25 research outputs found
Is there scope for cost savings and efficiency gains in HIV services? A systematic review of the evidence from low- and middle-income countries.
OBJECTIVE: To synthesize the data available--on costs, efficiency and economies of scale and scope--for the six basic programmes of the UNAIDS Strategic Investment Framework, to inform those planning the scale-up of human immunodeficiency virus (HIV) services in low- and middle-income countries. METHODS: The relevant peer-reviewed and "grey" literature from low- and middle-income countries was systematically reviewed. Search and analysis followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. FINDINGS: Of the 82 empirical costing and efficiency studies identified, nine provided data on economies of scale. Scale explained much of the variation in the costs of several HIV services, particularly those of targeted HIV prevention for key populations and HIV testing and treatment. There is some evidence of economies of scope from integrating HIV counselling and testing services with several other services. Cost efficiency may also be improved by reducing input prices, task shifting and improving client adherence. CONCLUSION: HIV programmes need to optimize the scale of service provision to achieve efficiency. Interventions that may enhance the potential for economies of scale include intensifying demand-creation activities, reducing the costs for service users, expanding existing programmes rather than creating new structures, and reducing attrition of existing service users. Models for integrated service delivery--which is, potentially, more efficient than the implementation of stand-alone services--should be investigated further. Further experimental evidence is required to understand how to best achieve efficiency gains in HIV programmes and assess the cost-effectiveness of each service-delivery model
Movilidad poblacional y VIH/sida en Centroam茅rica y M茅xico
OBJETIVO: Estimar la magnitud de la asociaci贸n entre la movilidad poblacional, medida con la tasa neta de migraci贸n (TNM) y la prevalencia de VIH en Centroam茅rica y M茅xico. M脡TODOS: Con modelos de series temporales se analiz贸 dicha asociaci贸n en personas de 15 a 49 a帽os de edad, ajustada por factores socioecon贸micos (educaci贸n, educaci贸n, desempleo, esperanza de vida e ingreso) y utilizando informaci贸n p煤blica de ONUSIDA, el PNUD, la CEPAL y el Banco Mundial para el per铆odo 1990-2009. RESULTADOS: La TNM fue negativa en todos los pa铆ses, excepto en Costa Rica y Panam谩. Los resultados no ajustados del modelo muestran una asociaci贸n positiva y que la TNM puede explicar el 6% de la prevalencia de VIH registrada. Cuando se incluyen cofactores socioecon贸micos por pa铆s (educaci贸n, salud e ingreso), la magnitud asciende a 9% (P<0,05). La TNM, incluso ajustada por factores socioecon贸micos, explica modestamente la prevalencia de VIH registrada. Los factores socioecon贸micos indican mejoras en todos los indicadores en Centroam茅rica y M茅xico, aunque persisten importantes brechas entre pa铆ses. CONCLUSIONES: La modesta asociaci贸n observada entre movilidad poblacional y prevalencia de VIH est谩 condicionada por la situaci贸n socioecon贸mica de los pa铆ses estudiados. La informaci贸n disponible limit贸 el alcance del an谩lisis para establecer con mayor certeza la existencia de esta asociaci贸n. En consecuencia, con la informaci贸n disponible no es posible atribuir a la migraci贸n un papel determinante en la diseminaci贸n del VIH
Does the new public management contribute to improving the performance of obstetric care in Mexico public hospitals?
In pursuit of higher performance in the Public Administration, the Mexican government implemented
the New Public Management (NPM) model in 2008, with the aim of correcting deficiencies in its public
services - including those of the Ministry of Health (MoH) -. In ten years of work under the new model, no
information has been provided on the effects of NPM on the performance indicators, such as effectiveness
and efficiency, of government institutions. The present study had the objective to analyze the impact of
the NPM on the effectiveness and efficiency of MoH care facilities. Effectiveness was evaluated as the
proportion of hospital discharges (HD) indicating a recovery diagnosis, and efficiency as the average length
of hospital stays, modeled with survival analysis and local kernel regression methods. Data analyzed pertained to a time series of 16.5 million obstetric HD (64% of total discharges) produced from 2000 to 2015.
The results revealed high levels of effectiveness (98% of HD with recovery diagnosis) and efficiency (an
average hospital stay of 1.74 days), before and after NPM. The consistently high performance throughout
the period analyzed, indicate that MoH hospitals had attained optimal effectiveness and efficiency levels
prior to the NPM implementation. The indistinctive impact of the public management reform may suggest
that NPM was applied as a blanket solution without considering institutional specificities.En la b煤squeda de mejorar el desempe帽o de la administraci贸n p煤blica, el gobierno mexicano implement贸,
en 2008, la Nueva Gesti贸n P煤blica (NGP). Con este modelo se pretend铆a corregir las deficiencias en
la provisi贸n de servicios p煤blicos, incluidos los otorgados por la Secretar铆a de Salud. A diez a帽os de
su implementaci贸n, se desconoce la contribuci贸n de la NGP en el desempe帽o de los hospitales de la
Secretar铆a de Salud de M茅xico. El presente estudio analiz贸 el impacto de la NGP en la efectividad y
eficiencia (dos de los principales indicadores de desempe帽o hospitalario) de la atenci贸n obst茅trica (la
principal actividad hospitalaria -64% del total de egresos hospitalarios-) en la Secretar铆a de Salud. Los
datos analizados corresponden a una serie temporal de 16,5 millones de egresos hospitalarios obst茅tricos
producidos entre 2000 y 2015. La efectividad se midi贸 como la proporci贸n de egresos con diagn贸stico
de recuperaci贸n y la eficiencia como el promedio de d铆a estancia. El cambio en la eficiencia, antes y
despu茅s de la implementaci贸n de la NGP, se model贸 con an谩lisis de sobrevida y Regresi贸n Kernel.
Los resultados revelaron altos niveles de efectividad (98% de egresos hospitalarios con diagn贸stico de
recuperaci贸n) y eficiencia (una estancia hospitalaria promedio de 1,74 d铆as), antes y despu茅s de NGP. El
alto rendimiento, constante durante todo el per铆odo analizado, indica que los hospitales de la Secretar铆a
de Salud alcanzaron, y conservaron, niveles 贸ptimos de efectividad y eficiencia antes y despu茅s de la
implementaci贸n de la NGP. La falta de impacto de esta reforma en la gesti贸n p煤blica puede sugerir que
el NGP se aplic贸 como una soluci贸n general sin considerar las especificidades institucionales
Factores asociados con la b煤squeda del servicio de interrupci贸n legal del embarazo en la Ciudad de M茅xico, 2010 Factors associated with the seeking of legal induced abortion services in Mexico City in 2010
OBJETIVO: Identificar factores asociados con la b煤squeda del servicio de interrupci贸n legal del embarazo (ILE) en la Ciudad de M茅xico. MATERIAL Y M脡TODOS: Se utiliz贸 un dise帽o casos-controles. Usuarias del servicio de ILE fueron definidas como casos, y usuarias de control prenatal con 13 o m谩s semanas de gestaci贸n con un embarazo no deseado constituyeron los controles. Se ajustaron modelos de regresi贸n log铆stica condicional. RESULTADOS: Los a帽os de escolaridad (RM=1.47, IC:1.04-2.07), la ocupaci贸n (estudiante, RM=7.31, IC:1.58-33.95; tener empleo remunerado, RM= 13.43, IC:2.04-88.54) y n煤mero de interrupciones de embarazo previas (RM=11.41, IC:1.65-79.07) se asociaron con la b煤squeda de ILE. El factor de mayor peso fue la ocupaci贸n; las mujeres que trabajan tuvieron 13.4 veces mayor posibilidad de demandar el servicio de ILE. CONCLUSIONES: En el contexto de la Ciudad de M茅xico, mujeres con m谩s educaci贸n y participaci贸n laboral activa utilizan m谩s los servicios de ILE. Se requieren estrategias dirigidas a incrementar el uso de estos servicios por mujeres menos favorecidas.<br>OBJECTIVE: To identify factors associated with the seeking of the legal-interruption-pregnancy (LIP) services in Mexico City. MATERIALS AND METHODS: We used a case-control design. Users who utilized the LIP were defined as cases, while users of the antenatal care service with gestational age 13 or more weeks and who reported having an unwanted pregnancy were defined as controls. Logistic regressions were fitted to estimate odds ratios. RESULTS: Higher level of education (OR=1.47, 95% CI:1.04-2.07), women's occupation (being student OR=7.31, 95% CI:1.58-33.95; worker OR=13.43, 95% CI:2.04-88.54), and number of previous abortions (OR=11.41, 95% CI:1.65-79.07) were identified as factors associated with the lookup of LIP. CONCLUSIONS: In Mexico City context, empowered women with a higher level of education, or having a work activity are the users of LIP services. Strategies for improving access of women with low empowerment conditions are needed
Costo-efectividad de pr谩cticas en salud p煤blica: revisi贸n bibliogr谩fica de las intervenciones de la Iniciativa Mesoamericana de Salud Cost-effectiveness of public health practices: A literature review of public health interventions from the Mesoamerican Health Initiative
OBJETIVO: Presentar y analizar informaci贸n de costo-efectividad de intervenciones propuestas por la Iniciativa Mesoamericana de Salud (IMS) en las 谩reas de nutrici贸n infantil, inmunizaciones, paludismo, dengue y salud materno-infantil y reproductiva. MATERIAL Y M脡TODOS: Se llev贸 a cabo una revisi贸n sistem谩tica de la literatura de evaluaciones econ贸micas publicadas entre el a帽o 2000 y agosto 2009 sobre intervenciones en las 谩reas de la salud mencionadas, en los idiomas ingl茅s y espa帽ol. RESULTADOS: Las intervenciones en nutrici贸n y de salud materno-infantil mostraron ser altamente costo-efectivas (con rangos menores a US100 para materno-infantil). En dengue s贸lo se encontr贸 informaci贸n sobre la aplicaci贸n de larvicidas, cuya raz贸n de costo efectividad estimada fue de US345.06 por AVAD evitado. Respecto al paludismo, las intervenciones estudiadas resultaron costo-efectivas (OBJECTIVE: Present and analyze cost-effectiveness information of public health interventions proposed by the Mesoamerican Health Initiative in child nutrition, vaccination, malaria, dengue, and maternal, neonatal, and reproductive health. MATERIAL AND METHODS: A systematic literature review was conducted on cost-effectiveness studies published between January 2000 and August 2009 on interventions related to the health areas previously mentioned. Studies were included if they measured effectiveness in terms of Disability-Adjusted Life Year (DALY) or death averted. RESULTS: Child nutrition and maternal and neonatal health interventions were found to be highly cost-effective (most of them below US100 for maternal and neonatal health). For dengue, information on cost-effectiveness was found just for application of larvicides, which resulted in a cost per DALY averted ranking from US345.06. Malarial interventions were found to be cost-effective (below US4,000 per death averted within Africa). In the case of pneumococcus and rotavirus vaccination, cost-effectiveness estimates were always above one GDP per capita per DALY averted. CONCLUSIONS: In Mesoamerica there are still important challenges in child nutrition, vaccination, malaria, dengue and maternal, neonatal, and reproductive health, challenges that could be addressed by scaling-up technically feasible and cost-effective interventions
Costos directos de las hospitalizaciones por diabetes mellitus en el Instituto Mexicano del Seguro Social
Resumen: Objetivo: Estimar para el Instituto los costos directos de las hospitalizaciones por diabetes mellitus y sus complicaciones en el Instituto Mexicano del Seguro Social. M茅todo: Se estimaron los costos hospitalarios de la atenci贸n a pacientes con diabetes mellitus utilizando los grupos relacionados por el diagn贸stico en el Instituto Mexicano del Seguro Social (IMSS) entre 2008 y 2013, y los egresos hospitalarios de los c贸digos E10-E14 correspondientes a diabetes mellitus. Los costos se agruparon seg煤n caracter铆sticas demogr谩ficas y afecci贸n principal, y se estimaron en d贸lares estadounidenses de 2013. Resultados: Se registraron 411.302 egresos hospitalarios por diabetes mellitus, con un costo de 1563 millones de d贸lares. El 52,44% correspondieron a hombres y el 77,26% fueron por diabetes mellitus tipo 2. El mayor costo es atribuible a las complicaciones circulatorias perif茅ricas (34,84%) y a las personas con 45-64 a帽os de edad (47,1%). En el periodo analizado, los egresos disminuyeron un 3,84% y los costos totales un 1,75%. Las complicaciones que provocaron mayor variaci贸n de los costos fueron la cetoacidosis (50,70%), las oft谩lmicas (22,6%) y las circulatorias (18,81%). Conclusiones: La atenci贸n hospitalaria de la diabetes mellitus representa un importante reto financiero para el IMSS, y m谩s a煤n lo es el incremento en la frecuencia de las hospitalizaciones en poblaci贸n en edad productiva, que afecta a la sociedad en su conjunto, lo que sugiere la necesidad de fortalecer las acciones de control de las personas diab茅ticas con miras a prevenir complicaciones que requieran atenci贸n hospitalaria. Abstract: Objective: To estimate the direct costs related to hospitalizations for diabetes mellitus and its complications in the Mexican Institute of Social Security Methods: The hospital care costs of patients with diabetes mellitus using diagnosis-related groups in the IMSS (Mexican Institute of Social Security) and the hospital discharges from the corresponding E10-E14 codes for diabetes mellitus were estimated between 2008-2013. Costs were grouped according to demographic characteristics and main condition, and were estimated in US dollars in 2013. Results: 411,302 diabetes mellitus discharges were recorded, representing a cost of $1,563 million. 52.44% of hospital discharges were men and 77.26% were for type 2 diabetes mellitus. The biggest cost was attributed to peripheral circulatory complications (34.84%) and people from 45-64 years of age (47.1%). Discharges decreased by 3.84% and total costs by 1.75% in the period analysed. The complications that caused the biggest cost variations were ketoacidosis (50.7%), ophthalmic (22.6%) and circulatory (18.81%). Conclusions: Hospital care for diabetes mellitus represents an important financial challenge for the IMSS. The increase in the frequency of hospitalisations in the productive age group, which affects society as a whole, is an even bigger challenge, and suggests the need to strengthen monitoring of diabetics in order to prevent complications that require hospital care. Palabras clave: Costos directos de servicios, Complicaciones de la diabetes, Seguridad social, Grupos relacionados por el diagn贸stico, Hospitalizaci贸n, M茅xico, Keywords: Direct service costs, Diabetes complications, Social security, Diagnosis-related groups, Hospitalisation, Mexic
Preoperative risk assessment and spirometry is a cost-effective strategy to reduce post-operative complications and mortality in Mexico.
AimCombining preoperative spirometry with the Assess Respiratory Risk in Surgical Patients in Catalunia (ARISCAT) risk scale can reduce post-operative complications and improve patient survival. This study aimed to assess the cost-effectiveness of performing spirometry or not in conjunction with the ARISCAT scale, to reduce post-operative complications and improve survival among adult patients undergoing elective surgery in Mexico.MethodsA cost-effectiveness analysis (CEA) was performed to compare the specific cost and health outcomes associated with the combined use of the ARISCAT scale and preoperative spirometry (Group 1), and the use of the ARISCAT scale without preoperative spirometry (Group 2). The health outcomes evaluated were post-operative complications and survival. The perspective was from the health care provider (Hospital General de M茅xico) and direct medical costs were reported in 2019 US dollars. A decision tree with a time horizon of eight months was used for each health outcome and ARISCAT risk level.ResultsThe combined use of the ARISCAT scale and spirometry is more cost-effective for reducing post-operative complications in the low and moderate-risk levels and is cost-saving in the high-risk level, than use of the ARISCAT scale without spirometry. To improve patient survival, ARISCAT and spirometry are also more cost-effective at the moderate risk level, and cost-saving for high-risk patients, than using the ARISCAT scale alone.ConclusionsThe use of preoperative spirometry among patients with a high ARISCAT risk level was cost-saving, reduced post-operative complications, and improved survival. Our findings indicate an urgent need to implement spirometry as part of preoperative care in Mexico, which is already the standard of care in other countries
El Fondo de Protecci贸n contra Gastos Catastr贸ficos: tendencia, evoluci贸n y operaci贸n Fund for Protection against Catastrophic Expenses
OBJETIVO. Documentar los procesos operativos y de gesti贸n del Fondo de Protecci贸n contra Gastos Catastr贸ficos (FPGC), evoluci贸n y distribuci贸n del gasto y explorar semejanza entre padecimientos cubiertos y perfil epidemiol贸gico. MATERIAL Y M脡TODOS. Estudio mixto, de naturaleza gerencial, que incluy贸 entrevistas semiestructuradas, revisi贸n de bases de datos de la Comisi贸n Nacional de Protecci贸n Social en Salud (CNPSS), egresos hospitalarios y mortalidad. RESULTADOS. El 52% de los estados tardan el doble del tiempo establecido para notificar y validar los casos. De 2004 a 2009 el FPGC pas贸 de 6 a 49 intervenciones, equivalente a un incremento nominal y real del gasto de 2 306.4 y 1 659.3%, respectivamente. La intervenci贸n priorizada fue VIH/SIDA con 39.3%; el Distrito Federal obtuvo la mayor proporci贸n del gasto (25.1%). Algunas de las principales causas de mortalidad son cubiertas por el FPGC. CONCLUSIONES. La revisi贸n de los criterios de inclusi贸n de enfermedades y la adecuaci贸n del fondo para atender la demanda creciente es impostergable.<br>OBJECTIVE. To document the status of operational and managerial processes of the Fund for Protection against Catastrophic Expenses (FPGC), as well as to describe its evolution, and to explore the relationship between covered diseases and the Mexican health profile. MATERIAL AND METHODS. This is a joint management study, which included a qualitative and a quantitative phase. We conducted semi-structured interviews with key informants. We also analyzed the records of CNPSS, the hospital discharge and mortality data bases. RESULTS. Fifty two percent of the states take twice as long to report and validate the cases. From 2004-2009 the FPGC increased its coverage from 6 to 49 interventions, that means a spending increase of 2 306.4% in nominal terms and 1 659.3% in real terms. The HIV/AIDS was the intervention prioritized with 39.3% and Mexico City had the highest proportion of expenditure (25.1%). A few diseases included in the health profile are covered by the FPGC. CONCLUSIONS. The review of the inclusion criteria of diseases is urgent, so as to cover diseases of epidemiological importance
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Costos directos de atenci贸n m茅dica por COVID-19 durante el primer a帽o de pandemia en un hospital reconvertido
Background: COVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system. Objective: To estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency. Material and methods: Retrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars. Results: Mean hospital length of stay (n = 3,241 patients) was 10.8 卤 8.2 days. Average cost of care per patient was USD 6,557 卤 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients. Conclusions: The costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel
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COVID-19 medical care direct costs during the first year of pandemic in a hospital converted for increasing bed capacity
BackgroundCOVID-19 health emergency caused an increase in the demand for hospitalization and high costs for the health system.ObjectiveTo estimate COVID-19 care direct costs from the perspective of the healthcare provider in a secondary care hospital that underwent conversion during the first year of health emergency.Material and methodsRetrospective, observational study. Information on quantities of goods and services was obtained from the SINOLAVE and CVOED platforms and from hospital administrative sources. Four cost groups were defined and estimated with 2021 unit prices in US dollars.ResultsMean hospital length of stay (n = 3,241 patients) was 10.8 卤 8.2 days. Average cost of care per patient was USD 6,557 卤 4,997. Respiratory therapy with assisted mechanical ventilation was used by 13% of patients.ConclusionsThe costs of COVID-19 medical care represent a large amount of resources. Most part of the costs (95%) were derived from hospital stay, respiratory therapy without assisted mechanical ventilation and costs related to personal protective equipment, hygiene, infrastructure adaptation and payments to medical personnel