Gastos de bolsillo privado, gastos catastróficos y empobrecedores en salud

Este estudio propone calcular el gasto de bolsillo en salud (GB), la capacidad de pago del hogar (CP), el gasto catastrófico (GC) en Costa Rica para el año 2018 utilizando la encuesta de Ingresos y Gastos, y compara estos resultados con las encuestas previas de 2013 y 2004, utilizando la metodología propuesta por (Knaul et al., 2013). También se comparan los resultados con el indicador de SDG 3.8.2 para el 2018 que utiliza como CP el gasto total y un umbral de 10%. Se estiman los determinantes de la carga financiera en salud (GB/CP) utilizando modelos tobit, regresiones de cuantiles y modelos logit para estimar la probabilidad de tener un GC. Los resultados muestran que el gasto de bolsillo representan entre un 3-4% la capacidad de pago en 2018, y entre 2% y 3% en 2004. La composición del gasto de bolsillo se ha modificado, el gasto en medicamentos representa una mayor proporción del gasto en 2018 que en el 2004. El 1,01 % de los hogares experimentan un gasto catastrófico, en el 2018 cuando se utiliza el indicador de OMS y varia entre 2,04% y 0,71% para el 2018 utilizando diferentes definiciones de CP con un umbral de 30%. Si se utiliza el gasto total como CP el indicador es 6,54% con un umbral de 10 (indicador SDG 3.8.2). En general, los hogares con adultos mayores aumentan la carga financiera en salud y estar en los quintiles 3 al 5 aumenta la carga financiera en general. Sin embargo, el efecto de los quintiles de gasto no es robusto a la capacidad de pago para los hogares que experimentan un GC.UCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Instituto de Investigación en Ciencias Económicas (IICE

Modelo de educación a distancia para la enseñanza de la Ingeniería Agronómica en Costa Rica

Teaching in science is usually systematic, currently constructivist and, sometimes, to some extent pragmatic. To be more objective, models of science education are increasingly integrated, agronomy does not escape this condition. In Costa Rica, education in Agronomic Engineering or Agricultural Sciences is represented mostly in public universities, its model is "face-to-face" and is justified by the practical nature of learning, but its way of approaching the sector differs between them. The teaching of this discipline under the model of "Distance Education" also considers the theoretical foundations of Agronomy in the country but uses the different technological tools to achieve its learning objectives. The teacher gets to develop skills and abilities, as many as the same student who learns from him. As an educational model strategy, the Agronomic Engineering degree teaches with an expanded agriculture approach, which is competitive, equitable and sustainable, it is a more active participation; It also seeks the implementation of good educational practices, through Socratic methods that promote independent and critical thinking. The distance model in Agronomic Engineering does not mean learning only online, it also involves the presence and practice of the field, the teacher is a mediator of the learning and the student is responsible for their progress, in addition there is greater coordination and commitment in all academic activities during their professional training.La enseñanza en las ciencias suele ser sistemática, actualmente constructivista y, en ocasiones, hasta en cierta forma pragmática. Para ser más objetivos, los modelos de las enseñanzas en las ciencias cada vez se integran más, no escapa a esta condición la agronomía. En Costa Rica, la educación en Ingeniería Agronómica o en las Ciencias Agropecuarias se ve representada mayoritariamente en las universidades públicas, su modelo es "presencial" y se justifica por la naturaleza práctica en el aprendizaje, pero su forma de enfocar el sector difiere entre ellas. La enseñanza de esta disciplina bajo el modelo de "Educación a distancia" también toma en cuenta los fundamentos teóricos de la agronomía en el país, pero utiliza diferentes herramientas tecnológicas para lograr sus objetivos de aprendizaje. El profesorado llega a desarrollar habilidades y destrezas, tantas como el mismo estudiantado que aprende de este. Como estrategia del modelo educativo, la carrera de Ingeniería Agronómica enseña con un enfoque de agricultura ampliada, el cual es competitivo, equitativo y sostenible, es una participación más activa; también busca la implementación de buenas prácticas educativas, a través de métodos socráticos que promuevan el pensamiento independiente y crítico. El modelo a distancia en Ingeniería Agronómica no significa un aprendizaje solo en línea, implica también la presencialidad y práctica de campo, cada docente es mediador/a de los aprendizajes y cada estudiante responsable de sus avances, además de que hay mayor coordinación y compromiso en todas las actividades académicas durante su formación profesional

Las transferencias intergeneracionales en Costa Rica

artículo (arbitrado)--Universidad de Costa Rica, Instituto de Investigaciones en Salud (INISA), 2010En este artículo se presentan las estimaciones del sistema de transferencias intergeneracionales de Costa Rica para 1991 y 2004. Los resultados más destacados de este ejercicio permitieron advertir que el tramo de edades superavitarias del ciclo de vida económico es relativamente breve en el país y que a partir de los 55 años el ingreso laboral de los costarricenses se torna insuficiente para sufragar su consumo. En este sentido, el papel del gobierno es crucial en el financiamiento del déficit de las personas mayores, mientras que el de los niños y jóvenes depende en gran medida de las transferencias de los padres. Se observó también que las personas de edad no representan por lo general una carga para sus familias, sino que, por el contrario, realizan más transferencias de las que reciben, incluso a edades muy avanzadas. De hecho, el ingreso de activos y el ahorro son sorprendentemente elevados y aumentan con la edad, hasta alrededor de los 70 años.Al combinar estas estimaciones con las proyecciones de población, se concluye que el envejecimiento poblacional de Costa Rica no representará la catástrofe que se ha anunciado, aunque sí supondrá un reto para las finanzas públicas en un futuro próximo, especialmente para las áreas del gobierno a cargo de las pensiones y la salud. Los bonos demográficos que se derivarían de los datos expuestos y el análisis realizado implican la posibilidad de aumentar el bienestar de los costarricenses. El desafío entonces es implementar las medidas necesarias para que ese potencial se materialice.This article presents estimates for the system of intergenerational transfers in Costa Rica in 1991 and 2004. The main findings of this exercise were that the age range during which surplus income was generated in the economic life cycle was fairly short in the country and that from the age of 55 onward, the earnings of Costa Ricans became insufficient to meet their consumption needs. Accordingly, the role of government is crucial in financing this deficit for older people, while for children and the young it largely falls to parental transfers to meet this need. It was also noted that the elderly were not on the whole financially dependent on their families but, on the contrary, originated more transfers than they received, even at very advanced ages. Indeed, asset income and saving are surprisingly high and rise with age until 70 or so. Combining these estimates with population projections, the conclusion is that population ageing in Costa Rica will not be the disaster it has been predicted to be, although it will entail a challenge for the public finances before too long, particularly for those sections of government responsible for pensions and health care. The demographic dividend that can be expected in view of the data provided and the analysis carried out suggest that the well-being of Costa Ricans could actually increase. The challenge, then, is to implement the measures needed for this potential to materialize.Cet article présente les estimations du système de transferts intergénérationnels du Costa Rica pour 1991 et 2004. Les résultats les plus saillants de cet exercice ont permis de déterminer que la tranche d’âge excédentaire du cycle de vie économique est relativement brève dans le pays et qu’à partir de 55 ans, le revenu du travail des Costaricains devient insuffisant pour couvrir leur consommation. En ce sens, le rôle du gouvernement est fondamental pour financer le déficit des personnes âgées, alors que celui des enfants et des jeunes dépend, en grande partie, des transferts effectués par les parents. Une autre conclusion est que les personnes âgées ne représentent pas, d’une manière générale, une charge pour leur famille et que, bien au contraire, elles réalisent plus de transferts qu’elles n’en reçoivent, même à des âges très avancés. En fait, le revenu d’actifs et l’épargne sont extraordinairement élevés et augmentent avec l’âge, jusqu’à environ 70 ans. La combinaison entre ces estimations et les projections de population permet de conclure que le vieillissement de la population du Costa Rica ne sera pas aussi catastrophique que prévu, mais qu’il va représenter un défi pour les finances publiques dans un avenir proche, en particulier dans les domaines publics liés aux pensions et à la santé. Le bonus démographique dérivé des données exposées et l’analyse réalisée impliquent qu’il sera possible d’accroître le bien-être des Costaricains. L’enjeu consiste donc à mettre en oeuvre les mesures voulues pour que cette possibilité se matérialise.Universidad de Costa RicaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias de la Salud::Instituto de Investigaciones en Salud (INISA

Transfer accounts in Costa Rica’s mixed economy under rapidly changing demographic conditions

In Costa Rica government transfers to the elderly population are exceptionally high in per capita terms. In contrast, net transfers from adult children to elderly parents are negligible until the parents reach very advanced ages. Intragenerational reallocations are also a surprisingly large source of funding of consumption at old ages. The narrow age span with a labor income surplus, combined with the early age (55 years) at which Costa Ricans start having a labor income defi cit, is another peculiarity of this country.International Development Research Centre/[104231]//CanadaUCR::Vicerrectoría de Investigación::Unidades de Investigación::Ciencias Sociales::Centro Centroamericano de Población (CCP

Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries

Abstract Background Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). Methods We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Results Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62–7.69]; Mexico OR = 5.00 [95% CI: 3.41–7.32]; Honduras OR = 2.60 [95% CI: 1.42–4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21–7.23]; Mexico OR = 4.02 [95% CI: 2.77–5.82]; Honduras OR = 2.14 [95% CI: 1.26–3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. Conclusions Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services

Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries

Background: Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. Methods: We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. Results: Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. Conclusions: Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region

Missed Opportunities for Measles, Mumps, and Rubella (MMR) Immunization in Mesoamerica: Potential Impact on Coverage and Days at Risk

<div><p>Background</p><p>Recent outbreaks of measles in the Americas have received news and popular attention, noting the importance of vaccination to population health. To estimate the potential increase in immunization coverage and reduction in days at risk if every opportunity to vaccinate a child was used, we analyzed vaccination histories of children 11–59 months of age from large household surveys in Mesoamerica.</p><p>Methods</p><p>Our study included 22,234 children aged less than 59 months in El Salvador, Guatemala, Honduras, Mexico, Nicaragua, and Panama. Child vaccination cards were used to calculate coverage of measles, mumps, and rubella (MMR) and to compute the number of days lived at risk. A child had a missed opportunity for vaccination if their card indicated a visit for vaccinations at which the child was not caught up to schedule for MMR. A Cox proportional hazards model was used to compute the hazard ratio associated with the reduction in days at risk, accounting for missed opportunities.</p><p>Results</p><p>El Salvador had the highest proportion of children with a vaccine card (91.2%) while Nicaragua had the lowest (76.5%). Card MMR coverage ranged from 44.6% in Mexico to 79.6% in Honduras while potential coverage accounting for missed opportunities ranged from 70.8% in Nicaragua to 96.4% in El Salvador. Younger children were less likely to have a missed opportunity. In Panama, children from households with higher expenditure were more likely to have a missed opportunity for MMR vaccination compared to the poorest (OR 1.62, 95% CI: 1.06–2.47). In Nicaragua, compared to children of mothers with no education, children of mothers with primary education and secondary education were less likely to have a missed opportunity (OR 0.46, 95% CI: 0.24–0.88 and OR 0.25, 95% CI: 0.096–0.65, respectively). Mean days at risk for MMR ranged from 158 in Panama to 483 in Mexico while potential days at risk ranged from 92 in Panama to 239 in El Salvador.</p><p>Conclusions</p><p>Our study found high levels of missed opportunities for immunizing children in Mesoamerica. Our findings cause great concern, as they indicate that families are bringing their children to health facilities, but these children are not receiving all appropriate vaccinations during visits. This points to serious problems in current immunization practices and protocols in poor areas in Mesoamerica. Our study calls for programs to ensure that vaccines are available and that health professionals use every opportunity to vaccinate a child.</p></div

Descriptive characteristics comparing children with and without coverage for MMR at the time of the survey (% unless otherwise noted).

<p>† N varies by variable due to missing values.</p><p>* p<0.05</p><p>** p<0.01</p><p>*** p<0.001</p><p>Descriptive characteristics comparing children with and without coverage for MMR at the time of the survey (% unless otherwise noted).</p