations, and chronic illness. Hospitalization and physician and dentist visits were proxies for health care utilization. Income was a proxy for socioeconomic status. Concentration indices were calculated before and after standardization for all dependent variables. Decomposition analysis was used to identify the main determinants of inequality in health care utilization. RESULTS In all three periods analyzed, the poor reported worse health status, while the wealthy reported more chronic diseases; health care utilization was pro-rich for medical and dental services. Yet, income-related inequality in health care utilization has been declining. Private health insurance, education, and income are the major contributors to the inequalities identified. CONCLUSIONS Income-related inequality in the use of medical and dental health care is gradually declining in Brazil. The decline is associated with implementation of pro-equity policies and programs, such as the Community Health Agents Program and the Family Health Program.

Aspectos sócio-econômicos da desnutrição no Brasil

Objetiva-se mostrar os fatores socio-economicos que tem sido identificados como os principais determinantes da situacao nutricional de um pais. Conclui-se que a renda e o fator isoladamente mais importante na determinacao do estado nutricional, mas uma vez fixada esta variavel, outros fatores - tais como extensao do sistema de atendimento de saude, nivel educacional, programa de alimentacao - tambem desempenham um papel relevante. Procura-se avaliar, empiricamente, com base em pesquisas ate agora realizadas, quais seriam os determinantes da situacao nutricional para o Brasil. Evidencia-se a hipotese, esperada na literatura, de que a renda e o fator mais importante, e, dado esta, tambem no caso brasileiro surgem como fatores relevantes o acesso a servicos de saude e saneamento. Em face disto, discutem-se algumas alternativas de uma politica de nutricao, mostrando-se a magnitude da redistribuicao de renda necessaria para cobrir o hiato nutricional e debatendo-se o papel dos programas de alimentacao e nutricao, na forma em que foram explicitados no Programa de Prioridades Sociais do atual Governo.Objetiva-se mostrar os fatores socio-economicos que tem sido identificados como os principais determinantes da situacao nutricional de um pais. Conclui-se que a renda e o fator isoladamente mais importante na determinacao do estado nutricional, mas uma vez fixada esta variavel, outros fatores - tais como extensao do sistema de atendimento de saude, nivel educacional, programa de alimentacao - tambem desempenham um papel relevante. Procura-se avaliar, empiricamente, com base em pesquisas ate agora realizadas, quais seriam os determinantes da situacao nutricional para o Brasil. Evidencia-se a hipotese, esperada na literatura, de que a renda e o fator mais importante, e, dado esta, tambem no caso brasileiro surgem como fatores relevantes o acesso a servicos de saude e saneamento. Em face disto, discutem-se algumas alternativas de uma politica de nutricao, mostrando-se a magnitude da redistribuicao de renda necessaria para cobrir o hiato nutricional e debatendo-se o papel dos programas de alimentacao e nutricao, na forma em que foram explicitados no Programa de Prioridades Sociais do atual Governo.

Health in the development process : the case of Brazil

Abstract This article describes the health situation of Brazil’s population, Brazil’s health system, and their implications for the development process. It is shown that although there were substantial improvements in the last decades, Brazil still has an epidemiologic pattern where infectious and parasitic diseases are still prevalent. This is due to the lack of an adequate sanitary infrastructure, which is related to the country’s highly concentrated distribution of income. The latter has resulted in a distortion of health expenditures, emphasizing curative at the expensive of preventive medicine.

Impacto econômico da doença de Alzheimer no Brasil: é possível melhorar a assistência e reduzir custos?

The scope of this study is to discuss data relating to the costs involved with Alzheimers Disease and the initiatives in terms of care in order to reduce costs and help family members and caregivers to cope with the disease. The biggest cost for people with mild Alzheimers Disease is the cost of time spent by the unremunerated caregiver, and for those at the advanced stages of the disease it is the cost of institutional care. In this respect, the literature proposes the adoption of models of care that maximize the functional independence of the elderly and maintain their skills, such as Day Care Centers for the Elderly and rehabilitation programs and support offered to the elderly and their family members. These models of care need to be discussed, structured and deployed in the context of the Brazilian reality.

Evolução dos preços relativos de grupos alimentares entre 1939 e 2010, em São Paulo, SP

OBJETIVO: Analizar la evolucion de los precios relativos de los grupos de productos alimenticios y su influencia en las politicas publicas para una alimentacion saludable. METODOS: Se analizaron datos del municipio de Sao Paulo de 1939 a 2010, a partir de la aplicacion de metodos de calculo de numeros-indices. Se utilizaron datos del banco de precios y estructuras de ponderacion de la Fundacion Instituto de Pesquisas Economicas (1939 a 1988) y del Instituto Brasileno de Geografia y Estadistica (1989 a 2010). El banco de precios fue organizado, su consistencia fue evaluada y los precios fueron deflacionados por el Indice de Precio al Consumidor. Los datos relativos a precios deflacionados fueron calculados y agregados por categorias y grupos alimenticios de la piramide alimenticia adaptada. Los indices de precios de cada grupo fueron construidos aplicando la formula de Laspeyres modificada. El indice general de precios de la alimentacion fue comparado con los indices de cada grupo alimenticio y respectiva categoria: alimentos in natura; alimentos industrializados; bebidas; carnes, leguminosas, leche y huevos; cereales y tuberculos y comidas ingeridas fuera del domicilio. RESULTADOS: Los grupos alimenticios de grasas, aceites, condimentos, azucares y alimentos procesados (alimentos industrializados) presentaron tendencia de reduccion de precios en terminos relativos. El indice de los alimentos in natura, como frutas y verduras, presentaron tendencia de elevacion de precios. Otros grupos alimenticios, como cereales, harinas y pastas, carnes, leche y huevos presentaron estabilidad de precios relativos a lo largo del tiempo. CONCLUSIONES: La evolucion de los precios relativos de los alimentos en el municipio de Sao Paulo muestra tendencia desfavorable para el mantenimiento de alimentacion saludable a nivel domiciliar a largo plazo.OBJECTIVE To analyze the evolution of relative prices of food groups and its influence on public healthy eating policies. METHODS Data from the municipality of Sao Paulo between 1939 and 2010 were analyzed based on calculating index numbers. Data from the Economic Researches Foundation Institute price database and weight structures (1939 to 1988) and from the Brazilian Institute of Geography and Statistics (1989 to 2010) were used to. The price database was organized, its consistency tested and prices were deflated using the consumer price index. Relative prices were calculated and associated to food categories and groups, according to the food pyramid guide adapted for the Brazilian population. The price indices for each group were calculated according to Laspeyres modified formula. The general food price index was compared with the indices for each food group and respective category: fresh food, processed food, beverages, meat, legumes, milk and eggs, cereals and root vegetables and eating out. RESULTS Price indices for fat, oil, spices, sugars and sweets and processed food showed relative price reduction. Fresh food, such as fruit and vegetables, showed an increase in relative prices. Other food groups, such as cereals, flour and pasta, meat, milk and egg, showed a steadier long term trend in relative prices. CONCLUSIONS The evolution of relative prices of food in the city of Sao Paulo demonstrates a negative trend towards healthy eating at household level in the long run.

Alternatives for the financing of health care in Latin America and the Caribbean

Latin America and the Caribbean (LAC) countries are experiencing both an economic crisis and a crisis in the public sector. As a result it is impossible to increase the amount of resources available to the health sector, unless there is a drastic restructuring of the way in which financing occurs. The measures so far referred to in the economic debate - user fees, cost recovery, privatization - at best represent partial solutions. Given the magnitude of health problem in LAC countries, they are unable to generate the amount of money needed to cover the deficit of financial resources for medical treatment. The central idea behind this article is that in order to cover the deficit of resources for medical it is necessary to utilize fiscal resources. It is shown that it is possible to increase the amount of financial resources available for medical treatment either through increases in taxes and/or through an increase in the proportion of the government budget dedicated to medical treatment. Increases in taxes collected provide a feasible alternative. In some of the poor countries of Latin America and the Caribbean, the proportion of the Gross National Product that goes for the payment of taxes is well below the figure for that proportion found in developed countries. To increase the proportion of the government budget dedicated to medical treatment is a political decision that depends solely upon the discretion of the governments concerned. The potential of Social Emergency Funds and debt swaps to finance innovations in the production of medical treatment services, thus maintaining the current level to activity in the sector, is discussed.

A comparative analysis of outpatient costs in HIV treatment programs

OBJECTIVE To analyze the costs of human immunodeficiency virus (HIV) outpatient treatment for individuals with different CD4 cell counts in the Brazilian public health system, and to compare to costs in other national health systems. METHODS A retrospective survey was conducted in five public outpatient clinics of the Brazilian national HIV program in the city of São Paulo. Data on healthcare services provided for a period of one year of HIV outpatient treatment were gathered from randomly selected medical records. Prices of inputs used were obtained through market research and public sector databases. Information on costs of HIV outpatient treatment in other national health systems were gathered from the literature. Annual costs of HIV outpatient treatment from each country were converted into 2010 U.S. dollars. RESULTS Annual cost of HIV outpatient treatment for the Brazilian national public program was US

Evolution of the relative prices of food groups between 1939 and 2010 in the city of Sao Paulo, Southeastern Brazil

2,572.92 in 2006 in São Paulo, ranging from US

Evolución de los precios relativos de grupos alimenticios entre 1939 y 2010, en Sao Paulo, SP, Brasil

1,726.19 for patients with CD4 cell count > 500 to US