El gasto sanitario en España en comparación con el de la Europa desarrollada, 1985–2001. La atención primaria española, Cenicienta europea

ObjetivoDescribir la evolución de la distribución de fondos en nuestro sistema sanitario desde el inicio de la reforma de atención primaria hasta 2001, en comparación con la de los países europeos de la Organización para la Cooperación y el Desarrollo Económico (OCDE)DiseñoEstudio descriptivo longitudinal y retrospectivoEmplazamientoPaíses de la OCDEParticipantesPaíses europeos de la OCDEMedicionesSe utilizan datos de la base Health Data 2003 (OCDE) referidos al período 1985–2001 respecto a variables de gasto sanitario por sectores y de renta. Se comparan los datos españoles con los del conjunto de los 22 países europeos de la OCDEResultadosEuropa aumentó el gasto ambulatorio público, tanto como porcentaje del gasto sanitario público como del producto interior bruto (PIB). España redujo el gasto ambulatorio público en ambos sentidos. Nuestro gasto hospitalario público recuperó gran parte del retraso respecto a Europa y desde 1995 se encuentra, como parte del PIB, en la media europea y, en términos per cápita, acorde con nuestra renta. Sin embargo, nuestro gasto ambulatorio público como parte del PIB es muy inferior al promedio europeo y, per capita, muy inferior a nuestra renta. Nuestro gasto ambulatorio privado es de los más altos de Europa y, en relación con ella, muy superior a nuestra renta, al contrario que su homónimo público. Nuestro gasto privado hospitalario es de los más bajos de Europa y, en relación con ella, muy inferior a nuestra rentaConclusionesRespecto a los recursos públicos comprometidos, la reforma de la atención primaria española no ha servido para aproximarla a Europa, tal y como sí lo ha hecho nuestro nivel hospitalario. La distancia entre España y Europa en el esfuerzo público ambulatorio es incluso mayor que la que había al inicio de la reformaObjetiveTo describe the evolution of the funds distribution in our health care system since the start of the primary care reform to 2001, in comparison with the European countries members of the Organisation for Economic Co-operation andDevelopment (OECD)DesignA longitudinal descriptive and retrospective studyParticipantsEuropean countries members of the OECDSettingCountries members of the OECDMethodsThe data come from the OECD database Health Data 2003. The data refer to period 1985–2001, and to a group of variables of health care expenditure by sectors and of income (Gross Domestic Product [GDP] per capita). We compare Spanish data series with those of the group of 22 European members countries of the OECDResultsEurope increased public expenditure on outpatient care both as a percentage of public health care expenditure and as a percentage of GDP. Spain reduced public expenditure on outpatient care in both senses. Spanish publicexpenditure on in-patient care reduced a great partof its difference with Europe so that since 1995 it isfound, as a percentage of GDP, in the Europeanaverage and, as per capita, it is according with theSpanish income. In contrast, public expenditure onout-patient care as a percentage of GDP in Spain isvery much lower than the European average and, asper capita, is very much lower than the Spanishincome. The Spanish private expenditure on outpatient is found among the highest in Europe and, compared with Europe, exceeds very much Spanish income, in contrast with his homonymous public. The Spanish private expenditure on in-patient care is found among the lowest in Europe and, compared with Europe, is very much lower than Spanish income levelConclusionsWith respect to public resources assigned, the reform of primary care in Spain has not been useful to approach Spanish primary health care level to Europe, in contrast with the Spanish hospital level. The difference between Spain and Europe in public expenditure on out-patient care as a percentage of GDP is, even, bigger than the one there was when the reform of Spanish primary care starte

Economic Valuation of Health Care Services in Public Health Systems: A Study about Willingness to Pay (WTP) for Nursing Consultations

BACKGROUND: Identifying the economic value assigned by users to a particular health service is of principal interest in planning the service. The aim of this study was to evaluate the perception of economic value of nursing consultation in primary care (PC) by its users. METHODS AND RESULTS: Economic study using contingent valuation methodology. A total of 662 users of nursing consultation from 23 health centers were included. Data on demographic and socioeconomic characteristics, health needs, pattern of usage, and satisfaction with provided service were compiled. The validity of the response was evaluated by an explanatory mixed-effects multilevel model in order to assess the factors associated with the response according to the welfare theory. Response reliability was also evaluated. Subjects included in the study indicated an average Willingness to Pay (WTP) of €14.4 (CI 95%: €13.2–15.5; median €10) and an average Willingness to Accept [Compensation] (WTA) of €20.9 (CI 95%: €19.6–22.2; median €20). Average area income, personal income, consultation duration, home visit, and education level correlated with greater WTP. Women and older subjects showed lower WTP. Fixed parameters explained 8.41% of the residual variability, and response clustering in different health centers explained 4–6% of the total variability. The influence of income on WTP was different in each center. The responses for WTP and WTA in a subgroup of subjects were consistent when reassessed after 2 weeks (intraclass correlation coefficients 0.952 and 0.893, respectively). CONCLUSIONS: The economic value of nursing services provided within PC in a public health system is clearly perceived by its user. The perception of this value is influenced by socioeconomic and demographic characteristics of the subjects and their environment, and by the unique characteristics of the evaluated service. The method of contingent valuation is useful for making explicit this perception of value of health services

Seroconvertion to hepatitis B vaccine after weight reduction in obese non-responder Soroconversão à vacina contra hepatite B após redução de peso em obeso não respondedor

Decreased responses to hepatitis B vaccine have been associated with some host conditions including obesity. Susceptible non-responders to a primary three-dose vaccine series should be revaccinated. Those who maintain a non-responder condition after revaccination with three vaccine doses are unlikely to develop protection using more doses. This is a description of an obese woman who received six doses of hepatitis B vaccine and persisted as a non-responder. She was submitted to a vertical banded gastroplasty Roux-en-Y gastric bypass Capellas's technique. After weight reduction, she received three additional doses of vaccine and seroconverted. Further studies should help clarify the need to evaluate antibody levels and eventually revaccinate the increasing population of individuals who undergo weight reduction.<br>A diminuição da resposta à vacinação contra hepatite B já foi relacionada a algumas condições clínicas, inclusive à obesidade. Indivíduos que não responderam à série de três doses devem ser revacinados. Caso continuem não-respondedores após duas séries de vacina, não há indicação de doses adicionais. Esta é a descrição de mulher obesa que não havia soroconvertido após ter recebido seis doses de vacina contra hepatite B. Ela foi submetida à gastroplastia em Y de Roux, pela técnica de Capella. Após a redução de peso, a paciente recebeu mais três doses de vacina contra hepatite B e soroconverteu. Novos estudos poderão indicar a necessidade de avaliação de níveis de anticorpos contra antígenos vacinais e eventualmente revacinar esta população cada vez maior de pacientes que se submetem à cirurgia para redução de peso