Giancarlo Buitrago

Violencia por conflicto armado y prevalencias de trastornos del afecto, ansiedad y problemas mentales en la población adulta colombiana

BACKGROUND Violence in Colombia has a history of over 50 years. Between 1985 and 2012 an estimated of 220,000 Colombians have died and about 6,000,000 have been displaced by violence. OBJECTIVE To describe and compare the prevalence of some problems and mental disorders in the adult population in Colombia, taking into account the characteristics of the municipality, as regards its history of violence or armed conflict. METHODS The results for adults (over 18 years) of some problems and mental disorders were taken from the ENSM-2015. The municipalities were classified according to the presence and intensity of the conflict using the classification proposed by the CERAC. Disorders were measured using CIDI-CAPI, and problems with AUDIT, modified PCL (Post-Traumatic Stress Disorder Checklist). An estimate was also made of psychoactive substances consumption. RESULTS A total of 10,870 people were interviewed, of whom 5,429 had not changed residence. There was had permanent conflict in 21.8% of the municipalities, 65.5% had a discontinued conflict, and only 12.7% had been pacified or had no conflict. The intensity of the conflict was reported as high by 31.8% of the people. Violent municipalities have a higher prevalence of anxiety disorders, depression, possible Post-Traumatic Stress Disorder, and smoking. Alcohol consumption was more common in municipalities with less intense conflict. CONCLUSIONS The municipalities classified as having high levels of violence have a higher prevalence of mental disorders and the majority of the mental problems.

Voluntary Health Plan Subsidies and Public Expenditure

Countries that seek to provide universal health coverage deal with considerable publicly funded expenses. This article discusses if a private health insurance subsidy policy can reduce the expenses covered by the public system. A theoretical model is developed in which individuals are characterized by two dimensions: inherited risk of illness and preferences for prevention activities. It is shown that when beneficiaries of a voluntary plan have lower risk, i.e. advantageous selection scenario, a subsidy raises heath expenses if articulation between coverage is complementary. On the contrary, in adverse selection scenarios a subsidy reduces expenditure if articulation is supplementary. Intermediate scenarios are also considered where articulations between coverages have both complementary and supplementary components, which is apparently the case for the Colombian health system. Calibrated numerical simulations are provided using the Colombian system data. The calibration strategy employed reveals that selection is adverse in the Colombian voluntary health insurance market. Furthermore, we identify the level of subsidy and changes in articulation (towards supplementarity) that could lead to a reduction in public spending.

Frecuencia de riesgo de desnutrición según la Escala de Tamizado para Desnutrición (MST) en pacientes del servicio de Medicina Interna del Hospital Universitario San Ignacio en Bogotá

Background: On admission, 30 to 50% of hospitalized patients have some degree of malnutrition, which is associated with longer length of stay, higher rates of complications, mortality and greater costs. Aim: To determine the frequency of screening for risk of malnutrition in medical records and assess the usefulness of the Malnutrition Screening Tool (MST). Material and methods: In a cross-sectional study, we searched for malnutrition screening in medical records, and we applied the MST tool to hospitalized patients at the Internal Medicine Wards of San Ignacio University Hospital. Results: Of 295 patients included, none had been screened for malnutrition since hospital admission. Sixty one percent were at nutritional risk, with a higher prevalence among patients with HIV (85.7%), cancer (77.5%) and pneumonia. A positive MST result was associated with a 3.2 days increase in length of hospital stay (p=0.024). Conclusions: The prevalence of malnutrition risk in hospitalized patients is high, but its screening is inadequate and it is underdiagnosed. The MST tool is simple, fast, low-cost, and has a good diagnostic performance.

Integración vertical en el sector colombiano de la salud

Este articulo presenta una revision de la literatura relacionada con la integracion vertical en sistemas de salud, con un enfasis especial en el sector colombiano de la salud. Empezamos introduciendo algunos conceptos generales acerca de la integracion vertical, y presentamos algunas de sus ventajas y desventajas tradicionales. Luego, nos enfocamos en las consecuencias de la integracion vertical en el sector de la salud, tomando como referencia la experiencia de Estados Unidos. A continuacion, describimos el sistema de salud colombiano y algunos cambios de la regulacion de la integracion vertical. Finalmente, proveemos algunas recomendaciones de politica publica relacionada con esta regulacion. En particular, recomendamos un cambio desde un enfoque regulatorio hacia un modelo de supervision.