Mario García Molina

¿Crisis financiera o de gestión? Evolución del sector salud desde la perspectiva de los entes territoriales

Tradicionalmente, los problemas asociados al sector salud en los entes territoriales se han enmarcado principalmente en un plano financiero. En esa linea los problemas de eficiencia se han venido tratando con medidas fiscales o financieras. El articulo presenta la situacion financiera del sector salud desde los entes territoriales, para ello estudia la normatividad y la evolucion de las principales cifras entre 2010 y 2014. El superavit de los ultimos anos de los fondos departamentales de salud sugiere que la politica publica deberia trascender de lo financiero y concentrarse en el fortalecimiento de herramientas institucionales y de gestion que permitan mejorar los resultados en salud.

Años de vida ajustados por calidad: evolución, fundamentos e implicaciones(Quality Adjusted Life Years: Evolution, Fundamentals and Implications)

Los años de vida ajustados por calidad – AVAC o QALY (en su sigla en inglés) – son una medida de resultados en salud que permite hacer comparaciones entre tratamientos con el fin de facilitar escogencias. A partir del desarrollo histórico de esta noción, se presenta su fundamento en las medidas de calidad de vida y en la teoría de utilidad esperada y los problemas derivados de los instrumentos de medición, en particular su fundamentación teórica, su facilidad de implementación y su falta de convergencia; también se presentan los problemas que deben ser tomados en cuenta para su estimación en Colombia específicamente en lo que tiene que ver con equidad y con la selección adecuada de muestra. Quality-adjusted life years – QALY – are a measure of health results that allows comparisons among treatments in order to make choices. Starting from the historical development of the concept, the paper presents its foundations in quality-of-life measures and in expected utility theory, as well as the problems arising from the measurement instruments, in particular their theoretical fundamentals, their implementability and their lack of convergence; it also presents the issues to be dealt with in their estimation for Colombia, with emphasis on those related to equality and the selection of an appropriate sample.

Cost-Effectiveness of CT, EUS and PET/CT in Evaluating Patients with Symptoms of Pancreatic Cancer in Colombia

Introduction: An estimated 1,399 new cases of pancreatic cancer (PC) and 1,406 deaths from the same cause occurred in Colombia in 2002. We evaluate the cost-effectiveness of multidetector computed tomography (CT), endoscopic ultrasonography (EUS) and positron emission tomography with computed tomography (PET/CT) in diagnosis and staging of patients with clinical suspicion of PC.Materials and methods: We conducted a cost-effectiveness analysis based upon a systematic search to determine the strategies´ sensitivity and specificity. The costs of administering and monitoring were taken from the official tariff manuals. The results were assessed in terms of number of correct behaviours. We performed deterministic and probabilistic sensitivity analyses.Results: CT showed the best cost-effectiveness indicator (Col

Bringing Institutions into Health Economics

3,397,163 for each appropriate behaviour). The cost of changing the strategy to that of CT plus EUS was Col

Anchoring bias in face-to-face Time-Trade-Off valuations of health states

7,893,573 for each additional appropriate behavior. In the probabilistic analysis the cost-effective strategy was USE for a willingness to pay higher than Col

Costo efectividad del suplemento de calcio para reducir la mortalidad materna asociada a preeclampsia en Colombia

9,000,000 per additional unit, or TAC for smaller values.Conclusion: The cost-effective strategy in the evaluation of patients suspected PCis the multidetector CT. For values of willingness to pay more than Col

RIESGO, INCERTIDUMBRE Y POLÍTICA PÚBLICA EN VACUNAS

7,893,573 and Col

Risk, uncertainty and public policy involved with the administration of vaccines.

9,000,000 per additional unit cost-effective alternatives are EUS or CT plus EUS in series.

Risco, incerteza e política pública em vacinas.

A reformulation of health economics is proposed that explicitly involves institutions. Decisions regarding health are taken under uncertainty, in the face of which institutions work and allow dealing with it. Taking institutions seriously allows moving forward from the economics of medical care (on which the mainstre am has focused) to a real economics of health; it also allows explaining the growth of health expenditure as the result of the interaction of social institutions. In this approach, the unit of analysis is changed to the rule, rather than the individual agent. The subject of study is the institution.

La Afiliación a un Grupo Ecónomico y el Desempeño e Inversiones de las Administradoras de Fondos de Pensiones en Colombia (Business Group Affiliation, Performance and Investments of Colombian Pension Funds Firms)

OBJECTIVE To test whether anchoring (a cognitive bias) occurs during face-to-face interviews to value health states by Time-Trade-Off. METHODS 147 Colombian subjects (111 males, 36 females) valued five EQ-5D health states better than death during a face-to-face interview. Subjects were randomly assigned to two different starting points. RESULTS Shapiro-Wilk test discarded normality, while non-parametric tests, including Kolmogorov-Smirnov and Wilcoxon-Mann-Whitney, showed that anchoring was significant in four out of five health states. A higher starting point increased the elicited value by 15 %-188 %. The size of the anchoring effect was not uniform among health states. CONCLUSION Anchoring effects may bias face-to-face Time Trade-Off valuations. The size of the anchoring effect is relevant enough for health policy.