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Resumen Introducción: El cáncer es una de las principales causas de muerte no violenta en el mundo, se calcula que anualmente se presentan más de 11 millones de casos nuevos, de los cuales 80% se presentan en países en vías de desarrollo. Objetivo: Conocer la prevalencia del cáncer en una población afiliada a una aseguradora en salud en Colombia. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en una cohorte de 11.500 pacientes con cáncer de una aseguradora en salud, identificados a partir de los sistemas de información de la compañía, durante los años 2010 a 2013, se analizaron los datos a través de frecuencias, tasas y razón de prevalencias. Resultados: La prevalencia general de cáncer fue de 543 por 100.000 afiliados. La mayor proporción de los casos (67%) se presentaron en mayores de 50 años. Las ciudades con mayor prevalencia fueron Manizales, Cali, Pereira y Neiva. Los tipos de cáncer más prevalentes fueron mama, otros sólidos, próstata, piel y tiroides. La prevalencia de cáncer infantil fue de 65 por 100.000 menores de 18 años afiliados. Las leucemias linfoides agudas, los tumores malignos cerebrales y los linfomas fueron las neoplasias más frecuentes en la población infantil. Conclusiones: Este es el primer estudio de prevalencia de cáncer en una población asegurada en Colombia, con lo cual se establece una herramienta que permite planear servicios, proporcionar estrategias de tamización, auditoría y evaluación de resultados en un contexto de aseguramiento y gestión del riesgo en salud.

Introduction: Cancer is one of the leading causes of non-violent death in the world. An estimated eleven million new cases occur worldwide every year, of which 80% occurred in developing countries. Objective: To determine the prevalence of cancer in a population affiliated to a health care insurance organization in Colombia. Materials and Methods: A descriptive cross-sectional study was conducted on a cohort of 11,500 patients with cancer affiliated to a health care organization. The patients were identified from the information systems of the company, during the years 2010-2013. Data were analysed using frequencies, rates, and prevalence ratio. Results: The overall prevalence of cancer was 543 per 100,000 members. The largest proportion of cases (67%) occurred in patients older than 50 years. The cities with the highest prevalence were Manizales, Cali, Pereira and Neiva. The most prevalent cancer types were breast, other solid tumours, prostate, skin, and thyroid. The prevalence of childhood cancer was 65 per 100,000 members under 18 years. Acute lymphoid leukaemia, malignant brain tumours, and lymphomas were the most common malignancies in children. Conclusions: This is the first study of the prevalence of cancer in an insured population in Colombia, becoming a tool for planning services, provide screening strategies, auditing and evaluation of results in the context of health insurance and risk management.

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El problema del incremento de los precios de los planes de salud de las Isapres es un factor desestabilizante en la industria, por el monto en que éstos se incrementan y por la forma en que éstos se fijan. Las Isapres han aumentado los precios en términos reales muy por sobre el IPC a pesar que todos los precios están fijados en UF. Por otro lado estas empresas aplican un modelo de fijación de precios de primas ajustada por riesgo (a mayor riesgo mayor precio) y en un marco de completa libertad para definir el reajuste del plan base de cada ISAPRE. El sistema privado se ha judicializado y el 2012 hubo más de 47.000 demandas judiciales, todas ganadas por los afiliados por la aplicación de tablas ajustadas por edad y sexo dejando en jaque este modelo de tarifas. A fines del 2012 se producen nuevos dictámenes de la Corte Suprema, sobre demandas en contra de la forma en que se reajusta el precio base de los planes de cada ISAPRE y que éstas deben justificar en forma adecuada. La corte nuevamente da la razón a los afiliados considerando que los aumentos de precios reclamados estaban insuficientemente justificados, y señalando además que las Isapres no pueden utilizar el aumento de frecuencia de uso de los servicios como justificación porque es consustancial al riesgo que administran poniendo en jaque otro elemento clave del modelo de precios de las Isapres. En este artículo los autores hacen un detallado análisis del contexto en que se desarrolla el problema, sobre los dictámenes judiciales propiamente tal y sus consecuencias sobre el sistema concluyendo que será necesario reformar en forma profunda el sistema de Isapres.

The problem with the price raise of the medical plans of the ISAPRES is a destabilizing factor in the industry, because of the amount that these are increasing and the way they are set. ISAPRES have increased their prices in real terms way over the IPC even though all the prices are set in UF. On the other side these companies apply a model of price setting of primes adjusted by risk (the greater the risk the higher the price) in a framework of complete freedom to define de readjustment of the base plan of each ISAPRE. The private system has been judicialized and in 2012 there were over 47.000 sues, every one of them won by the affiliates by the application of the boards adjusted by age and gender leaving this model of rating obsolete. By the end of 2012 new decisions made by the Supreme Court, about sues against the way the price is readjusted in the plans of each ISAPRE and that these should justify in an adequate form. The court once again supports the affiliates considering that the amount of prices sued were insufficiently justified, even pointing out that the ISAPRES cannot use the raise in the frequency of the service use as a justification because its consubstantial to the risk that they administer leaving another key element of this price model obsolete in the ISAPRES. In this article the authors make a detailed analysis of the context in which the problem is developed, about the judicial decisions taken and their consequences on the system concluding that it will be necessary to make a profound reform in the ISAPRES system.

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A legislação brasileira normatiza a doação de recursos financeiros provenientes de fontes privadas para as campanhas de candidatos majoritários e proporcionais. Com base em aportes da literatura sobre a estrutura partidária e relações entre o Legislativo e Executivo, o presente estudo analisa, a partir das categorias de representação política e de interesses, as informações sobre empresas de planos de saúde doadoras e as candidaturas destinatárias. As empresas de planos de saúde doadoras foram devidamente identificadas, assim como os recursos doados para candidatos. O cotejamento desses dados fornece um mapeamento de interesses das empresas de planos de saúde projetados no Poder Legislativo, mas não autoriza o estabelecimento de relações causais entre os doadores e a atuação dos parlamentares. O comparecimento das empresas de planos de saúde na disputa eleitoral e a inclinação das doações para partidos situados mais à direita no gradiente político partidário são os principais resultados do trabalho.

The Brazilian legislation regulates the financial donations from private sources to both majoritarian and proportional election candidates. Based on approaches found in the literature on the party-system structure and on the relationships between the Legislative and Executive, this study uses the categories political representation and interests to analyze the information on donating health insurance companies and the receiving candidacies. The donating health plan companies were duly identified, as well as the resources donated to candidates. Comparing these data allows an assessment of the health plan companies' interests projected in the Legislative Power, but does not authorize the establishment of causal relationships between donors and the representatives' performance. The presence in the electoral dispute of health plan companies from every region in the country and the tendency of donations to go to parties on the right of the political spectrum are the major findings of this paper.

La ley brasileña regula la donación de recursos financieros provenientes de fuentes privadas a los candidatos a las elecciones. Sobre la base de la literatura sobre la estructura partidaria y las relaciones entre el poder legislativo y el poder ejecutivo, este estudio examina, desde las categorías de la representación política y de intereses, la información sobre empresas de planos de salud donantes y las candidaturas destinatarias. Las empresas de plano de salud donantes fueren debidamente identificadas, así como los recursos donados a los candidatos. La comparación entre estos datos proporciona una asignación de los intereses de las empresas de planes de salud involucrados en el poder legislativo, pero no autoriza el establecimiento de relaciones causales entre donadores y la actuación de los parlamentarios. A presencia de las compañías de seguros de salud durante la campaña electoral y la inclinación de las donaciones a los partidos situados más a la derecha en el gradiente político-partidario son los principales resultados del trabajo.

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This piece begins with a brief discussion of the concepts leading to the social right to health protection. Special emphasis is placed on the principle of social cohesion, which has influenced social health protection in European countries. ChileÆs experience in this field from the 1990s to the present is described, as exemplified in three dimensions. In the first place, social security coverage is presented as a means to achieve universal (horizontal) coverage. A discussion follows on vertical coverage, where the author identifies health problems for which insured persons have guaranteed rights of access to medical care. This section describes available emergency care, primary health care, and the special plan for Universal Access to Explicit Guarantees (Acceso Universal de Garantías Explícitas de salud, or AUGE). Thirdly, the discussion covers the funding sources supporting the Chilean health care system: Government subsidies, contributions to social security, and out-of-pocket disbursements for private care. ChileÆs public health system has various special programs. One of them is catastrophic insurance, which covers 100 percent of the care needed for complex and very costly treatments. Older persons (over 65) have coverage for 100 percent of the cost of eyeglasses and hearing aids, and for 50 percent of the cost of home care. If life expectancy is an appropriate indicator of health system results, it is worth noting that Chile and the United States of America have both achieved a life expectancy of 77 years, even though Chile spends only 5.9 percent of its gross domestic product on health care, as compared to the 15 percent spent by the United States.

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This article proposes a set of measures to reform the Argentine health care system and turn the country's current crisis into an opportunity for progressive, sustainable change. The proposal consists of a model for the intergovernmental division of health responsibilities. The national government would be responsible for strengthening its leadership role and for developing national insurance for low-prevalence high-cost diseases. With the provincial governments, the insurance role would be strengthened, with public health insurance making certain that there is universal coverage. Public hospitals would function as autonomous entities financed by social insurance, private insurance, and provincial public insurance. Municipalities would have an active role in disease prevention and health promotion, principally through primary care

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