RESUMO
This article analyzes spending on mental health by the Brazilian Ministry of Health between 2001 and 2014. It is documental research of the Brazilian Ministry of Health's databases. It analyzes the data using descriptive statistical analysis. Total spending on mental health for the period 2001 to 2014 shows a percentage increase in resources destined for outpatient care, but this increase is a reallocation from hospital services to community-based services and total resources for the mental health program remain at an average of 2.54% of the total health budget. Within outpatient expenditure, spending on medications remains high. Professionals committed to psychiatric reform fight to guarantee that a small fraction of the surplus appropriated by the state is directed towards social policies.
Assuntos
Serviços Comunitários de Saúde Mental/economia , Financiamento Governamental/legislação & jurisprudência , Reforma dos Serviços de Saúde/economia , Política de Saúde/economia , Unidade Hospitalar de Psiquiatria/economia , Instituições de Assistência Ambulatorial/economia , Instituições de Assistência Ambulatorial/legislação & jurisprudência , Instituições de Assistência Ambulatorial/tendências , Brasil , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/tendências , Desinstitucionalização/economia , Desinstitucionalização/legislação & jurisprudência , Desinstitucionalização/tendências , Financiamento Governamental/tendências , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/tendências , Gastos em Saúde/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Gastos em Saúde/tendências , Política de Saúde/legislação & jurisprudência , Política de Saúde/tendências , Prioridades em Saúde/economia , Prioridades em Saúde/legislação & jurisprudência , Prioridades em Saúde/tendências , Humanos , Direitos do Paciente/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/legislação & jurisprudência , Unidade Hospitalar de Psiquiatria/tendências , Tratamento Domiciliar/economia , Tratamento Domiciliar/legislação & jurisprudência , Tratamento Domiciliar/tendências , Transtornos Relacionados ao Uso de Substâncias/economia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
Tuberculosis (TB) is a disease associated with inequality, and wise investment of economic resources is considered critical to its control. Panama has recently secured its status as an upper-middle-income country with robust economic growth. However, the prioritisation of resources for TB control remains a major challenge. In this article, we highlight areas that urgently require action to effectively reduce TB burden to minimal levels. Our conclusions suggest the need for fund allocation and a multidisciplinary approach to ensure prompt laboratory diagnosis, treatment assurance and workforce reinforcement, complemented by applied and operational research, development and innovation.
Assuntos
Países em Desenvolvimento/economia , Desenvolvimento Econômico , Custos de Cuidados de Saúde , Programas Nacionais de Saúde/economia , Tuberculose/economia , Produto Interno Bruto , Prioridades em Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Panamá/epidemiologia , Tuberculose/diagnóstico , Tuberculose/tratamento farmacológico , Tuberculose/epidemiologiaRESUMO
This study mapped the application of financing in research and development in health (R&D/H) by the Brazilian Ministry of Health in 2003-2005, according to the National Agenda for Health Research Priorities, created in 2004. The analysis was based on data from a study aimed primarily at measuring these investment flows during the same period. The calculations included only direct financing with actual outlays in research, including payroll expenditures. The studies were categorized according to the 24 sub-agendas of the national priority agenda by two independent researchers, and disagreements were resolved by consensus. Research and development expenditures in health totaled 409.7 million reais, concentrated mainly in the following sub-agendas: transmissible diseases, the health industry complex, clinical research, pharmaceutical care, and non-communicable diseases (79% of the total). All 24 sub-agendas received some financing during the period. The study established a baseline for subsequent evaluations of this financing instrument's inductive capacity and the relationship between R&D/H investments and the population's health needs.
Assuntos
Política de Saúde , Prioridades em Saúde/estatística & dados numéricos , Apoio à Pesquisa como Assunto/economia , Pesquisa/estatística & dados numéricos , Brasil , Prioridades em Saúde/economia , Humanos , Pesquisa/economia , Apoio à Pesquisa como Assunto/estatística & dados numéricosRESUMO
Priority setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Traditionally, health economists have proposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that the social value from health improvements be a product of gains in years of life, quality of life, and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the rule of maximizing this gain sufficient. The social value of a health gain appears not to be linear in terms of mortality and morbidity, or neutral vis-à-vis people's characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.
Assuntos
Alocação de Recursos para a Atenção à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Anos de Vida Ajustados por Qualidade de Vida , Custos e Análise de Custo , Alocação de Recursos para a Atenção à Saúde/economia , Prioridades em Saúde/economia , Acessibilidade aos Serviços de Saúde , HumanosRESUMO
Estabelecer prioridades em saúde traduz-se em escolhas entre programas alternativos e/ou entre pacientes ou grupos de pacientes. Tradicionalmente, os economistas da saúde propuseram a agregação dos ganhos de saúde, avaliados em QALYs, como forma de estabelecer prioridades e maximizar o bem-estar social. Isso requer que o valor social dos ganhos de saúde seja um produto dos ganhos em anos de vida, qualidade de vida e número de pessoas tratadas. Resultados da revisão de literatura sugerem que nem os potenciais ganhos de saúde são, por si só, um determinante significativo de valor nem a regra da maximização dos ganhos de saúde parece suficiente. O valor social de um ganho de saúde parece não ser uma função linear dos ganhos de mortalidade e morbidade, nem parece neutral às características dos doentes ou à distribuição final de saúde entre a população. Paralelamente à revisão do debate sobre o papel e limitação dos QALYs para a priorização dos recursos da saúde, o artigo procura justificar a controvérsia de alguns resultados empíricos, em particular, no que se refere à formação e manifestação das preferências sociais.
Priority setting in health care involves choosing between alternative health care programs and/or patients or groups of patients who will receive care. Traditionally, health economists have proposed maximizing the additional health gain measured in QALYs as a way of setting priorities and maximizing social welfare. This requires that the social value from health improvements be a product of gains in years of life, quality of life, and number of people treated. The results of a literature review suggest that potential health gain is not a single relevant determinant of value, nor is the rule of maximizing this gain sufficient. The social value of a health gain appears not to be linear in terms of mortality and morbidity, or neutral vis-à-vis people's characteristics or the ultimate distribution of health in society. In parallel with the review of the debate on the role and limitation of QALYs for prioritizing health care resources, the article attempts to justify the controversy over some empirical results, particularly in relation to the construction and expression of social preferences.
Assuntos
Humanos , Alocação de Recursos para a Atenção à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Anos de Vida Ajustados por Qualidade de Vida , Custos e Análise de Custo , Acessibilidade aos Serviços de Saúde , Alocação de Recursos para a Atenção à Saúde/economia , Prioridades em Saúde/economiaRESUMO
Chile has achieved great success in terms of growth and development. However, growing inequalities exist in relation to income and health status. The previous Chilean government began to reform the healthcare system with the aim of reducing health inequities. What is meant by "equity" in this context? What is the extent of the equity aimed for? A normative framework is required for public policy-makers to consider ideas about fairness in their decisions about healthcare reform. This paper aims to discuss the main features of the Chilean healthcare reform and their implications for such a normative framework.
Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Prioridades em Saúde/ética , Acessibilidade aos Serviços de Saúde/ética , Programas Nacionais de Saúde/ética , Chile , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Prioridades em Saúde/economia , Prioridades em Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/economia , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Classe Social , Justiça Social/economia , Justiça Social/ética , Justiça Social/legislação & jurisprudência , Fatores SocioeconômicosRESUMO
BACKGROUND: In developing countries rotavirus is the leading cause of severe diarrhoea and diarrhoeal deaths in children under 5. Vaccination could greatly alleviate that burden, but in Mexico as in most low- and middle-income countries the decision to add rotavirus vaccine to the national immunisation program will depend heavily on its cost-effectiveness and affordability. The objective of this study was to assess the cost-effectiveness of including the pentavalent rotavirus vaccine in Mexico's national immunisation program. METHODS: A cost-effectiveness model was developed from the perspective of the health system, modelling the vaccination of a hypothetical birth cohort of 2 million children monitored from birth through 60 months of age. It compares the cost and disease burden of rotavirus in an unvaccinated cohort of children with one vaccinated as recommended at 2, 4, and 6 months. RESULTS: Including the pentavalent vaccine in the national immunisation program could prevent 71,464 medical visits (59%), 5,040 hospital admissions (66%), and 612 deaths from rotavirus gastroenteritis (70%). At US$10 per dose and a cost of administration of US$13.70 per 3-dose regimen, vaccination would cost US$122,058 per death prevented, US$4,383 per discounted life-year saved, at a total net cost of US$74.7 million dollars to the health care system. Key variables influencing the results were, in order of importance, case fatality, vaccine price, vaccine efficacy, serotype prevalence, and annual loss of efficacy. The results are also very sensitive to the discount rate assumed when calculated per life-year saved. CONCLUSION: At prices below US $15 per dose, the cost per life-year saved is estimated to be lower than one GNP per capita and hence highly cost effective by the WHO Commission on Macroeconomics and Health criteria. The cost-effectiveness estimates are highly dependent upon the mortality in the absence of the vaccine, which suggests that the vaccine is likely to be significantly more cost-effective among poorer populations and among those with less access to prompt medical care - such that poverty reduction programs would be expected to reduce the future cost-effectiveness of the vaccine.