RESUMO
OBJECTIVE: To analyze the financial flows in the drug dependency programs in México City, their financial source, and the way how funding monies are spent. MATERIAL AND METHODS: A discrete number of institutions devoted to drug dependency control in Mexico City was selected. Analysis of financial flows was carried out using the National Health Accounts methods. Questionnaires to quantify resources were applied to health service managers and users. In addition to collection of financial flow data, we calculated the expenditures per user for each institution. For the period 1990-1993, expenditures were estimated from financial budgets allocated to each program in 1990, at constant values to eliminate the effects of inflation. RESULTS: Financial sources identified were: the federal budget allocation (50-90%), user fees (10-20%), and non-governmental organization contributions (15-80%). CONCLUSIONS: Even though budgets in participant institutions have increased in the last four years, they are still inadequate to cover the large demand of services. It is important to identify new ways to increase the availability of resources as well as to ensure their efficient use. Continuing financial analysis of these programs will allow the assessment of changes to guide optimal financial decision making.
Assuntos
Organização do Financiamento , Avaliação de Programas e Projetos de Saúde , Centros de Tratamento de Abuso de Substâncias/economia , Humanos , México , Saúde da População UrbanaRESUMO
OBJECTIVE: This study presents the demographic, socioeconomic profile, working conditions and labor fatigue among fertile age street vendors in Mexico City. MATERIAL AND METHODS: 426 female street vendors were interviewed in Mexico City. This population was described and the association between the components labor fatigue and low birth weight (LBW) was analyzed by logistic regression in a subgroup of women who worked as street vendors during their last pregnancy. RESULTS: Of the interviewed group, 56% works more than 48 h per week, 87% had no social security, and 68% only had primary school level. The risk of LBW increased when workers had to cover selling quotes (OR 6.5, CI95% 1.3-31) when the merchandise were seasonal tools such as accessories or spare parts (OR 6.3, CI95% 1.5-26), when women had to exhibit their merchandise on the floor or carry it (OR 7.7 CI95% 1.8-32) and when financial support to initiate vending activities came from someone other than a close relative or friend (OR 7.4 CI95%, 1.2-44). CONCLUSIONS: These results contribute to identify the female vendors with higher risk of having child with LBW and suggest preventive actions.
Assuntos
Peso ao Nascer , Fadiga/etiologia , Ocupações , Mulheres Trabalhadoras , Trabalho , Adolescente , Adulto , Criança , Feminino , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , México , Pessoa de Meia-Idade , Paridade , Gravidez , Cuidado Pré-Natal , Fatores SocioeconômicosRESUMO
OBJECTIVE: Previous researches pointed out the critical changes needed to increase the efficiency of the National Screening Programme of Cervical Cancer in Mexico. These changes were assessed through a cost-benefit analysis. This paper presents the results of that appraisal. Figures are presented as US Dollars of 1996 valued as 7.5 pesos for each dollar. RESULTS: The operational unitary cost of the integral process of the cytology-the obtention of the Pap smear, its transportation to the interpretation centre, its analysis, and the notification of results to users-was estimated in US$ 11.6. If the proposed changes are operated, the cost of each citology would increase by 32.7%. The benefit/cost ratio would be 2 and the net benefit of 88 millions of US dollars for the next five years. CONCLUSIONS: The operation of the proposed changes is socially desirable, but should be supported the training activities of the personnel, the increase of the coverage of women at risk, the quality control activities, the monitoring of the program and the communication with women detected as positive cases.
Assuntos
Carcinoma in Situ/prevenção & controle , Programas de Rastreamento/economia , Avaliação de Programas e Projetos de Saúde/economia , Neoplasias do Colo do Útero/prevenção & controle , Carcinoma in Situ/economia , Análise Custo-Benefício , Reações Falso-Negativas , Feminino , Humanos , México , Teste de Papanicolaou , Neoplasias do Colo do Útero/economia , Esfregaço Vaginal/economiaRESUMO
OBJECTIVE: To construct a comprehensive model to evaluate the social or overall impact of a chronic disease. MATERIAL AND METHODS: Case studies of a convenience sample of 28 patients seen at secondary and tertiary levels of health care services. Bronchitis was selected for evaluation. Among the variables included in the model are the direct costs of health care for bronchitis, the indirect costs or costs of opportunity, and the intangible costs or loss of quality of life. Information on costs estimated by the home institution was also included. RESULTS: The social costs attributable to this condition are as high as $ 14 761.60 each case per year; 53% of this cost corresponds to case-management at health care services; 5% to household economic costs; 14% to intangible costs and 28% to production costs. CONCLUSIONS: The model allowed the identification of variables necessary to evaluate production, household and intangible costs, which have been seldom utilized in our country. Including these variables results in a more comprehensive economic evaluation of social costs of disease.
Assuntos
Bronquite , Custos de Cuidados de Saúde , Qualidade de Vida , Adulto , Idoso , Bronquite/economia , Doença Crônica , Custos e Análise de Custo , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Fatores SocioeconômicosRESUMO
Due to the increasing deterioration of the environment and its possible consequences for the health of the population the design and implementation of policies for the control of economic activities according to criteria for the protection of human health and the environment itself have become an unquestionable need. Such policies would include the economic feasibility of existing alternatives for protection. Due to the huge interests involved, however, other factors, both social and political should also be taken into consideration. Economic evaluation has been seen as a promising foundation for the decision making process in this subject. This tool's capacity systematically to organize and compare the costs and the benefits of the alternatives for the solution of environmental problems is analysed. The main characteristics of cost-benefit and cost-effectiveness studies are summarized, as well as the possible forms of economic evaluation, of the environment and the details of this field for the application of such techniques of analysis. The limits of these tools for the quantification of the non-monetary costs of environmental risks and the consequent damage to health, whether as pain, suffering or the disability of non-economic ally active persons are set out as these constitute the methodological challenge of the economic evaluation in the area. The importance of the enhancement of information input for the decision-making process relating to environmental health issues such as the distributions of costs and benefits among the different social groups is scrutinized. Lastly, the growing political concern with environment issues is stated, as well as the technical possibility of the manipulation of these analytical tools. On the basis of these elements, the need for evaluators to be conscious on the political implications of their studies, as well as the importance of their relationship with the decision-makers in view of the need for effective relevance to current environmental issues.
Assuntos
Tomada de Decisões , Saúde Ambiental/economia , Análise Custo-Benefício , Planejamento Ambiental/economia , Humanos , PolíticaRESUMO
This work offers an overview of the state of the art and future state of environmental health in our country from a viewpoint of the impact of the commercial opening established in the Free Trade Agreement among Mexico, the USA, and Canada. In the first section of this work, we analyze the expected economic changes resulting from the implementation of the FTA and foretells the way in which those changes will influence the present environmental and epidemiologic profiles of this country in the medium and long term. The main changes predicted by the analysis are, in the epidemiologic context, the acceleration of the transference of occupational, consumption, environmental and population risks, characteristic of industrialized countries, to the country's polarized epidemiologic profile; and, in the environmental context, a transition consisting of a broadening and composition of the spectrum of pollutants, including and important lagging of bacteriologic control. The second section offers an analysis of the predicted response capacity facing the new environmental risk dynamics in the country, encompassing regulation, normativeness and enforcement of environmental and consumer protection, as well as obstacles found in health services to the implementation of surveillance, detection and treatment of health damages caused by environmental factors. The analysis of the organized social response to these problems discloses a relative flexibility of the normativeness and enforcement functions in comparison with our northern neighbors, a paramount factor for the possible transference of environmental risks, as well as the informational and research deficiency about environmental issues, basic elements for sustaining environmental health in the country, aiming at speeding up the development and transference of technologies for prevention, detection and management of environmental risks in the country, drawing upon the systematization of our experience and that of our neighbors. This speeding process ought to match, in the medium term, the velocity of risk transference produced by the commercial opening. In this way, the commercial integration of North America will become a favorable context for the development of the environmental health infrastructure of the country.
Assuntos
Comércio/legislação & jurisprudência , Saúde Ambiental/legislação & jurisprudência , Cooperação Internacional , Canadá , Comércio/economia , Defesa do Consumidor , Saúde Ambiental/economia , Poluição Ambiental/economia , Poluição Ambiental/legislação & jurisprudência , Poluição Ambiental/prevenção & controle , México , Condições Sociais , Estados UnidosRESUMO
This article presents a general view of the evolution of the conceptual approach to equity in health and its current meaning. The analysis of equity from the standpoint of distribution-accesibility, use and outcome of health services is proposed. Every point of view is addressed to an operational and policy-making position. This paper concludes with a proposal of perspectives for research development in this field.