Um bom texto

Made available in DSpace on 2015-03-16T14:13:53Z (GMT). No. of bitstreams: 2 CARVALHO_TRAVASSOS_COELI_BOM_TEXTO_2013.pdf: 34587 bytes, checksum: d1383d31288dfdacea320f1b6844e382 (MD5) license.txt: 1901 bytes, checksum: 5b151416ca540ee931d567773e47becf (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informações em Saúde. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil

Equity in the use of private hospitals contracted by a compulsory insurance scheme in the city of Rio de Janeiro, Brazil, in 1986.

The Brazilian Health Care System involves a large variety of sources of finance and methods of organising medical care. Inpatient care in the country is mainly financed by a compulsory insurance scheme - INAMPS. The most relevant providers of inpatient care for INAMPS are contracted private hospitals which are reimbursed on a prospective payment scheme. Hospitals' claims - AIH forms are processed by a central computer system. This study aimed to investigate inequalities in health care in Brazil - more specifically, to assess inequalities in the use of contracted private hospitals in the city of Rio de Janeiro in 1986. The main hypothesis was that contracted private hospitals would be treating selective groups within the population and that the pattern of use of these services would vary across social groups. This investigation was based on data originated from the AIH forms and a study was conducted to assess the reliability of these data. Contracted private hospitals were shown to treat a limited and selective share of the health care market in the city of Rio de Janeiro - split between the areas of maternity and geriatric care using low technology. Variations in the patterns of use between the social groups are discussed in relation to age and sex distribution, case-mix, process and outcome of care. The explanatory role of the social variable (payment status) was tested. Payment status was shown to be a significant variable in explaining variations in use between patients. The less prestigious social groups, such as the unemployed, appeared less likely to receive appropriate care. Variations between the payment groups could also be the result of supply-induced demand or even fraud

Comparison between two race/skin color classifications in relation to health-related outcomes in Brazil

<p>Abstract</p> <p>Background</p> <p>This paper aims to compare the classification of race/skin color based on the discrete categories used by the Demographic Census of the Brazilian Institute of Geography and Statistics (IBGE) and a skin color scale with values ranging from 1 (lighter skin) to 10 (darker skin), examining whether choosing one alternative or the other can influence measures of self-evaluation of health status, health care service utilization and discrimination in the health services.</p> <p>Methods</p> <p>This is a cross-sectional study based on data from the World Health Survey carried out in Brazil in 2003 with a sample of 5000 individuals older than 18 years. Similarities between the two classifications were evaluated by means of correspondence analysis. The effect of the two classifications on health outcomes was tested through logistic regression models for each sex, using age, educational level and ownership of consumer goods as covariables.</p> <p>Results</p> <p>Both measures of race/skin color represent the same race/skin color construct. The results show a tendency among Brazilians to classify their skin color in shades closer to the center of the color gradient. Women tend to classify their race/skin color as a little lighter than men in the skin color scale, an effect not observed when IBGE categories are used. With regard to health and health care utilization, race/skin color was not relevant in explaining any of them, regardless of the race/skin color classification. Lack of money and social class were the most prevalent reasons for discrimination in healthcare reported in the survey, suggesting that in Brazil the discussion about discrimination in the health care must not be restricted to racial discrimination and should also consider class-based discrimination. The study shows that the differences of the two classifications of race/skin color are small. However, the interval scale measure appeared to increase the freedom of choice of the respondent.</p

Independência editorial

Made available in DSpace on 2015-03-16T14:13:51Z (GMT). No. of bitstreams: 2 CARVALHO_TRAVASSOS_COELI_INDEPENDENCIA_EDITORIAL_2013.pdf: 37986 bytes, checksum: 5dc869a420cb93a30a6f4c8817a2b51d (MD5) license.txt: 1901 bytes, checksum: 5b151416ca540ee931d567773e47becf (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Laboratório de Informações em Saúde. Rio de Janeiro, RJ, Brasil.Universidade Federal do Rio de Janeiro. Instituto de Estudos em Saúde Coletiva. Rio de Janeiro, RJ, Brasil

The financial relevance of adverse events in hospitals in Brazil

RESUMO - Objetivo: Estimar o volume de recursos financeiros gastos com pacientes com Eventos Adversos em hospitais no Brasil, utilizando informações financeiras disponíveis no Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH-SUS). Metodologia: Estudo descritivo e exploratório sobre a magnitude financeira associada à ocorrência de EAs em hospitais no Brasil. As fontes de dados empregadas foram: informações coletadas no estudo de incidência de EA em hospitais no Brasil (estudo de base) e informações registradas no SIH-SUS. Essas fontes de dados foram encadeadas (linkage). O universo de estudo foram os pacientes internados em dois hospitais públicos de ensino do estado do Rio de Janeiro em 2003. Selecionou-se uma amostra aleatória simples de 622 prontuários de pacientes. Para estimar os custos dos eventos adversos, foram analisados os dias adicionais decorrentes dos EAs avaliados pelos médicos revisores, o tempo de permanência e as informações financeiras do SIH-SUS. Resultados: Nos prontuários de pacientes analisados, 583 pacientes não sofreram EA e 39 (6,3 %) sofreram algum EA. Do total de casos com EA, 25 foram considerados evitáveis (64,1 %). O valor médio pago (R$3.195,42) pelo atendimento aos pacientes com EA foi 200,5 pacientes com EA evitável (R$1.270,47) foi apenas 19,5 % superior ao valor médio pago aos pacientes sem EA. Já o observado para os pacientes com EA não evitável (R$6.632,84) foi 523,8 tempo médio de permanência no hospital 28,3 dias superior ao observado nos pacientes sem EA. Extrapolados para o total de internações nos dois hospitais, os eventos adversos implicaram no gasto de R$ 1.212.363,30, que representou 2,7 % do reembolso total. Conclusão: O estudo mostrou que os danos ao paciente decorrentes do cuidado à saúde têm expressivo impacto nos gastos hospitalares e apontou várias razões para supor que os resultados apresentados estejam subestimados. Apesar de ser um estudo exploratório, mostrou que a importância financeira da ocorrência de eventos adversos, que, em parte, implicam em dispêndio de recursos desnecessários que poderiam ser utilizados para financiar outras necessidades de saúde da população.ABSTRACT - Aim: To estimate how much is spent on patients suffering Adverse Events (AEs) in hospitals in Brazil, using financial information available in the National Health Service Hospital Information System (SIH-SUS). Methodology: Exploratory descriptive study of total expenditure associated with occurrence of AEs in hospitals in Brazil. The data sources used were information collected in incidence studies of AEs in hospitals (baseline study) and information recorded in the SIH-SUS. These sources were then linked. The study population was inpatients at public teaching hospitals in Rio de Janeiro State in 2003. A simple random sample of 622 patient records was selected. The costs associated with adverse events were estimated from the additional days stay resulting from AEs established by medical review, length of hospital stay and financial data from the SIH-SUS. Results: The patient records showed that 583 patients had not suffered and 39 (6.3 %) had suffered an AE. Of the total number of cases of AE, 25 (64.1 %) were considered to have been avoidable. The mean amount paid (R$3,195.42) for care to patients with AE was 200.5 higher than the amount paid for patients with no AE, while the mean amount paid to patients with avoidable AE (R$1,270.47) was only 19.5 % higher than the mean amount paid to patients with no AE. Meanwhile the amount paid to patients with an unavoidable AE (R$6,632.84) was 523.8 hospital stay among patients with an AE was 28.3 days longer than among patients with no AE. When extrapolated to total admissions at the two hospitals, AEs entailed expenditure of R$ 1,212,363.30, representing 2.7 % of total reimbursements. Conclusion: The study showed that health care-related patient harm has substantial impact on hospital expenditures and pointed to various reasons for believing the results to be understated. Although this was an exploratory study, it showed the financial significance of the occurrence of adverse events, which in part entail unnecessary expenditure of funds that could be used to finance other health needs.info:eu-repo/semantics/publishedVersio

Produção de serviços e qualidade da assistência hospitalar no Estado do Rio de Janeiro, Brasil - 1992 a 1995

INTRODUCTION: Recent trends in hospital care in the Stade of Rio de Janeiro, Brazil, are analysed. The data are taken from the Unified Health Care System (SUS) and cover monthly obsevations between January 1992 and October 1995 for the public, teaching and private hospital subsectors. METHODOLOGY: The data entries are based on hospital declarations on the AIH form, processed by the National Inpatient Information System (SIH-SUS). When comparing the three subsectors, production of services and outcome were examined particularly closely. Comparisons are made using structural models for time series based on the break-down of a time series into components of interest, such as trend, seasonal variation and irregularity. RESULTS: The analysis shows a significant downward trend in the frequency of hospital admissions in the State of Rio de Janeiro, probably reflecting the deliberate withdraw of financial investments in this sector, which began in 1993. This reduction was selective with regard to age group distribution - being greater in the adult and elderly groups. The analysis has also shown that the teaching sector has steadilly raised its admissions. The quality of care was analysed through the sentinel event approach. For the State of Rio de Janeiro as a whole, the occurrence of avoidable deaths during the hospital admission process shows a weak overall tendency to decline as detected by the reduction of this kind of death in the private sub-sector. In public and teaching hospitals the frequency of avoidable deaths has remained stable. The frequency of maternal deaths has remained high and stable, while the number of caesarean sections shows a significant increase, despite the high figures observed at the beginning of the period. CONCLUSIONS: The results of this study indicate an overall decline in the quality of health care offered by the SUS within the Rio de Janeiro State. Regardless of the existing limitations in SIH-SUS, this study has shown this to be a useful instrument for monitoring hospital care services.INTRODUÇÃO: Objetivou-se analisar as tendência recentes na assistência hospitalar no Estado do Rio de Janeiro. Os dados originam-se da prestação mensal de serviços dos subsetores, universitários e privado, credenciados ao Sistema Único de Saúde (SUS), entre janeiro de 1992 e outubro de 1995. METODOLOGIA: Foram utilizadas as informações registradas nos formulários de Autorização de Internação Hospitalar, processadas pelo Sistema de Informações Hospitalares do SUS (SIH-SUS). A análise comparativa dos três subsetores centrou-se na produção dos serviços e resultados. Tais comparações foram realizadas utilizando-se modelos estruturais de séries temporais, que se baseiam na decomposição de componentes de interesse, como tendência, sazonalidade e irregularidade. RESULTADOS: A freqüência de internações no Estado tendeu ao declínio, em decorrência especialmente da retração do subsetor público a partir de 1993. Essa redução foi seletiva &#151; no que se refere à distribuição por faixas etárias &#151; concentrando-se nos adultos e idosos. Somente o subsetor universitário aumentou gradativamente o volume de admissões. A qualidade da assistência foi avaliada por meio da abordagem de eventos-sentinelas. A ocorrência de óbitos evitáveis nas internações no Estado apresentou discreta tendência ao declínio, detectada pela sua redução no subsetor privado. Nos subsetores público e universitário, a freqüência dos óbitos evitáveis manteve-se estável. A ocorrência de óbitos maternos no Estado permaneceu alta e estável, enquanto os índices de cesárea revelaram significativo crescimento, apesar de já ter sido observado, desde o início do período, valores bastante altos. CONCLUSÕES: Há problemas sérios na qualidade da atenção hospitalar prestada pelo SUS, no Estado, os quais, a julgar pela situação apresentada nos indicadores utilizados, vêm se agravado. Embora exiba limitações, o banco de dados do SIH-SUS mostrou ser instrumento útil para o monitoramento dos serviços hospitalares

Psychometric evaluation of the SF-36 (v.2) questionnaire in a probability sample of Brazilian households: results of the survey Pesquisa Dimensões Sociais das Desigualdades (PDSD), Brazil, 2008

<p>Abstract</p> <p>Background</p> <p>In Brazil, despite the growing use of SF-36 in different research environments, most of the psychometric evaluation of the translated questionnaire was from studies with samples of patients. The purpose of this paper is to examine if the Brazilian version of SF-36 satisfies scaling assumptions, reliability and validity required for valid interpretation of the SF-36 summated ratings scales in the general population.</p> <p>Methods</p> <p>12,423 individuals and their spouses living in 8,048 households were selected from a stratified sample of all permanent households along the country to be interviewed using the Brazilian SF-36 (version 2). Psychometric tests were performed to evaluate the scaling assumptions based on IQOLA methodology.</p> <p>Results</p> <p>Data quality was satisfactory with questionnaire completion rate of 100%. The ordering of the item means within scales clustered as hypothesized. All item-scale correlations exceeded the suggested criteria for reliability with success rate of 100% and low floor and ceiling effects. All scales reached the criteria for group comparison and factor analysis identified two principal components that jointly accounted for 67.5% of the total variance. Role emotional and vitality were strongly correlated with physical and mental components, respectively, while social functioning was moderately correlated with both components. Role physical and mental health scales were, respectively, the most valid measures of the physical and mental health component. In the comparisons between groups that differed by the presence or absence of depression, subjects who reported having the disease had lower mean scores in all scales and mental health scale discriminated best between the two groups. Among those healthy and with one, two or three and more chronic illness, the average scores were inverted related to the number of diseases. Body pain, general health and vitality were the most discriminating scales between healthy and diseased groups. Higher scores were associated with individuals of male sex, age below 40 years old and high schooling.</p> <p>Conclusions</p> <p>The Brazilian version of SF-36 performed well and the findings suggested that it is a reliable and valid measure of health related quality of life among the general population as well as a promising measure for research on health inequalities in Brazil.</p