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INTRODUCTION: Self-perceived health reported by older adults is a tool of great importance for the health care system as it provides an indicator representing physical, cognitive, and emotional aspects of health. OBJECTIVE: To report how a group of older adults covered by a health insurance plan evaluate their self-perceived health and which variables influence their perception. METHODS: This quantitative cross-sectional study included 148 older adults living in the city of São Paulo, Brazil, in 2017. The study variables were sex, age, marital status, performance in basic activities of daily living and instrumental activities of daily living, sleep quality, leisure activity, number of diseases, and use of continuous medication. Statistical analysis was performed using Student's t-test, χ2 test, or Fisher's exact test, and logistic regression was used. RESULTS: Significant relationships were observed between poor self-perceived health and the following variables: being female, polypharmacy, number of diseases, sleep quality, and performance in instrumental activities of daily living. Dependence on the instrumental activities of daily living made these older adults 5.33 times more likely to have poor self-perceived health. Each comorbidity added to the health status of this group increased the chance of poor self-perceived health by 1.39 times. CONCLUSION: Self-perceived health in this group of older adults is influenced by several variables; however, degree of dependence and number of diseases were those with the greatest impact.

OBJECTIVE: To verify the association of sociodemographic and clinical variables to different levels of physical activity in older adults enrolled in a health insurance plan in Brazil. METHODS: A quantitative cross-sectional study was conducted on a sample of 361 older adults enrolled in a health insurance plan in the city of São Paulo, SP, Brazil. Levels of physical activity were measured using the International Physical Activity Questionnaire (IPAQ), which has been translated, adapted and validated for use in Brazilian geriatric populations. Sociodemographic characteristics, functional capacity for activities of daily living, cognitive function, depressive symptoms, risk of falls, self-perceived health and nutritional status were also evaluated. Results were analyzed using descriptive methods followed by ANOVA and Chi-Square tests. When homogeneity of variances was violated, the Brown-Forsythe test was used, followed by Dunnett's test for multiple comparisons. RESULTS: Low levels of physical activity were reported by 63.3% of participants, with only 5.6% practicing vigorous physical activity. In this sample, variables such as positive self-perceived health (p = 0.032), adequate sleep without medication (p = 0.020) and independence for activities of daily living (p < 0.001) were positively associated with higher levels of physical activity. Advanced age (p < 0.001), cognitive decline (p < 0.001), depressive symptoms (p < 0.001) and mobility impairments (p < 0.001) were associated with low levels of physical activity. CONCLUSION: Demographic and clinical variables displayed positive and negative associations with different levels of physical activity in older adults receiving health insurance plans.

Based on literature analysis, the paper systematically summarizes the development history, grouping and payment mode of the Home Health Prospective Payment System (HHPPS) in the United States. The HHPPS has developed three versions since its establishment, and the grouping results are more refined and scientific, from the initial 80 home health resource groups to 432 home health resource groups. This method can effectively control expenses, but it requires a large amount of home health care data, scientific and complete expense settlement system and medical record management system. There are still some difficulties in the promotion and implementation in our country at this stage. Our country should learn from the HHPPS of the American, establish a unified and standardized evaluation system, develop and improve the home medical service information collection system, promote the development of home care services in various aspects, and finally realize the establishment of a scientific and effective payment model, so as to enable the sustainable development of home care service.

Background: The use of potentially inappropriate medications (PIM) by the elderly is commonly studied, but studies evaluating the use of PIM by frail elderly covered by prepaid health plans are still lacking. Objective: To identify the prevalence of use and the factors associated with the use of PIM by the elderly patients with high and moderate risk of clinical-functional vulnerability, according to the Beers criteria 2019. Methods: A cross-sectional study was developed with elderly people from a private health plan in Vitória-ES, Brazil. Socioeconomic, demographic and clinical data were collected through a digital platform and a structured questionnaire through an interview, from October 2018 to June 2019. The association between the use of PIM and independent variables was verified by univariate logistic regression with their respective confidence intervals (CI) 95%. The Multiple Model included the variables with P ≤.20. Results: 332 elderly patients were interviewed (mean age 81.5 years, gender 237 female, 95 male). A 65% prevalence of PIM use was identified. In the multiple logistic regression model, the variables associated with the use of PIM were self-medication (P =.004), high risk of clinical-functional vulnerability (P =.022), use of psychotropic medications (P =.000001), musculoskeletal medications (P =.04) and alimentary tract medications (P =.03). Physical exercises were considered a protection factor (P =.02). Conclusion: The high prevalence of PIM use indicates the need for improvement in elderly private health care, to increase pharmacotherapy safety for this population. [ABSTRACT FROM AUTHOR]

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Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives. To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities. Methods. We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors. Results. We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively. Conclusions. Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies. [ABSTRACT FROM AUTHOR]

To synthesize knowledge about the incorporation of initiatives based on Primary Health Care by the Brazilian Supplementary Health sector. This is an integrative review, which followed six phases: elaboration of the guiding question, literature search, data collection, critical analysis of the articles, discussion, and synthesis. Brazilian publications were searched, in the SciELO, Pubmed, CAPES Periodicals, EBSCOHost, and Google Scholar databases, between 2009 and 2019. 22 publications were analyzed. The articles were about concepts and experiences of Primary Care by private health plan operators. The results point to more effective management with greater beneficiary satisfaction. The resistance of specialist physicians, lack of professional qualification, political motivation, and cultural bias constitute obstacles to this care reorganization. The Primary Care model impacts both the quality of health services and the economic sustainability of the Supplementary Health sector, providing users with comprehensive care, disease prevention, and health promotion. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Salud Pública is the property of Universidad Nacional de Colombia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

This paper aims to analyze the relationship between the cost of health care and the aging of the population assisted by a self-managed plan, reflecting on the ways to address the challenge arising from this conjunction of population demographic changes. This is a descriptive study of the 1997-2016 period based on secondary data from the management operator of the health plan under study and from another administrative database of a self-managing provider with broad nationwide coverage. Older adults (over 60 years) increased 55% during the study period. On the other hand, the so-called "very old" (over 80 years) grew 332.8%. The population above 60 years corresponds to 25.7% of the total, and accounts for 68.8% of expenses. Most of the population covered (84,6%) is located in the State of Rio de Janeiro, which has the highest per capita health care cost in Brazil. We found a relationship between aging of the beneficiary population and increased expenditure. It is imperative to invest in health promotion and disease prevention initiatives as a way of improving the quality of life and financial sustainability of the plan, and define a subsystem that delimits and regulates access to the network and is accepted by the beneficiaries. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

ABSTRACT OBJECTIVE To quantify the household expenditure per capita and to estimate the percentage of Brazilian households that have spent with dental insurance. METHODS We analyzed data from 55,970 households that participated in the research Pesquisa de Orçamentos Familiares in 2008–2009. We have analyzed the annual household expenditure per capita with dental insurance (business and private) according to the Brazilian states and the socioeconomic and demographic characteristics of the households (sex, age, race, and educational level of the head of the household, family income, and presence of an older adult in the household). RESULTS Only 2.5% of Brazilian households have reported spending on dental insurance. The amount spent per capita amounted to R$5.10 on average, most of which consisted of private dental insurance (R$4.70). Among the characteristics of the household, higher educational level and income were associated with higher spending. São Paulo was the state with the highest household expenditure per capita (R$10.90) and with the highest prevalence of households with expenditures (4.6%), while Amazonas and Tocantins had the lowest values, in which both spent less than R$1.00 and had a prevalence of less than 0.1% of households, respectively. CONCLUSIONS Only a small portion of the Brazilian households has dental insurance expenditure. The market for supplementary dentistry in oral health care covers a restricted portion of the Brazilian population.

This paper discusses part of the results obtained from a study carried out in two cities of the so-called ABCD Paulista Region in the period 2010-2012, in an attempt to spot the existence of non-state regulatory rationale towards access and consumption of health care services. The first stage includes interviews carried out with strategic stakeholders (managers and politicians) and key workers players. The second stage collected the stories of 18 very frequent users of health care services. This study revealed the leading role played by users to produce "health care maps", with emphasis on the frequent use of public and private resources in their itineraries, circumventing or merging with government regulation to obtain the care they need. The different formats of public- private mix transcend the still prevailing "official" concepts about the clear distinction between the two systems, which reveals the importance of this theme to public health management. [ABSTRACT FROM AUTHOR]

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

O objetivo deste trabalho é caracterizar a cobertura de planos privados de saúde segundo a inserção dos indivíduos no mercado de trabalho brasileiro. Considerando as informações sobre status de cobertura de plano de saúde e inserção no mercado de trabalho, foram definidos grupos homogêneos de trabalhadores. Para construção da tipologia, recorre-se ao método Grade of Membership (GoM) - ou Grau de Pertencimento, utilizando a Pesquisa Nacional de Amostra de Domicílios (PNAD) referente aos anos de 1998 e 2003, que apresentam suplemento de saúde. Cinco perfis de indivíduos foram definidos. As variáveis-chave para denominação dos grupos são: grau de cobertura de planos de saúde, condição de atividade e escolaridade do indivíduo. Os achados revelam relação positiva entre cobertura de plano, rendimento do trabalho e, em alguma medida, sindicalização.This paper aims to describe health insurance coverage among different types of workers in Brazil. Health insurance coverage and labor market insertion are used to define homogeneous groups of workers. The Grade of Membership method is used to build a typology of workers. The database was the Brazilian National Household Survey (PNAD) for 1998 and 2003, including a health survey. Five worker profiles were defined. The key variables were: health insurance coverage, schooling, and work status. The main findings show a positive association between health insurance coverage, income from work, and trade union membership.

This paper analyzes the relationship between the financial health and organizational form of private health care providers in Brazil. It also examines the major determinants of customer satisfaction associated with the provider's organ-izational form. An adjusted Altman's z-score is used as an indicator of financial health. A proxy variable based on customer complaints filed at the Brazilian National Agency for Supplementary Health is used as an indicator for customer satisfaction. The study uses a sample of 270 private health care providers and their operations over the period 2003-2005. Panel data analysis includes control variables related to market, operations, and management. Principal results indicate that: (1) private health care providers benefit from economies of scale; (2) self-funded health plans have better financial health; (3) spending on marketing does not have a signif-icant impact on customer satisfaction in Brazil; (4) weak empirical evidence exists showing that good financial performance enhances customer's satisfaction.Este artigo analisa a situação financeira das operadoras de saúde suplementar no Brasil, de acordo com a modalidade de gestão. Adicionalmente, examina os principais determinantes para a satisfação do consumidor desses serviços. Como indicador principal de saúde financeira, utiliza-se uma versão adaptada do z-score de Altman. A proxy para satisfação do consumidor é o nível de reclamações fundamentadas registradas junto à Agência Nacional de Saúde Suplementar. Utilizamos uma amostra de 270 operadoras de saúde suplementar para o período 2003-2005, e regressões de dados em painel, com variáveis de controle de mercado, operacionais e de gestão. Os resultados principais indicam que (1) as operadoras de saúde se beneficiam de economias de escala; (2) as empresas que operam no modelo de autogestão têm situação financeira melhor que as demais; (3) as despesas com marketing não impactam a satisfação dos consumidores dos planos de saúde; (4) finalmente, encontra-se também alguma evidência empírica indicando que a boa situação financeira implica maior satisfação do consumidor.

A grande quantidade de reclamações dos consumidores de planos e seguros privados de saúde se tornou freqüente no setor suplementar, com reflexos sobre o Poder Judiciário. Essa problemática fez surgir a necessidade de regulação desse mercado privado, que se iniciou em 1998, por meio da Lei nº. 9.656. Um dos desafios que a Agência Nacional de Saúde Suplementar (ANS) enfrenta é a resistência das operadoras perante a legislação, além do fato de ainda existirem contratos não regidos pela referida lei. O objetivo do estudo foi analisar recursos de decisões judiciais que concederam ou não o pedido liminar da antecipação da tutela solicitado pelo consumidor de plano de saúde, julgados nos Tribunais de Justiça do Rio de Janeiro e de São Paulo. Os principais dados pesquisados foram: Tribunal que proferiu a decisão; réu; tema debatido; posicionamento de 1ª e de 2ª Instâncias e fundamentação jurídica. Verifica-se que o Poder Judiciário continua sendo um importante espaço de reivindicação dos consumidores de planos de saúde. O papel da ANS é importante para preencher algumas lacunas que ainda não foram solucionadas pela regulação do setor.Consumer complaints against private health insurance plans and companies in Brazil have become increasingly frequent in the country's "supplementary" (non-public) health care sector, with numerous cases reaching the courts. The problem raised the need for regulation of this private market, which began in 1998, through Law no. 9.656. One of the challenges faced by the National Agency for Supplementary Health Care (ANS) is resistance to the legislation by health insurance companies, besides the fact that there are still some contracts not covered by this law. The objective of the current study was to analyze health insurance policyholders' appeals against court rulings for or against injunctions concerning coverage, in cases heard by the courts in Rio de Janeiro and São Paulo. The main data investigated were: court issuing the ruling; defendant; basis for the case; ruling by the Circuit Court and Court of Appeals; and the legal arguments. Based on the findings, the Brazilian court system still plays an important role in hearing and ruling on complaints by health insurance policyholders. The ANS has an important role in filling some gaps that have still not been solved in regulating the health insurance industry.

Com o objetivo de determinar a prevalência de dor lombar nos últimos três meses e fatores associados foi realizado um estudo transversal, com indivíduos de ambos os sexos, de 20 a 59 anos titulares do plano de saúde da COOPERSINOS da Universidade do Vale do Rio dos Sinos. Foram utilizados questionários auto-aplicados incluindo questões demográficas, sócio-econômicas, ocupacionais e hábitos de vida. Entre os 775 indivíduos a prevalência de dor lombar no último ano foi de 52,8% (IC95%: 49,3-56,3) e nos últimos três meses foi de 46% (IC95%: 42,5-49,5). Através de regressão de Poisson foram encontradas associações para dor lombar nos últimos três meses nos indivíduos de 40 a 49 anos, naqueles que consideravam seu trabalho penoso e nos fumantes. Apesar da elevada prevalência de dor lombar na população estudada e de ter provocado dificuldades no desempenho das atividades laborais, a condição não foi incapacitante. Mesmo que 29,9% dos trabalhadores tenham referido dificuldades para realizar suas atividades de vida diária ou no trabalho por dor lombar, detectou-se absenteísmo muito baixo.A cross-sectional study was conducted with individuals of both sexes (20-59 years of age), all covered by the COOPERSINOS Health Care Plan of Vale do Rio dos Sinos University. The study aimed to determine the prevalence of lower back pain and associated factors in the previous three months. A self-applied questionnaire included socioeconomic, demographic, occupational, and lifestyle questions. Prevalence of lower back pain among the 775 individuals was 52.8% in the previous year (95%CI: 49.3-56.3) and 46% in the previous three months (95%CI: 42.5-49.5). Poisson regression for lower back pain in the previous 90 days showed an association with: (1) age 40-49 years; (2) self-reported strenuous or difficult work; and (3) smoking. Despite the high prevalence of lower back pain and difficulty in performing work activities, the pain was not disabling. Although 29.9% of workers reported some difficulty in performing their daily or work-related activities due to lower back pain, absenteeism was quite low.

O artigo reconstrói a disputa travada entre os principais atores sociais interessados diretamente no processo de regulamentação da saúde suplementar no Brasil, no período imediatamente anterior à edição da Lei nº. 9.656/98, destacando convergências e divergências destes atores em relação a 28 temas centrais para a configuração do arcabouço regulatório vigente no Brasil desde 1998. O material utilizado para a descrição e sistematização das posições em disputa no processo regulatório resultou de um estudo empírico, descritivo, de natureza comparativo-contrastante, baseado em análise documental e entrevistas com atores-chave. O estudo sistematiza os principais pontos de polêmica e/ou consenso entre os vários atores, destacando, em particular, as muitas convergências das propostas das entidades médicas com aquelas defendidas pelas organizações de usuários e pelos institutos de defesa dos consumidores, apontando para a possibilidade de construção de um bloco ético-político compromissado com a defesa de uma melhor qualificação da assistência, em contraposição a uma lógica meramente de mercado.This paper reconstructs the dispute between the main social actors with direct interests in the regulation of private health care in Brazil during the period immediately prior to the passage of Act 9.656/98, highlighting the divergences between these actors in relation to 28 central topics for shaping the regulatory framework prevailing in the country since 1998. The material used in the description and systematization of the positions in the regulatory dispute resulted from an empirical, descriptive, comparative study based on document analysis and interviews with key actors. The study systematizes the main points of controversy and consensus among the various actors, particularly highlighting the many points of agreement between proposals by medical organizations and those of users' organizations and consumer defense institutes, thereby suggesting the possibility of establishing an ethical and political bloc committed to the defense of improved health care as opposed to sheer market logic.

OBJETIVO: Descrever o desempenho gerencial de hospitais filantrópicos com operadoras de planos de saúde em comparação com o conjunto de hospitais filantrópicos no Brasil. MÉTODOS: Foram comparadas as estruturas gerenciais presentes nos hospitais filantrópicos com operadoras próprias de planos de saúde com aquelas observadas num conjunto representativo do setor hospitalar filantrópico, em seis dimensões: direção e planejamento, econômico-financeira, recursos humanos, serviços técnicos, serviços logísticos e tecnologia de informações. Consideraram-se os dados de uma amostra aleatória de 69 hospitais, extraída do setor hospitalar filantrópico, e 94 hospitais filantrópicos com operadoras próprias de planos de saúde. Nos dois casos incluíram-se apenas os hospitais com menos de 599 leitos. RESULTADOS: Foram identificados resultados mais positivos para o conjunto de hospitais com operadoras próprias de planos de saúde em todas as dimensões gerenciais comparadas. Em particular, destacaram-se as dimensões econômico-financeira e de tecnologia de informações, nas quais mais de 50% dos hospitais com operadoras apresentaram quase todas as condições consideradas. CONCLUSÕES: O setor hospitalar filantrópico é importante na prestação de serviços ao Sistema Único de Saúde. Os desafios para a sua manutenção e desenvolvimento impõem encontrar alternativas. O fomento de uma parceria público-privado neste segmento, por meio da operação de planos próprios ou prestação de serviços a outros planos de saúde convivendo com o SUS, constitui um campo que merece uma análise mais aprofundada.OBJECTIVE: To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS: The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS: The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS: The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.

Background: Preauthorisation is a control mechanism that is used by Health Insurance Providers (HIPs) to minimise wastage of resources through the denial of the procedures that were unduly requested. However, an efficient preauthorisation process requires the round-the-clock presence of a preauthorisation reviewer, which increases the operating expenses of the HIP. In this context, the aim of this study was to learn the preauthorisation process using the dental set from an existing database of a non-profit HIP.Methods: Pre-processing data techniques as filtering algorithms, random under-sample and imputation were used to mitigate problems that arise from the selection of relevant attributes, class balancing and filling unknown data. The performance of classifiers Random Tree, Naive bayes, Support Vector Machine and Nearest Neighbor was evaluated according to kappa index and the best classifiers were combined by using ensembles.Results: The number of attributes were reduced from 164 to 15 and also were created 12 new attributes from existing discrete data associated with the beneficiary's history. The final result was the development of a decision support mechanism that yielded hit rates above 96%.Conclusions: It is possible to create a tool based on computational intelligence techniques to evaluate the requests of test/procedure with a high accuracy. This tool can be used to support the activities of the professionals and automatically evaluate less complex cases, like requests not involving risk to the life of patients. [ABSTRACT FROM AUTHOR]

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Introduction: This article describes a case study which aimed to explore the association between health promotion actions and the prevention of cardiovascular diseases (CD). These actions were developed by a Brazilian health maintenance organization that has adopted the Family Health Strategy and the use of health services and their related costs. Methods: The method involved the selection of beneficiaries from two capitals, aged 30 years or older, who subscribed until Dec 31, 2004. A description of the demographic profile and risk factors for CD was performed, as well as an evaluation of the profile of use of services and their corresponding costs between 2004 and 2007. Results: There was a reduction in the average number of appointments per beneficiary and in the average cost of these appointments. There was an increase in the number of exams per capita, increasing assistance costs. In Curitiba, there was an increase in the average number of hospitalizations per beneficiary and in their average cost, whereas in Goiania a reduction of such numbers was observed. Conclusion: Considering that approximately 25% of the Brazilian population is currently covered by health maintenance organizations, it is important to encourage the adoption of these programs, in agreement with the policies undertaken by the Ministry of Health, in addition to evaluating the use of health services and the outcomes in the health of individuals. [ABSTRACT FROM AUTHOR]

Objective: To identify the financial resources and investments provided for preventive medicine programs by health insurance companies of all kinds. Methods: Data were collected from 30 large health insurance companies, with over 100 thousand individuals recorded, and registered at the Ag ência Nacional de Saúde Suplementar. Results: It was possible to identify the percentage of participants of the programs in relation to the total number of beneficiaries of the health insurance companies, the prevention and promotion actions held in preventive medicine programs, the inclusion criteria for the programs, as well as the evaluation of human resources and organizational structure of the preventive medicine programs. Conclusion: Most of the respondents (46.7%) invested more than US$ 50,000.00 in preventive medicine program, while 26.7% invested more than US$ 500,000.00. The remaining, about 20%, invested less than US$ 50,000.00, and 3.3% did not report the value applied. [ABSTRACT FROM AUTHOR]

The objective of this study was to estimate catastrophic healthcare expenditure in Brazil, using different definitions, and to identify vulnerability indicators. Data from the 2002-2003 Brazilian Household Budget Survey were used to derive total household consumption, health expenditure and household income. Socioeconomic position was defined by quintiles of the National Economic Indicator using reference cut-off points for the country. Analysis was restricted to urban households. Catastrophic health expenditure was defined as expenditure in excess of 10% and 20% of total household consumption, and in excess of 40% of household capacity to pay. Catastrophic health expenditure varied from 2% to 16%, depending on the definition. For most definitions, it was highest among the poorer. The highest proportions of catastrophic health expenditure were found to be in the Central region of Brazil, while the South and the Southeast had the lowest. Presence of an elderly person, health insurance and socioeconomic position were associated with the outcome, and coverage by health insurance did not protect from catastrophic health expenditure.O objetivo deste trabalho foi estimar o gasto catastrófico em saúde no Brasil e identificar indicadores de vulnerabilidade. Dados da Pesquisa de Orçamentos Familiares 2002-2003 foram utilizados para derivar consumo domiciliar total, despesa com saúde e renda domiciliar. Posição socioeconômica foi definida por meio de quintis do Indicador Econômico Nacional, usando pontos de corte de referência para o país. A análise se restringiu a domicílios urbanos. Gasto catastrófico em saúde foi definido como o gasto além de 10% e 20% do consumo domiciliar total e além de 40% da capacidade de pagar. Estimativas do gasto catastrófico em saúde variaram de 2% a 16%, dependendo da definição. Para a maioria delas, ele foi mais alto entre os pobres. A Região Centro-oeste apresentou as maiores proporções de gasto catastrófico em saúde, enquanto que o Sul e o Sudeste apresentaram as mais baixas. Presença de um idoso, plano privado de saúde e posição socioeconômica se associaram com o desfecho, sendo que a cobertura por plano de saúde não protegeu contra o gasto catastrófico em saúde.

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OBJECTIVE: To analyze clinical outcomes of patients on hemodialysis linked to health care plan provider METHODS: Cohort study of hemodialysis events in Belo Horizonte, MG, Southeastern Brazil, between 2004 and 2008, based on records from health care plan provider databases. The independent variables were: sex, age, time between first appointment with nephrologist and starting hemodialysis, type of first vascular access, diabetes mellitus, length of time spent in hospital/year of treatment and death. Dependent variables: time between starting hemodialysis and death and length of time spent in hospital/year of treatment > 7.5 days. Statistical analysis was carried out using Pearson's Chi-squared test in the univariate analysis for the outcomes 'death' and 'length of time spent in hospital/ year of treatment'; the Kaplan-Meier method was used to analyze survival; the Cox model and Poisson regression were used for risk of death and chance of length of time spent in hospital/year of treatment >7.5 days. The Business Intelligence tool and Stata ® 10.0 software were used to extract data. RESULTS: There were 311 patients on hemodialysis included in the study, with a mean age of 62 (sd 16.6 years), of whom 55.5% were male. Prevalence increased 160% during the period in question. Survival analysis showed a higher mortality among older patients, patients that did not consult a nephrologists, those whose first vascular access was using a temporary catheter,, those with diabetes mellitus, those admitted to hospital within a month of beginning hemodialysis. The Cox model showed that a higher risk of death was associated with age, diabetes mellitus, not consulting a nephrologists and those that were hospitalized within a month of beginning hemodialysis. Greater length of time spent in hospital/year of treatment was not associated with sex or diabetes. According to Poisson regression, the variables were not significant. CONCLUSIONS: Assessment by a specialist before starting hemodialysis decreases the risk of death in cases of chronic kidney disease, whereas the presence of diabetes and being hospitalized within a month of beginning hemodialysis increases the risk of death [ABSTRACT FROM AUTHOR]

An altered colonic microbiota probably increases colorectal adenoma (CRA) and cancer (CRC) risk, but large, unbiased fecal collections are needed to examine the relationship of gut microbiota diversity and composition to colorectal carcinogenesis. This study assessed whether fecal immunochemical tests (FITs) from CRA/CRC screening may fulfill this requirement. Using FIT, self-collected by members of Kaiser Permanente Hawaii (KPH), as well as interspersed quality control (QC) specimens, DNA was extracted and amplified to generate 16S rRNA microbiome profiles rarified at 10,000 reads. CRA/CRC were diagnosed by colonoscopy and histopathology. Covariates were from electronic KPH records. Of 921 participants' FIT devices, 538 (58%) yielded at least 10,000 rRNA reads and 1016 species-level variants mapped to 46 genera. Of the 538 evaluable participants, 63 (11.7%) were FIT-negative per protocol, and they were considered negative for CRA/CRC. Of the 475 FIT + participants, colonoscopy and pathologic review revealed that 8 (1.7%) had CRC, 71 (14.9%) had high-risk CRA, 107 (22.5%) had low-risk CRA, and 289 (60.8%) did not have CRA/CRC. Men were 2.27-fold [95% confidence interval (CI) 1.32-3.91] more likely than women to be FIT+ . Men also had 1.96-fold (CI 1.24-3.07) higher odds of low-risk CRA, with similar trends for high-risk CRA and CRC. CRA/CRC were not associated with overweight, obesity, diabetes, or antibiotic prescriptions in this study. QC analysis across 24 batches of FIT devices revealed QC outliers in four batches. With or without exclusion of the four QC-outlier batches, as well as lenient (1000-read) rarefaction, CRA/CRC had no consistent, statistically significant associations with fecal microbiome alpha diversity, beta diversity or genera relative abundance. CRA/CRC had expected associations with male sex but not with microbiome metrics. Fecal microbiome profiling using DNA extracted from at-home collected, re-used FIT devices is feasible, albeit with substantial challenges. Using FITs for prospective microbiome studies of CRA/CRC risk should consider the impact of the current findings on statistical power and requisite sample sizes., (© 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

Objectives: To quantify socioeconomic inequalities in COVID-19 mortality in Colombia and to assess the extent to which type of health insurance, comorbidity burden, area of residence, and ethnicity account for such inequalities., Methods: We analyzed data from a retrospective cohort of COVID-19 cases. We estimated the relative and slope indices of inequality (RII and SII) using survival models for all participants and stratified them by age and gender. We calculated the percentage reduction in RII and SII after adjustment for potentially relevant factors., Results: We identified significant inequalities for the whole cohort and by subgroups (age and gender). Inequalities were higher among younger adults and gradually decreased with age, going from RII of 5.65 (95% confidence interval [CI] = 3.25, 9.82) in participants younger than 25 years to RII of 1.49 (95% CI = 1.41, 1.58) in those aged 65 years and older. Type of health insurance was the most important factor, accounting for 20% and 59% of the relative and absolute inequalities, respectively., Conclusions: Significant socioeconomic inequalities exist in COVID-19 mortality in Colombia. Health insurance appears to be the main contributor to those inequalities, posing challenges for the design of public health strategies.

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Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Cadernos de Saude Publica is the property of Escola Nacional de Saude Publica Sergio Arouca and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Revista de Saúde Pública is the property of Faculdade de Educacao da Universidade de Sao Paulo and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)