Armando Arredondo

Road traffic injuries in an urban area in Mexico. An epidemiological and cost analysis.

The objective of this study was to do an epidemiological and costs analysis of the impact of road traffic injuries on the demand for emergency room services at hospitals located in the city of Cuernavaca, Mexico. The studied population included injured people who demanded medical attention at the emergency room for injuries due to events in public places, occurring between February and April 2001. Trained interviewers collected the data at the emergency room, 24h a day. The statistical analysis included simple and bivariate analysis using chi(2) odds ratio (OR), and a confidence interval of 95%. The costs analysis included the expenses during the process of searching for and finding care for injuries. There were 433 injured people, 233 (54%) were victims of road traffic accidents, 72% of crashes, and 28% were injured pedestrian and cyclists. Variables associated with the demand of emergency care due to road traffic injuries in comparison with other accidents, were: severity of injuries (OR 2.60, CI 1.44-4.71), and thorax injury (OR 4.64, CI 1.03-20.89). Pedestrians had higher costs for health care and 80% of them had to pay out-of-pocket (P<0.05). Differences between patients injured by crashes or as a pedestrian, were: age under 14 years (OR 5.9, CI 2.5-13.9), being unemployed (OR 2.1, CI 1.20-3.96), and being an elementary school student (OR 13.9, CI 3.08-63.13). The present study is, so far, the only one in Mexico to include an epidemiological and costs analysis in approaching the problem of road traffic injuries. Similar methods must be used, especially in developing countries, to reduce this important public health problem.

Análisis y reflexión sobre modelos teóricos del proceso salud-enfermedad

Este trabajo parte de la necesidad de hacer una revision y analisis de los diferentes modelos teoricos sobre los determinantes y condicionantes del proceso salud-enfermedad como herramienta relevante de los programas educativos en la formacion de recursos humanos. Determinando para cada modelo la hipotesis propuesta, las variables de estudio, ventajas, desventajas, epoca y representantes, se plantea como objeto de analisis el caracter cientifico y/o metodologico de los modelos: magico-religioso, sanitarista, unicausal, multicausal, epidemiologico, ecologico, social, historico-social, geografico, economico e interdisciplinario. La discusion y conclusiones se centran en la necesidad de discutir hasta que punto la metodologia, los planteamientos y aportes fundamentales de cada modelo son compatibles, complementarios, contradictorios, cientificamente solidos, tendenciosos, conservadores, criticos y reflexivos, asi como su relevancia en la formacion de recursos humanos en salud.

Costs and Epidemiological Changes of Chronic Diseases: Implications and Challenges for Health Systems

Background The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries. Objective To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county. Methods We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014–2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test. Results Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8–12% in all three studied institutions, (p < .05). Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA) and 65737 for the insured population (IMSS and ISSSTE). On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US

Effects of health decentralization, financing and governance in Mexico

ranged from

Atención médica ambulatoria en México: el costo para los usuarios

699 to

A workplace physical activity program at a public university in Mexico can reduce medical costs associated with type 2 diabetes and hypertension

748 for annual case management per patient in the case of diabetes, and from

Likelihood ratios of clinical, laboratory and image data of pancreatic cancer: Bayesian approach

485 to

Impact of decentralization on health financing in Mexico

622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p < .05). The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population. Conclusions If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.

Health financing changes in the context of health care decentralization: the case of three Latin American countries

OBJECTIVE To identify the effects of decentralization on health financing and governance policies in Mexico from the perspective of users and providers. METHODS A cross-sectional study was carried out in four states that were selected according to geopolitical and administrative criteria. Four indicators were assessed: changes and effects on governance, financing sources and funds, the final destination of resources, and fund allocation mechanisms. Data collection was performed using in-depth interviews with health system key personnel and community leaders, consensus techniques and document analyses. The interviews were transcribed and analyzed by thematic segmentation. RESULTS The results show different effectiveness levels for the four states regarding changes in financing policies and community participation. Effects on health financing after decentralization were identified in each state, including: greater participation of municipal and state governments in health expenditure, increased financial participation of households, greater community participation in low-income states, duality and confusion in the new mechanisms for coordination among the three government levels, absence of an accountability system, lack of human resources and technical skills to implement, monitor and evaluate changes in financing. CONCLUSIONS In general, positive and negative effects of decentralization on health financing and governance were identified. The effects mentioned by health service providers and users were related to a diversification of financing sources, a greater margin for decisions around the use and final destination of financial resources and normative development for the use of resources. At the community level, direct financial contributions were mentioned, as well as in-kind contributions, particularly in the form of community work.

Hypertension and its effects on the economy of the health system for patients and society: suggestions for developing countries.

Objetivo. Analizar los resultados de la Encuesta Nacional de Salud II (ENSA-II), en lo relativo a los costos del proceso de busqueda y obtencion de la atencion medica ambulatoria en diferentes instituciones del sector publico y privado. Material y metodos. La informacion se obtuvo a partir de los indicadores de costos de la atencion medica que notifico la poblacion de estudio de la ENSA-II. Los costos para el bolsillo del consumidor fueron la variable dependiente, y las independientes, la condicion de aseguramiento y el ingreso economico. La significancia de los niveles de variacion se identifico aplicando la prueba de Duncan. Resultados. Los costos en todo el pais, en dolares estadunidenses, fueron: transporte,