Health maximisation versus equality of treatment: what is the optimal trade-off from the general public’s perspective?

Resumo da comunicação apresentada à 10.ª Conferência Nacional de Economia da Saúd

Catastrophic expenditure on medicines: an analysis based on the portuguese household budget survey 2015/2016

Financial protection is a core dimension of health system evaluation and several works on catastrophic health expenditure (CHE) have been developed. There are however some gaps in the literature, hence, this work aims to look at CHE from a different angle, following the money spent by households. The objectives are to identify how many and which health services are driving CHE and analyse the profile of households with CHE. Data come from the Portuguese Household Budget Survey 2015/2016 and the study includes 11,398 observations. WHO methodology for CHE identification was adopted. Over a fifth of households incurring CHE spent only on medicines and this item presented by far the highest expenditures. All families with CHE spent on medicines and about two thirds spent on up to three items. Expenditures on medical devices and hospital services were low. Dental care expenditures tended to assume extreme values. Although primary care services are spread across the country, expenditures on GP services were not at all negligible. The typical household with CHE consists of an old poor person living alone. Exempting these people from medicine co-payments is crucial to prevent catastrophic expenditure.CEBER, University of Coimbra, Coimbra, Portugal; CICF - IPCA, Polytechnic Institute of Bragança (IPB), Bragança, Portugal,info:eu-repo/semantics/publishedVersio

Water Pricing and Social Equity in Portuguese Municipalities

Water supply services are Services of General Interest (SGI), subject to specific public service obligations, such as universality, continuity, quality, affordability, transparency, and consumer protection. There is an extensive empirical literature on the design of optimal prices. However, these contributions tend to neglect the issue of universal service and equity concerning the volume of water for basic needs (the ‘essential minimum quantity’). Addressing this gap in the literature, and using empirical data for the Portuguese municipalities, this paper aims to evaluate whether income-related equity considerations are embodied in water supply Portuguese municipalities’ tariffs. Accordingly, essential minimum quantities of water for representative households are computed, and then compared with the lowest tariff block’s upper limit by water utility. Next, representative households are ranked by costs underlying essential minimum quantities and by income. This analysis also considers concentration curves and indexes which show that water bills are regressive, i.e., there is socioeconomic inequity favourable to the better-off representative households.Water Policy, Water Pricing, Social Equity, Efficient Water Use, Portugal.

Equidade: a chave para explicar os tarifários de água em Portugal?

Given the gap in the literature regarding equity analyses in the water industry, the objective of this paper is to evaluate whether or not income-related equity considerations are embodied in water supply tariffs, in the Portuguese municipalities. Essential minimum quantities of water are determined for representative households, which are then compared with the first tariff block’s upper limit applying on their respective municipalities. Next, representative households are ranked by costs underlying minimum quantities and by income. The methodology used in this paper is also based on concentration curves and indexes. We conclude that payments of water bills are regressive, or, in other words, there is inequity favourable to the better-off representative households.

Picturing Prevalence and Inequalities in Cancer Screening Attendance to Population-Based Programs in Portugal

Introduction: Screening is effective in reducing cancer-related morbidity and mortality. The aim of this study was to analyze the level of, and income-related inequalities in, screening attendance, in Portugal for population-based screening programs. Methods: Data from the Portuguese Health Interview Survey 2019 was used. Variables included in the analysis were self-reported: mammography, pap smear test, fecal occult blood test. Prevalence and concentration indices were computed at national/regional level. We analyzed: up-to-date screening (within recommended age/interval), under-screening (never or overdue screening), and over-screening (due to frequency higher than recommended or screening outside target group). Results: Up-to-date screening rates were 81.1%, 72%, and 40%, for breast, cervical and colorectal cancer, respectively. Never-screening was 3.4%, 15.7%, and 39.9%, for breast, cervical, and colorectal cancer, respectively. Over-screening related with frequency was highest for cervical cancer; in breast cancer, over-screening was observed outside recommended age, affecting one third of younger women and one fourth of older women. In these cancers, over-screening was concentrated among women with higher income. Never-screening was concentrated among individuals with lower income for cervical cancer and higher income for colorectal cancer. Beyond the recommended age, 50% of individuals never underwent screening for colorectal cancer and 41% of women never underwent screening for cervical cancer. Conclusion: Overall, screening attendance was high, and inequalities were low in the case of breast cancer screening. The priority for colorectal cancer should be to increase screening attendance

Preferences as a Determinant of the Optimal Level of Decentralisation in Health Care Resource Allocation : Theoretical Insights and an Empirical Application

From an economic point of view, decentralisation is expected to increase social welfare through better matching of service delivery to preferences. The latter have been a central piece of the economic rationales for decentralisation but only indirectly. Thus, at the theoretical level, the main question addressed in this dissertation is: might preferences in themselves influence the impact of decentralisation on allocative efficiency, in the context of health care resource allocation? Regardless of which model (public choice theory or principal-agent theory) is used to explain the positive outcome above mentioned, in any case, the benefits generated by decentralisation depend on the assumption of variation in preferences across jurisdictions. However, there is little empirical evidence regarding this matter. Consequently, at the empirical level, the main question addressed in the current work is: does geographic variation in preferences, in the context of health care resource allocation, exist? To answer this question we developed and administered the same questionnaire (eliciting preferences) to two independent samples drawn from two Portuguese municipalities. Within our framework, central and local decision-makers are seen as alternative agents acting on behalf of local populations. Given the different capabilities possessed by agents, decentralisation of resource allocation generates some trade-offs between objectives. Depending on the trade-offs that local populations are willing to make, they will be better-off with one or the other agent. Therefore, we conclude that the specific preferences held by individuals might also determine in themselves whether or not decentralisation is optimal, when compared to centralisation. Concerning the empirical work, the principal conclusion is that the results do not corroborate the hypothesis of geographic variation in preferences, meaning that the theoretical discussion about the impact of decentralisation on allocative efficiency might have to be revisited. The empirical results further suggest that the geographical dimension of (in)equality in treatment matters to people and that a maximum opportunity cost of equality, in terms of health gain foregone, is likely to exist

Teste de dependência à nicotina: validação linguística e psicométrica do teste de Fagerström

O Teste de Fagerström para a Dependência da Nicotina tem uma utilização generalizada como medida da dependência tabágica. No entanto, a sua versão portuguesa nunca tinha sido sujeita a um processo de equivalência linguística e semântica nem a testes psicométricos de qualidade. Esse foi o objectivo do presente estudo. A adaptação cultural e linguística incluiu a utilização da técnica de tradução-retroversão, precedida de uma definição conceptual e seguida de testes piloto e de uma revisão final. Para validar a versão portuguesa obtida na fase anterior, foram recolhidas amostras compostas pelos fumadores que acorreram a consultas de Medicina no Trabalho e a consultas de Pneumologia e de Desabituação Tabágica, num total de 264 fumadores. A fiabilidade teste-reteste foi garantida por valores de correlação da escala original de 0,990 e das perguntas individuais de 0,975 a 1,000. O valor de alfa de Cronbach de coerência interna foi 0,660, valor baixo em relação aos valores padrão tradicionais, mas superior ao valor encontrado pelos autores e semelhante aos encontrados em outros estudos. O teste de validade de critério obteve bons resultados ao compararem-se os valores obtidos pela escala com algumas variáveis relacionadas com o hábito tabágico e com a própria auto-avaliação da dependência tabágica. A validade de construção através de análise factorial explicou 59% da variância e detectou dois factores referentes ao consumo de cigarros e ao fumo matinal. Em conclusão, algumas dúvidas persistem em relação à continuação da utilização do Teste de Fagerström para a Dependência Tabágica. Consideramos que os profissionais e os investigadores não devem confiar apenas nos resultados desta escala e devem incluir outras perguntas sobre a adição, não pertencentes à versão original

Consumption of Non-Prescribed Drugs in Portugal During the Pandemic in 2021

Objectives: Portugal liberalised the over-the-counter drugs market in 2005 and provides universal healthcare coverage in a mainly Beveridge-type health system. However, the COVID-19 pandemic has forced healthcare to change how services were delivered, especially increasing remote consultations in primary care. This analysis aims to find the drivers for taking non-prescribed drugs during the pandemic in Portugal. Specifically, it seeks to understand the role of taking prescribed drugs and attending remote medical appointments in the self-medication decision.Methods: In this observational study, we used data collected during the pandemic in Centre Region of Portugal and estimated logistic regression for the whole sample and stratified by sex.Results: The main findings show that people taking prescribed medications and attending a remote consultation are more likely to take non-prescribed drugs. Also, reporting unmet healthcare needs seems to motivate people to choose self-medication.Conclusion: Policy implications are pointed out concerning the health risks raised from self-medication, the role of the pharmacist advising non-prescribed drugs, and the related health risks arising from unmet healthcare needs

Os tempos de espera para cirurgia superiores a 12 meses na Região Centro: evolução e perfil dos utentes antes e durante a pandemia por COVID-19

Introduction: Waiting times for elective surgery are a priority of health policy in Portugal, as in other countries. The assessment of waiting times usually focuses on the compliance with maximum waiting times guarantees. However, among the cases where waiting maximum times are not met, there waiting times particularly long. In 2019, the Ministry of Health announced its intention of reducing the number of patients waiting for surgery for more than 12 months. Objectives: Our objectives are to analyse the evolution of this number and to compare the profile of patients waiting less and more than 12 months, before and after the outbreak of the COVID-19 pandemic, in the Centre Region. Materials and methods: Data come from the waiting list for surgery in three moments: 31st May 2019 (50245 observations), 31st December 2019 (50382 observations) and 31st July 2020 (49112 observations). To analyse the association between risk factors and wating time longer than 12 months we use multiple logistic regression. Results: The number of patients waiting more than 12 months increased, both in absolute and relative terms, in 2019 and particularly in 2020. The odds of waiting more than one year are greater for younger patients, for non-ambulatory surgery, normal priority and ophthalmology and for one of the hospitals considered. Those odds are lower for oncology and there is no difference between sexes. Conclusions: The objective of decreasing, already in 2019, the number of patients wating for surgery for more than 12 months seems to have been too ambitious. The pandemic compromised this objective even further.Introdução: Os tempos de espera para cirurgia eletiva são uma prioridade da política de saúde em Portugal, como em outros países. O enfoque da avaliação dos tempos de espera incide habitualmente sobre o cumprimento ou não dos tempos máximos de resposta garantidos. Contudo, dentro dos casos onde estes tempos não são cumpridos incluem-se tempos de espera particularmente longos. Em 2019, o próprio Ministério da Saúde anunciou a intenção de reduzir o número de utentes à espera para cirurgia há mais de 12 meses. Objetivos: Os nossos objetivos são analisar a evolução deste número e comparar o perfil dos utentes à espera há menos e há mais de 12 meses, antes e após o início da pandemia por COVID-19, na Região Centro. Materiais e métodos: Os dados provêm da lista de inscritos para cirurgia em três momentos: 31 de maio de 2019 (50245 observações), 31 de dezembro de 2019 (50382 observações) e 31 de julho de 2020 (49112 observações). Para analisar o perfil dos utentes usamos a regressão logística múltipla. Resultados: O número de utentes à espera há mais de 12 meses aumentou, em termos absolutos e proporcionais, em 2019 e sobretudo em 2020. A chance de esperar por mais de um ano é maior para os mais novos, prioridade normal, cirurgia convencional, Oftalmologia e num dos hospitais considerados. Aquela chance é muito inferior na presença de indicador oncológico e não há diferenças por sexo. Conclusões: O objetivo de reduzir já em 2019 o número de utentes à espera há mais de 12 meses parece ter sido demasiado ambicioso e ficou ainda mais comprometido com a pandemia

Impact of moderating fees on utilisation of paediatric health care: study applied to school age children in the city of Coimbra

RESUMO - Este estudo pretende avaliar o impacto das taxas moderadoras na utilização de cuidados pediátricos e a perspetiva dos pais sobre fatores condicionadores da procura. Foi construído um questionário; preenchido por pais de crianças entre 6-18 anos. Usámos o modelo binomial negativo para avaliar os efeitos sobre utilização de cuidados. A amostra inclui 203 crianças (109 isentas). Ser isento tem efeito positivo (negativo) na utilização por motivo doença (prevenção); rendimento e escolaridade dos pais têm efeitos mistos; tal como isento*rendimento – efeitos não significativos. Pelos resultados obtidos, as taxas moderadoras não afetam a utilização de cuidados, questionando-se a justificação para a sua existência.ABSTRACT - This study aims to assess the impact of moderating fees on utilisation of paediatric health care and the perspectives of parents regarding factors that influence demand. A questionnaire was developed; data was self-reported by parents of children aged 6-18. To assess the effects on utilisation we used the negative binomial model. The sample includes 203 children (109 exempt). Being exempt has a positive (negative) impact on utilisation due to illness (prevention); income and parents’ education have mixed effects; the same happens to exempt*income–effects not significant. Based on the results obtained, moderating fees do not affect utilisation, raising the question on their justification.info:eu-repo/semantics/publishedVersio