Nebel Silvana Moscoso

Evaluación de políticas públicas de provisión de fármacos para diabetes mellitus tipo 2 en Argentina: estudio de caso

In Argentina, the provision of drugs for patients suffering from type 2 diabetes mellitus who lack health insurance is carried out through public programs. In the Province of Buenos Aires, the national program Remediar and the provincial program PRODIABA (from the Spanish Programa de Prevencion, Diagnostico y Tratamiento del Paciente Diabetico) coexist. This study estimates the percentage of adults in the municipality of Bahia Blanca (Province of Buenos Aires) who suffer from type 2 diabetes mellitus and lack health insurance, thus satisfying their need for oral antidiabetic treatments within the public sector. It is a quantitative study that assesses the need and demand for public provision. The results indicate that: 1) the greatest percentage of demand is satisfied at the primary health care level; 2) the province of Buenos Aires funds the largest share of the pills, followed by the municipal and the national levels; 3) the local government intervenes to satisfy the demand and 4) the total public provision covers approximately 25% of the overall need in relation to the average consumption. This shows that despite the presence of these public programs, the provision is insufficient and thus requires the intervention of the local government even though economic theory does not recommend the decentralization of drug purchases.In Argentina, the provision of drugs for patients suffering from type 2 diabetes mellitus who lack health insurance is carried out through public programs. In the Province of Buenos Aires, the national program Remediar and the provincial program PRODIABA (from the Spanish Programa de Prevención, Diagnóstico y Tratamiento del Paciente Diabético) coexist. This study estimates the percentage of adults in the municipality of Bahia Blanca (Province of Buenos Aires) who suffer from type 2 diabetes mellitus and lack health insurance, thus satisfying their need for oral antidiabetic treatments within the public sector. It is a quantitative study that assesses the need and demand for public provision. The results indicate that: 1) the greatest percentage of demand is satisfied at the primary health care level; 2) the province of Buenos Aires funds the largest share of the pills, followed by the municipal and the national levels; 3) the local government intervenes to satisfy the demand and 4) the total public provision covers approximately 25% of the overall need in relation to the average consumption. This shows that despite the presence of these public programs, the provision is insufficient and thus requires the intervention of the local government even though economic theory does not recommend the decentralization of drug purchases.

Descentralización y equidad: el gasto público en salud en los municipios de la provincia de Buenos Aires

In this paper we analyze the degree of equity in access to the public health care system in the Province of Buenos Aires (Argentina). Through a quantitative retrospective study, we analyze the inequalities in the distribution of the total public health expenditure per capita. This variable is used as a proxy for the ability of the inhabitants of each jurisdiction to access health care services. The results indicate the existence of large disparities in the levels of expenditure devoted to the population without health coverage. Moreover, the existence of greater health care needs (estimated using infant mortality rates and percentage of homes with basic needs unmet) does not translate into higher levels of public expenditure. Finally, we detect a positive association between the relative wealth of municipalities (measured by the gross geographic product per capita) and the public health expenditure per capita.In this paper we analyze the degree of equity in access to the public health care system in the Province of Buenos Aires (Argentina). Through a quantitative retrospective study, we analyze the inequalities in the distribution of the total public health expenditure per capita. This variable is used as a proxy for the ability of the inhabitants of each jurisdiction to access health care services. The results indicate the existence of large disparities in the levels of expenditure devoted to the population without health coverage. Moreover, the existence of greater health care needs (estimated using infant mortality rates and percentage of homes with basic needs unmet) does not translate into higher levels of public expenditure. Finally, we detect a positive association between the relative wealth of municipalities (measured by the gross geographic product per capita) and the public health expenditure per capita.

Clasificación de las causas que determinan estadía inadecuada útil para la gestión hospitalaria

Introduccion: la busqueda de eficiencia en la gestion hospitalaria motiva el empleo de indicadores de gestion que detecten y evaluen la presencia de estancias hospitalarias inadecuadas. Objetivo: disenar una clasificacion de las causas que determinan una estadia hospitalaria inadecuada adaptada al contexto del sistema de salud argentino. Metodos: se revisaron 25 articulos publicados entre los anos 1990 y 2009 en revistas argentinas y de otras nacionalidades, en idioma ingles y espanol. Para la exploracion se incluyeron buscadores genericos de Internet y las bases de datos bibliograficos: Medline, Cochrane y Lilacs. Las palabras clave empleadas fueron: inappropriateness, inappropriate hospital days, the appropriateness evaluation protocol, factors associated with inappropriate hospitalization days, uso inadecuado de la hospitalizacion, lenght of stay. Sintesis de los datos: es necesario distinguir entre ingresos y estadias inadecuadas. Las causas de estas ultimas, segun la clasificacion disenada, pueden deberse a la responsabilidad de: 1. La planificacion y gestion hospitalaria. 2. El medico. 3. La familia del paciente. 4. El sistema de salud. Conclusiones: el diseno de esta clasificacion es una herramienta util para la implementacion de indicadores de gestion hospitalaria que involucren los dias de estadia.

Eficiencia del Gasto Total en Salud: Análisis no paramétrico en una muestra amplia de países

OBJECTIVE To measure the efficiency of 190 countries in producing health results and the factors that determine such efficiency. METHODOLOGY A data envelopment analysis was conducted on worldwide data from the year 2009 in order to estimate the efficient frontier, based on total health expenditure per capita, as well on infant mortality rate and life expectancy at birth. At the same time, an analysis of the determinants of expenditure efficiency was performed through Tobit models. RESULTS African nations have lower technical and allocative efficiency, but higher scale efficiency. The quality of institutions has a statistically significant impact on the levels of technical and allocative efficiency and on the levels of scale efficiency. The percentage of health expenditure financed by private insurers has an impact on technical and allocative efficiency, while urbanization rates affect the scale efficiency. DISCUSSION the fact that more than 70 % of countries show decreasing returns suggest that, once certain minimal standards of life quality are achieved, the marginal effect of each additional dollar assigned to health is not substantial. Conversely, in poor countries, where the expenditure in health presents increasing returns, the health performance could be substantially better by marginally raising the expenditure. On the other hand, financing structures of health expenditures may influence technical-allocative efficiency, while urbanization levels may impact scale efficiency (source: MeSH, NLM).

Concentración y desigualdades en el financiamiento de las obras sociales posdesregulación: un análisis comparativo de los años 2004 y 2011

In Argentina, during the decade of the 1990s major changes were introduced into the regulatory framework of the national obras sociales, or union-based health coverage plans. Using data from the Federal Administration of Public Income (AFIP) [Administración Federal de Ingresos Públicos], this study evaluates for the years 2004 and 2011: a) the importance of obras sociales within the healthcare system, b) the degree of concentration of this health social security subsystem, and c) the inequalities in the availability of funds among the obras sociales and their beneficiaries. The results show an increased importance of obras sociales within the Argentine health system. The concentration of funds distributed to the most important institutions within the subsystem showed no change, while the concentration of contributors to these institutions slightly increased and that of beneficiaries decreased. Finally, a reduction of the inequalities in funds per beneficiary received by different institutions was observed. This trend can be explained, among other factors, by the attenuation of wage differentials between branches of economic activity and the actions of the so-called Solidarity Redistribution Fund.

The role of the pharmacist in the determination of pharmacotheraphy costs: Ischemic cardiopathy patients with smoking habits

In the last decades the pharmacist has played a main role in the policies of costs containment in the health sector. The present study has been designed to assess this role in the costs containment of the pharmacological treatments of patients at a Coronary Care Unit (CCU) of a public hospital in Argentina, through an analitic and retrospective study. It has been observed that the pharmacist could determine in all the service a saving of

Costos de enfermedades: clasificación y perspectivas de análisis

3,393.03 buying the prescriptive drugs at minimum prices during the analized period. However, it has been proved that there are costs which the pharmacist cannot modify, as in the case of certain risk factors that may increase the pharmacological costs in the treatment of a pathology. This cost variation has been proved in ischemic cardiopathy patients with smoking habits.