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Objective: To determine the factors associated with the absenteeism from medical appointments among patients at a national hospital in Peru. Materials and methods: An observational, retrospective and analytical case-control study among patients who either missed or attended their scheduled medical appointments. The population of absentees was 2,963, while that of attendees was 12,125 patients. The sample consisted of 126 scheduled individuals in the case group and 253 in the control group, selected by systematic sampling, considering selection criteria. From the appointment scheduling records and the medical consultation database, personal factors such as place of residence, condition in the facility, condition in the service, financing and sex as well as institutional factors such as the deferral of appointments were collected using a data collection form. The associated factors were analyzed using binary logistic regression. Results: The absenteeism rate was 19.64 %. A total of 81.75 % of absent patients and 65.22 % of those in the control group receive medical care through the Sistema Integral de Salud (SIS, Comprehensive Health Insurance) scheme. Furthermore, 68.25 % of the absentees booked their medical appointment seven or more days in advance, compared to 51.38 % of the control group. The factors associated with absenteeism were financing (p = 0.002; OR = 2.385; 95 % CI [1.365-4.168]) and the deferral of the appointment (p = 0.005; OR = 1.965; 95 % CI [1.225-3.152]). Regarding the likelihood of being absent, that of SIS beneficiaries was 2.385, while that of users who scheduled an appointment seven or more days in advanced was 1.965. Conclusions: Being a SIS beneficiary patient and the granting of an appointment deferred by more than seven days increases the probability of absenteeism from scheduled medical appointments. A processes review is suggested as a part of the continuous improvement. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar los factores asociados al ausentismo de la cita médica en pacientes de un hospital nacional peruano. Materiales y métodos: Estudio observacional, retrospectivo, analítico, de casos y controles, en pacientes que se ausentaron o no a la cita médica programada; la población de ausentes fue de 2963 y los que cumplieron fueron 12 125. La muestra fue de 126 citados para el grupo casos y 253 para el grupo control, seleccionados por muestreo sistemático, considerando criterios de selección. A partir de los registros de programación de citas y la base de datos de las atenciones médicas, en una ficha de recolección de datos se recogieron factores personales, como residencia, condición en el establecimiento, condición en el servicio, financiamiento y sexo, e institucionales, como el diferimiento de citas. Los factores asociados se analizaron con regresión logística binaria. Resultados: La proporción de ausentismo fue 19,64 %. El 81,75 % de los pacientes ausentes y el 65,22 % de los del grupo control se atienden por el Seguro Integral de Salud (SIS); por otro lado, 68,25 % de los primeros y 52,38 % de los segundos separaron su cita con siete días o más de anticipación. Los factores asociados al ausentismo fueron el financiamiento (p = 0,002; OR = 2,385; IC 95 % [1,365-4,168]) y el diferimiento de la cita (p = 0,005; OR = 1,965; IC 95 % [1,225-3,152]). Respecto a la probabilidad de ausentarse, la del beneficiario del SIS corresponde a 2,385, mientras que la de los usuarios que programan una cita con siete o más días de anticipación, 1,965. Conclusiones: Ser paciente beneficiario del SIS y el otorgamiento de una cita con un diferimiento de más de siete días ocasionan mayor probabilidad de ausentarse a la cita médica programada; se sugiere la revisión de los procesos como parte de la mejora continua.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

The government of Nepal introduced a national health insurance program in 2016 to comply with the constitution and international commitments to ensure universal health coverage by 2030. This qualitative study explores public perceptions and satisfaction concerning the new health insurance program. The study is guided by an interpretive worldview using both in‐depth interviews (IDIs) and focus group discussions (FGDs). Altogether, 34 (28 IDIs and 6 FGDs) events were conducted covering both self‐ and government‐sponsored health insurance enrollees in the new health insurance program. The study found that insurees had larger expectations as well as both favorable and negative perceptions of the program. Positive perceptions included that the program helped to lower the gap between the wealthy and the poor, increase coverage with fewer financial contributions, and make it easier to receive health services financially. Negative perceptions included long waiting times for registration, consultations, laboratory test results, and pharmacy visits, as well as the lack of drugs, inadequate coverage (a low ceiling), low‐quality services, and strict procedures, which combined to make insurees dissatisfied. We noticed that insurees had expectations that went beyond the program's guidelines, such as the expectation that services would be provided without queues and long waits, that additional services and coverage would be provided, and that preference would be shown for patients who lived far from hospitals. Adequate information, education, and communication‐ and process‐related interventions that address these issues may help minimize the insurees' unrealistic expectations and areas of dissatisfaction. Key points: Government‐sponsored insurees had more comments of appreciation than negative comments, while self‐sponsored insurees had more negative comments than comments of gratitude. Fewer grievances were noticed regarding the services available free of cost.Insurees had more program expectations than comments about the program's limitations. More exceptions were noticed concerning service coverage and ceiling amount than about the insurance guidelines.Findings suggest that appropriate interventions (information, education, and communication) are needed to address concerns and expectations for households and insurees. [ABSTRACT FROM AUTHOR]

Objetivo: Determinar la relación entre la ejecución presupuestal de transferencias financieras del Seguro Integral de Salud (SIS) y la disponibilidad de suministros médicos en establecimientos de tercer nivel del Ministerio de Salud (MINSA) en Lima Metropolitana. Material y método: Estudio transversal, realizado en 20 establecimientos del nivel III en Lima Metropolitana. La información sobre ejecución presupuestal (total, en gastos de reposición, de medicamentos, y de materiales o insumos) se obtuvo de las Actas de Cierre de Supervisión Financiera de la Gerencia Macrorregional del SIS; mientras que la disponibilidad de suministros médicos (productos farmacéuticos, dispositivos médicos y/o productos sanitarios) fue recolectada del portal web Mundo IPRESS (por el acrónimo de Instituciones Prestadoras de Servicios de Salud). Para correlacionar ambos conceptos se utilizó el test de Spearman (rho), considerándose un valor p

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru 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.)

El sistema de salud en Chile ha logrado un gran desarrollo y cobertura nacional, pero mantiene limitaciones organizacionales que hacen necesaria una reforma estructural impostergable, debido a deficiencia de recursos y desempeño, con segmentación e inequidad. El programa gubernamental 2022-2026 plantea una reforma sustancial para crear un sistema universal de salud. Existen otras propuestas de reforma elaboradas por diversos programas y comisiones gubernamentales y centros de estudio, que aportan insumos útiles para contextualizar la propuesta gubernamental. Diversos tipos de modelos coexisten en el sistema de salud, pues el seguro público es de tipo seguridad social, el sistema asistencial público provee atención gratis a los asegurados públicos, y los seguros y proveedores asistenciales privados tienen modalidad de mercado. El sistema propuesto sería de tipo de sistema nacional de salud, en el que se combinan una modalidad predominante de servicio nacional de salud (tipo Beveridge) estatal con un sistema de seguridad social (tipo Bismarck) complementario, según la necesidad de financiamiento. Bajo un enfoque de evaluación de proyectos sociales, se revisaron los criterios de pertinencia (coherencia interna y consistencia externa) y de factibilidad política y económica de los contenidos del programa gubernamental. La propuesta tiene coherencia interna, aunque una consistencia externa limitada con el sistema político y económico predominante, y escasa capacidad del Estado para aumentar el financiamiento y la cobertura de empresas públicas. El contenido de la propuesta no permite identificar que existan suficientes condiciones facilitadoras para sustentar una factibilidad política y económica razonable de aprobación legal e implementación efectiva de la reforma propuesta.

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco 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.)

Local policy experimentation was a driving force behind China's economic progress, but its results in the field of social policy are more ambiguous. This article takes a lesson‐drawing perspective on the transfer of international hospital payment reforms to Chinese cities, focusing on the Urban Employees' Basic Medical Insurance. We distinguish two waves of reform. The first wave was driven by local government initiatives dominated by simplified versions of international models which lacked strong prospective payment components (inspirations) and protected local bureaucratic and hospital interests. The second wave was driven by central government intervention dominated by syntheses and adaptations with strong prospective payment components and was more oriented toward patients' interests. Data were collected via expert interviews, administrative documents, academic studies, and newspaper articles. We find that elements of social policy are transferred depending on central–local interaction, with pressure from the center needed to overcome local bureaucratic self‐interest. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ibero-Latinoamericana de Seguros is the property of Pontificia Universidad Javeriana 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 Facultad de Medicina de la Universidad Nacional de Colombia 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.)

Copyright of Acta Médica Peruana is the property of Colegio Medico del Peru 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.)

Objetivo: Determinar el impacto del aseguramiento en salud en la economía de los hogares peruanos en el periodo 2010-2019. Materiales y Métodos: Estudio analítico transversal, que utilizó la base de datos de la Encuesta Nacional de Hogares de los años 2010, 2014 y 2019 para analizar el impacto del aseguramiento en salud en términos de gasto de bolsillo en salud, gasto catastrófico y empobrecimiento de los hogares peruanos, así como determinar qué otros factores se encuentran asociados. Resultados: Durante el periodo de estudio se observó que los hogares peruanos presentaron una disminución del gasto de bolsillo en salud promedio mensual (S/.119,9 en 2010 a S/.107,9 en 2019), así como del porcentaje de hogares con gasto catastrófico en salud (4,06 % en 2010 a 3,47 % en 2019) y del porcentaje de hogares que empobrecen por gastos de bolsillo en salud (1,78 % en 2010 a 1,51 % en 2019). Los factores asociados al gasto catastrófico en salud y al empobrecimiento fueron el menor nivel de escolaridad del jefe del hogar, la presencia de miembros con enfermedad crónica y el área de residencia rural. La ausencia de aseguramiento en salud se asoció significativamente a un mayor riesgo de gasto de bolsillo en salud catastrófico, mas no al empobrecimiento. Conclusiones: El aumento de la cobertura de aseguramiento en salud contribuye a la protección financiera de los hogares peruanos frente al gasto de bolsillo en salud; sin embargo, las barreras para el acceso efectivo a los servicios de salud y otros factores socioeconómicos pueden limitar significativamente su impacto.

The health system in Chile is well developed, with broad national coverage. However, organizational limitations necessitate urgent structural reform due to a lack of resources and poor performance, with segmentation and inequity. The government's program for 2022--2026 proposes substantial reforms aimed at creating a universal health system. Other reform proposals formulated by various government programs and commissions, as well as think tanks, provide useful inputs to contextualize the government proposal. Different types of models coexist in the health system: public insurance is based on a social security model, the public system provides free care to the insured population, and private insurance and private care providers work on a market basis. The proposed system would function on the national health system model, combining a predominant national health service (Beveridge model) with a complementary social security system (Bismarck model), depending on the need for funding. With a focus on social project evaluation, the relevance (internal coherence and external alignment) and political and economic feasibility of the contents of the government program were reviewed. The proposal has internal coherence, but limited external alignment with the prevailing political and economic system, and little State capacity to increase the financing of public enterprises and their coverage. The contents of the proposal do not show sufficient facilitating conditions to reasonably suggest political and economic feasibility in terms of legal approval and effective implementation of the proposed reform. [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.)

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 Recherches en Sciences de Gestion is the property of ISEOR 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.)

Objective. To describe the burden of colorectal cancer (CRC) in Mexico and understand mortality patterns based on sex, geography, and insurance status. Materials and methods. Mortality data (1998-2018) from the Instituto Nacional de Estadística y Geografía was obtained. We included colon (C18.0, C18.2-18.9) and rectal cancer ICD-10 codes (C19, C20), and estimated age-standardized national, statelevel and health insurance mortality rates. We estimated the average annual percent change using joinpoint regression. Results. Between 1998 and 2018, the observed women and men mortality rate increased annually by 1.3 and 2.7%, respectively. Higher CRC mortality was observed in northern and more urbanized states and in groups with greater access to health insurance, which currently facilitates but does not routinely cover screening. Conclusion. CRC mortality in Mexico is increasing rapidly, with marked differences based on sex, geography, and insurance status. Our findings underscore potential benefits of increased investment in comprehensive screening, diagnosis, and treatment strategies for the general population. [ABSTRACT FROM AUTHOR]

The pattern of health risk perception among Portuguese mineworkers changed during the twentieth century, as did forms of state intervention and risk management. Up to the mid-20th century, mining accidents, risks and the need for sickness assistance promoted different healthcare models. Mining companies offered medical and pharmaceutical assistance, and, during the First Republic, the state introduced compulsory social insurance and other labour legislation. The health assistance offered by trade unions was integrated into the general health system during New State (1934-74). From the 1950s on, the legal struggle for recognition of silicosis as a debilitating occupational disease made mine owners accountable. This paper traces this historical experience, the significant path leading to the institutionalization of occupational medicine, health systems and social support in Portugal. [ABSTRACT FROM AUTHOR]

Background: Colombia's health system allows workers to claim paid sick leave due to health conditions, some of this conditions are related to metabolic and cardiovascular disease. There has been an association between these diseases and depression. However, the effect of behavioral disorders such as depression on absence from work is unknown in the developing world. The objective of the research is to estimate whether low-wage workers suffering from depression, metabolic disease, and cardiovascular disease request more paid sick days than people with the same medical comorbidities, but without depression. Data and Methods: We conducted a retrospective study using data from an insurer in the southwestern region of Colombia in 2016. Depression was identified using an international algorithm that detects chronic conditions from diagnosis and pharmacy data. Outcome variables were the number of days on sick leave allowed by the insurer in one year, and the amount paid by the insurer. We used multivariate regression to estimate whether depression increases sick leave due to metabolic and cardiovascular disease after pre-processing the data using coarsened exact matching. Results: Individuals diagnosed with depressive disorders and absent from work due to metabolic and cardiovascular disease tend to have more paid sick days throughout the year than individuals with no depression suffering from these diseases. Additional absence days were statistically significant in nutritional and metabolic disease (10.6 days) and circulatory diseases (7.4 days). Conclusions: Depression comorbid with a physical disease increases the number of days and consequently the associated costs to the insurer. The incremental cost due to depression is higher compared to what insurers receive annually from the government to cover health services; consequently, additional research is warranted to identify prevention activities that can treat depression, thus lowering the healthcare system's financial burden. [ABSTRACT FROM AUTHOR]

Objetivo. El objetivo de este estudio fue averiguar qué factores afectan el gasto de bolsillo en servicios de salud prestados por el MINSA y los gobiernos regionales a la población en condiciones de pobreza monetaria relativa entre 2010 y 2014. Materiales y métodos. Estudio transversal descriptivo econométrico con cortes anuales (2010-2014) a nivel nacional con información de encuestas de hogares. La variable dependiente fue el gasto de bolsillo en salud de las personas en situación de pobreza monetaria relativa para costear su atención médica en servicios de salud públicos. Las variables independientes fueron la afiliación al Seguro Integral de Salud (SIS), el nivel de gasto familiar per capita, el grupo de edad (0-5 años), ser mujer en edad fértil (15-49 años), ser persona adulta mayor (mayor de 60 años)), la carga familiar (cuyo indicador proxy fue el número de miembros en el hogar), y el nivel de complejidad del prestador de servicios. Resultados. Sólo 5% de la población rural objeto de estudio fue atendida en centros de mayor nivel de complejidad (hospital) frente a 16% de la del medio urbano. Los medicamentos concentraron el mayor gasto de hogares: 44% en los asegurados en el SIS y 62% en los no asegurados (2014). El gasto de bolsillo en salud se asoció positivamente con no estar afiliado en el SIS, el mayor nivel de complejidad del prestador, el nivel del gasto familiar per capita y ser adulto mayor. Conclusiones. La afiliación al SIS es una variable de política relevante para disminuir el gasto de bolsillo en hogares pobres. El menor gasto de bolsillo de la población rural pobre, especialmente vulnerable, está fuertemente asociado con el uso casi exclusivo de servicios provistos por prestadores del primer nivel de atención. Se necesitan políticas específicas de protección de la población adulta mayor en condiciones de pobreza. Para lograr la cobertura universal en salud, Perú necesita políticas más intensivas de protección financiera y de reestructuración de su oferta pública.

Objetivos. Caracterizar el proceso de la Reforma del Sector Salud (RSS) en Perú expresada públicamente en 2013, identificando los principales avances en su implementación y los desa fíos pendientes desde la perspectiva de los actores participantes. Métodos. Se trata de un estudio de sistematización de la experiencia en el cual se realizaron entrevistas semiestructuradas a 21 informantes clave, incluyendo a tres exministros de salud, y empleando como marco temporal el decenio 2005–2015. Se analizaron bases de datos oficiales para comprobar las variaciones de los indicadores de salud. Resultados. La propuesta se basa en la expansión del aseguramiento con predominio de un seguro público en salud bajo el modelo del pluralismo estructurado, con una clara separación entre las funciones de prestación, intermediación financiera, regulación y gobierno. Los principales avances de la RSS identificados son: haber trascendido el criterio de pobreza para el aseguramiento público, el refuerzo de la inversión física y de recursos humanos, el fortalecimiento de una superintendencia orientada a los derechos del usuario, y el del papel del Ministerio de Salud en la salud pública. Y los principales desafíos, la cobertura poblacional del aseguramiento no vinculada con la pobreza, la dotación de recursos humanos especializados y la reducción de gasto de bolsillo. Conclusiones. La RSS en el decenio examinado es un proceso que se construye sobre avances de años precedentes al periodo analizado, que consolida en el país un modelo de aseguramiento encaminado a la cobertura poblacional universal sobre la base de un seguro público de salud, y que se expresa en un incremento demostrable del gasto público y de la cobertura, aunque sus avances se ven limitados principalmente en la dotación de recursos humanos especializados y en el gasto de bolsillo, que todavía es muy elevado.

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.)

Copyright of Revista E-mercatoria is the property of Universidad Externado de Colombia, Departamento de Derecho Comercial 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.)

Objetivo. Analizar la tendencia en desigualdades en pro­tección financiera y acceso a servicios de salud en México entre 2000 y 2012, usando medidas de brecha y de gradiente. Material y métodos. Análisis de las encuestas naciona­les de salud de 2000, 2006 y 2012, estimando las brechas absoluta y relativa en indicadores de protección financiera y de acceso a servicios de salud y el índice de desigualdad de la pendiente, utilizando como indicador socioeconómico el ingreso imputado, así como las diferencias en resultados por sexo, ámbito de residencia y condición étnica. Resultados. Entre 2000 y 2012 se ha eliminado la desigualdad en protec­ción financiera relacionada con condición socioeconómica de forma paralela a la disminución general de la carencia en protección financiera, en tanto que persiste la desigualdad en indicadores de acceso a servicios de salud, tanto por nivel socioeconómico como por otros estratificadores sociales. Conclusiones. La reforma de 2003 se ha traducido en la eliminación de la desigualdad en protección financiera; no obstante, persiste la desigualdad en el acceso a los servicios de salud. Se requiere reenfocar acciones hacia la eliminación de las barreras relacionadas con la calidad de los servicios de salud, que promuevan el acceso efectivo a la salud en México.

The purpose of this research is to examine the extent to which public opinion on health insurance requirements depends on the level of government and political leader, if any, associated with them. The results reveal that respondents exhibited evenly divided opinions on health insurance requirements. [ABSTRACT FROM AUTHOR]

Puerto Rico's politically liminal status as a US territory has dire consequences for Puerto Rico's economy: the island does not receive the same funding as states for health insurance. In addition, Puerto Rico's unraveling health care system, coupled with the island's high poverty rate and the medical brain drain, interact. I weave my research on depression into this article as an example of the ways in which political and economic factors aggravate disease. [ABSTRACT FROM AUTHOR]

Objective. To ascertain which factors affect out-of-pocket spending on health services provided by the Ministry of Health of Peru and regional governments to the population living in relative poverty between 2010 and 2014. Materials and methods. Cross-sectional, descriptive, nationwide, econometric, yearon- year (2010-2014) study using information from household surveys. The dependent variable was out-of-pocket spending by people in relative poverty to pay for medical care at public health services. The independent variables were affiliation to the Comprehensive Health Insurance (SIS) scheme, level of family expenditure per capita, age group 0-5 years, being a woman of childbearing age (15-49 years), being an older adult (over age 60 years), family burden (using the number of members of the household as a proxy indicator), and the level of complexity of the service provider. Results. Only 5% of the rural population in the study were treated at higher-complexity facilities (hospitals), compared to 16% of the population in urban centers. Drugs accounted for the majority of household expenditures: 44% among those insured via SIS and 62% among the uninsured (2014). Out-of-pocket spending on health was positively associated with not being insured via SIS, higher level of provider complexity, level of family spending per capita, and being an older adult. Conclusions. Comprehensive Health Insurance coverage is a relevant policy variable to reduce out-of-pocket spending in poor households. The lower out-of-pocket spending among the rural poor----an especially vulnerable group----was strongly associated with near-exclusive use of services delivered by primary health care providers. Specific policies are needed to protect older adults living in poverty. To achieve universal health coverage, Peru needs to implement more intensive financial protection policies and restructure its public service offering. [ABSTRACT FROM AUTHOR]

Objective. To characterize the process of health sector reform (HSR) in Peru (launched publicly in 2013), identifying the principal advances in its implementation and the pending challenges from the perspective of the participating actors. Methods. This study systematizes experiences through semi-structured interviews conducted with 21 key informants, including three ex-ministers of health, using the decade 2005-2015 as the time frame. Official databases were analyzed to verify variations in health indicators. Results. The proposed reform was based on expanding insurance coverage (predominantly public health insurance), following the structured pluralism model, with clear separation between the functions of delivery, financing, regulation, and governance. The main progress in HSR identified by this study involves: having transcended the poverty criterion for public insurance, strengthening investments in infrastructure and human resources, strengthening the National Health Authority with a focus on the rights of users, and reinforcing the public health role of the Ministry of Health. The main challenges involve providing non-poverty- related insurance coverage for the population, having sufficient specialized human resources, and reducing out-of-pocket expenditure. Conclusions. In the 10 years under analysis, HSR is a process that builds on the progress made in prior years; a process that consolidates an insurance model aimed at universal coverage based on public health insurance and that has led to a demonstrable increase in public spending and population coverage. However, progress has been limited mainly due to insufficient provision of specialized human resources and out-of-pocket expenditure, which remains very high. [ABSTRACT FROM AUTHOR]

Objetivo. Describir los mecanismos de asignación y compra del Seguro Popular, la forma en que operan y los controles que se dan sobre ellos. Discutir esquemas de incentivos que mejoren el desempeño en general, fortalezcan la atención primaria y mejoren el acceso a los hospitales de especialidades. Material y métodos. Se evalúan las reformas de 2014 a la Ley General de Salud para entender su intención, que es fortalecer los sistemas estatales y la relación con la autoridad federal. Se discuten opciones para que los mecanismos de asignación incentiven mejor la atención primaria y el acceso a los tratamientos de especialidades para avanzar hacia mejores garantías de acceso a los servicios de salud. Conclusiones. Para convertir a los Regímenes Estatales de Protección Social en Salud en agentes para la expansión de los servicios debe superarse el enfoque programático para lograr una relación más eficaz entre la Federación y los Estados.

The National Health Authority (SUSALUD) has developed an online platform, “ReSUelve tu afiliación”, with the intent to solve the problems with health service access experienced by Peruvian citizens who hold health insurance policies through institutions that manage health insurance funds (IAFAS). This platform virtually articulates the main IAFAS in Peru, which receives requests from any user requiring an update on his/her affiliation status to be resolved within 24 hours. Nearly 8 months after the implementation of this platform, more than 55 thousand applications have been resolved, thus ensuring timely access to health services under the corresponding user coverage form. As a result, this platform has helped to guarantee citizens’ rights to health service access in the face of infringement caused by delays in affiliation processing among the different IAFAS in Peru.

Este artículo revisa el rol que cumplen los seguros privados de salud en Chile, comparado con los principios y recomendaciones internacionales sobre seguridad social en salud. El objetivo fue revisar la situación actual desde la perspectiva de salud pública, los sistemas de salud, protección social, y los derechos y necesidades de la población. Creados en 1981, estos seguros han logrado un sólido desarrollo institucional, pero mantienen problemas e inconsistencias que limitan el acceso adecuado al aseguramiento y a los beneficios requeridos del sistema de salud. Sus limitaciones se relacionan con el modelo neoliberal prevalente en un mercado poco regulado; su clientela y rentabilidad está concentrada en cotizantes de mayores ingresos y menor riesgo, ante quienes realizan fijación arbitraria de planes y alzas de precios. En su quehacer, predomina el interés comercial y sustentabilidad económica por sobre las necesidades y capacidad de pago de sus beneficiarios. Sin embargo, continúan siendo la alternativa preferente de elección en el grupo de población con mayores ingresos, debido a la limitada y no competitiva opción que les puede ofrecer el seguro público. Si bien están consolidados, son vulnerables a cambios que puedan arriesgar su sustentabilidad y rentabilidad. Se les ha realizado mejorías parciales y ajustes desde 1990, lo que aún es insuficiente. Desde 2010, existen estudios y propuestas gubernamentales sobre reformas concretas, lo que se mantiene pendiente, debido a las restricciones que impone el modelo prevalente y la presión de los grupos de interés económico

Objetivo. Medir el impacto de la red propia (proveedores verticalmente integrados) de una aseguradora privada sobre los costos médicos ambulatorios de sus asegurados, a través de un análisis econométrico. Se busca verificar si un mayor uso de la red propia reduce los costos en los que la aseguradora incurre, de acuerdo con lo que sugiere la literatura especializada. Material y métodos. Estudio basado en una regresión lineal múltiple sobre los datos de una aseguradora privada. La variable dependiente es el costo per cápita de los servicios ambulatorios. Las variables explicativas son la adherencia a la red propia y una serie de variables para especificar mejor el modelo. Resultados. En relación con la cobertura de los costos de atención ambulatoria, si los demás factores se mantienen constantes, se observa que los asegurados con alta adherencia a la red propia presentan menores costos de atención que aquéllos con baja adherencia. Conclusión. El proceso decisorio sobre qué servicios y en qué grado debe ser aplicado a cada persona, por condiciones particulares de la oferta como el hecho de reunir recurso humano en sedes propias bajo reglas formales, presenta un impacto en los costos de atención en salud. Condiciones particulares de la oferta producen variaciones en la forma como son empleados los recursos.

Objectives. Describe the profile of need and patterns of use of outpatient health services in populations who are enrolled and non-enrolled in a health insurance program in Peru. Materials and methods. Descriptive cross-sectional study using data from the 2011 National Household Survey. The data were divided into five groups: persons enrolled in the Social Health Insurance (ESSALUD), Integral Health Insurance (SIS), Health Insurance of the Armed Forces and Police Force (AF-PF), Private Health Insurances (SPS) and the uninsured. Results. People insured and enrolled in ESSALUD were more likely to use outpatient services than uninsured people and those enrolled in SIS. SIS members mainly attended health centers and small health posts (47.1%), while other insurance members mainly used hospitals and private hospitals. The uninsured used as their first choice pharmacies and drugstores (46.7%) in order to solve their health problems. In all insurances, out-of-pocket payment was made for the consultation, medications and tests. The perception of “not serious” was the main reason for not seeking care in the insured (40.0%) and uninsured (41.4%); however the lack of money showed an important difference between insured (10.6%) and uninsured (16.3%). Conclusions. The outpatient health services utilization profile of the Peruvian population expresses differences that relate to enrollment in and type of insurance.

Antecedentes. La cirugía bariátrica es un procedimeinto efectivo para el tratamiento de la obesidad. En Colombia, a muchos pacientes le es negada la realización de esta cirugía por parte de algunas aseguradoras por lo cual deben recurrir a acciones legales como la tutela para proteger su derecho a la salud y obtener acceso a un tratamiento efectivo para su patología. Objetivo. Evaluar la efectividad de la acción de tutela para acceder a la cirugía bariátrica e indagar las características de los sujetos en las sentencias de tutela, además de las consideraciones y factores relacionados con la aprobación o negación del procedimiento. Materiales y métodos. Mediante la búsqueda sistemática de sentencias de tutela en el radicador de sentencias de la Corte Constitucional de Colombia, se obtuvo una base de datos sobre la cual se realizó un análisis para evaluar la acción de tutela en los casos de cirugía bariátrica. Resultados. Se realizó un análisis de 42 sentencias de tutela dentro de las cuales se encontró una tasa de aprobación de 72%. La prevalencia de obesidad grado III asociada a comorbilidades en el estudio fue de 69%. La vulneración del derecho a la salud y la exclusión de la cirugía bariátrica del plan obligatorio de salud fueron los argumentos más frecuentemente empleados por los demandantes y las entidades promotoras de salud, respectivamente. Conclusiones. La tutela es un mecanismo efectivo para el acceso a la cirugía bariátrica en los casos en que este procedimiento haya sido negado por alguna entidad prestadora de salud.

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Copyright of CES Medicina is the property of Universidad CES 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 Acta Médica Peruana is the property of Colegio Medico del Peru 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.)

The focus of this article is on post-migration entitlement and access to health security of women international migrants in England who are in vulnerable circumstances. Here ‘health security’ is defined as the protection of health within a broader public health context. The aim is to understand the factors underlying migrants’ vulnerabilities and how national and local health policies and practices respond in allowing or denying them rights to healthcare, thus impacting their ability to safeguard their health. This article is predominantly concerned with experiences of access to healthcare of categories of migrant women who may be in vulnerable situations including asylum seekers, refugees, refused asylum seekers or other undocumented migrant women, women with no recourse to public funds who are supported by local authorities, trafficked women, Roma women, women with limited fluency in English, and migrants from the European Union (EU) with no health insurance card. By examining empirical evidence of such women’s experiences of entitlement and access to healthcare we are able to gain theoretical insight into the relationship between migration, gender and human (health) security. [ABSTRACT FROM AUTHOR]

Chile maintains a health system segmented by risks and income. A Presidential Commission convened in 2014 presented two scenarios for its health system in accordance with a timeline of expected results. For the long term, it proposed a vision for the direction of the Chilean health system that would converge in a single public insurance. For the short term, it proposed a transition that consisted of regulating pension health institutions to function under social security rules and principles. The central approaches were based on international evidence of systems that have achieved success in offering universal health access and coverage to the population, through appropriate transformations and regulations. The analysis carried out by the Commission signaled the beginning of a new paradigm for health policies in Chile. This points out that the strategy used previously--to promote greater competition and freedom of choice in health insurance markets--has not yielded results, and that in order to advance towards equitable access to health it is necessary to focus on the right to health and the principles of solidarity and equity, as well as assessing progress in the world, recognizing that the Chilean scheme moves away from the best practices in terms of the design of health systems. The proposal has not been implemented yet, and it will be necessary to propose an accelerated implementation plan for its long-term vision. Chile's experience is relevant for other countries in the Region of the Americas that discuss the problems of health segmentation. [ABSTRACT FROM AUTHOR]

Objetivo: identificar el porcentaje de hogares cuyos desembolsos por concepto del gasto de bolsillo pueden llegar a constituirse en una catástrofe financiera (30 o 40%del ingreso familiar). Métodos: se utiliza el módulo de Equidad y Protección Financiera del software ADePT, del Grupo de Investigación y Desarrollo del Banco Mundial, así como una serie de rutinas programables que replican la metodología de análisis del gasto catastrófico del estudio desarrollado por Knaul, Wong, y Arreola-Ornelas (2012). Resultados: la incidencia de gasto catastrófico se incrementó levemente al pasar de un 0.6 % de los hogares en el año 2004 a un 0.8 % en el 2013. Conclusiones: la incidencia del gasto catastrófico en salud de los hogares costarricenses no representa un problema para el sistema de salud costarricense, pero es un aspecto que debe focalizarse a sus características estructurales.

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.)