private health system

  • 文章类型: Journal Article
    1978年《阿拉木图宣言》为卫生系统提出了建议,这严重影响了低收入国家。这些指导方针标志着人们获得健康方面的改善,覆盖面和财务公平性,尤其是在拉丁美洲国家。
    本文着重于私营部门(包括营利性和非营利性组织)在实现全民健康覆盖(UHC)中的作用。它检查了他们在管理中的参与,服务交付,在可持续发展目标(SDGs)范围内对初级卫生保健(PHC)进行资源投资和融资。
    该研究涵盖了对卫生系统的审查,强调私人机构对公共卫生的影响,并评估私营部门的经验如何对系统功能和实现UHC的进展做出贡献。
    研究结果表明,私营部门在全球卫生系统中的关键作用,特别是在几个国家扩大。私人行为者对于改善获取和覆盖面至关重要,特别是在健康指标较低的国家。本文强调了初级保健医生理解这些动态的重要性,因为他们的管理对于实施UHC的公共政策至关重要。
    The 1978 Alma Ata Declaration established recommendations for health systems, which significantly impacted low-income countries. These guidelines marked improvements in access to health, coverage and financial equity, especially in Latin American countries.
    UNASSIGNED: This paper focuses on the role of the private sector (including for-profit and non-profit organizations) in achieving Universal Health Coverage (UHC). It examines their involvement in the management, service delivery, resource investment and financing of primary health care (PHC) within the sustainable development goals (SDGs).
    UNASSIGNED: The study covers a review of health systems, emphasizing the influence of private institutions on public health, and evaluates how private sector experiences contribute to system functions and progress towards UHC.
    UNASSIGNED: The findings indicate the crucial role of the private sector in global health systems, notably expanded in several countries. Private actors are essential to improve access and coverage, particularly in countries with low health indicators. The article highlights the importance of primary care physicians understanding these dynamics since their management is vital in implementing public policies for UHC.
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  • 文章类型: Journal Article
    高血压(HT)仍然是全球死亡的主要原因。在巴西,据估计有35%的成年人患有HT,其中约20%的血压值在建议降低心血管风险的目标范围内。有一些数据表明公共和私人转诊中心心脏病专家治疗的患者控制率不同,这是需要调查和讨论的重要问题。
    为了比较社会人口统计学特征,体重指数(BMI),抗高血压(AH)药物,公共(PURC)和私人(PRRC)转诊中心的血压(BP)和控制率。
    一项横断面多中心研究,分析了PURC(一个在中西部地区,另一个在东北地区)和PRRC(相同分布)辅助的高血压患者的数据。分析的变量:性别,年龄,BMI,类,通过办公室测量和家庭血压测量(HBPM),使用的AH数量以及收缩压和舒张压BP的平均值。评估未控制的高血压(HT)表型和BP控制率。进行描述性统计和χ2检验或非配对t检验。认为P<0.05的显著性水平。
    以女性为主(58.9%)的2.956名患者样本,PURC中肥胖(p<0.001)和PRRC中超重(p<0.001)的患病率较高。PURC使用的平均AH为2.9±1.5,PRRC为1.4±0.7(p<0.001)。PURC的平均收缩压和舒张压值均较高,办公室测量的不受控制的HT发生率分别为67.8%和47.6%(p<0.001),而PURC和PRRC的HBPM则为60.4%和35.3%(p<0.001)。分别。
    在PURC中,HT患者的肥胖患病率更高,并且使用了几乎两倍的AH药物。PURC的血压控制率更差,按办公室测量,平均比PRRC高15.3mmHg和12.1mmHg。
    UNASSIGNED: Hypertension (HT) remains the leading cause of death worldwide. In Brazil it is estimated that 35% of the adult population has HT and that about 20% of these have blood pressure values within the targets recommended for the reduction of cardiovascular risk. There are some data that point to different control rates in patients treated by cardiologists in public and private referral center and this is an important point to be investigated and discussed.
    UNASSIGNED: To compare sociodemographic characteristics, body mass index (BMI), antihypertensive (AH) drugs, blood pressure (BP) and control rate in public (PURC) and private (PRRC) referral centers.
    UNASSIGNED: A cross-sectional multicenter study that analyzed data from hypertensive patients assisted by the PURC (one in Midwest Region and other in Northeast region) and PRRC (same distribution). Variables analyzed: sex, age, BMI, classes, number of AH used and mean values of systolic and diastolic BP by office measurement and home blood pressure measurement (HBPM). Uncontrolled hypertension (HT) phenotypes and BP control rates were assessed. Descriptive statistics and χ2 tests or unpaired t-tests were performed. A significance level of p < 0.05 was considered.
    UNASSIGNED: A predominantly female (58.9%) sample of 2.956 patients and a higher prevalence of obesity in PURC (p < 0.001) and overweight in PRRC (p < 0.001). The mean AH used was 2.9 ± 1.5 for PURC and 1.4 ± 0.7 for PRRC (p < 0.001). Mean systolic and diastolic BP values were higher in PURC as were rates of uncontrolled HT of 67.8% and 47.6% (p < 0.001) by office measurement and 60.4% and 35.3% (p < 0.001) by HBPM in PURC and PRRC, respectively.
    UNASSIGNED: Patients with HT had a higher prevalence of obesity in the PURC and used almost twice as many AH drugs. BP control rates are worse in the PURC, on average 15.3 mmHg and 12.1 mmHg higher than in the PRRC by office measurement.
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  • 文章类型: English Abstract
    目的:本研究的目的是分析,哪些个人特征(社会人口统计学,态度和政治因素)在2022年西班牙选择私人与公共医疗保健替代家庭医生,医生专家,入院和紧急情况。
    方法:使用社会调查中心(CIS)的健康晴雨表,我们进行了四次Logistic回归(然后,平均边际效应[AME]),其因变量是家庭医生的私人选择与公共选择的偏好,偏好私人选择专科医生而不是公共医生;偏好私人选择入院而不是公共入院,偏好私人选择紧急入院而不是公共入院。因变量是二进制的(1=私有;0=公共)。样本由超过4,500名18岁以上的人组成,分布在整个西班牙。
    结果:选择私人而不是公共的可能性与个人的年龄相关:50岁以上的人不太可能选择私人替代品(P<0.01),以及对国家卫生系统(NHS)工作方式的意识形态和满意度。具有保守意识形态的患者更有可能选择私人选择(P<.01),而对NHS更满意的个人则不太可能选择私人选择(P<.01)。
    结论:对NHS的满意度和患者的意识形态是私人选择与公共选择最相关的因素。
    The aim of the study was to analyze, which individual characteristics (sociodemographic, attitudinal and political factors) mediates in the choice in Spain in 2022, of a private versus public health care alternative for family doctor, doctor specialist, hospital admissions and emergencies.
    Using the health barometers of the Centro de Investigaciones Sociológicas (CIS), we carried out four logistic regressions (then, average marginal effects [AMEs]) whose dependent variables are the preference for a private choice of family doctor versus a public one, the preference for a private choice of doctor specialist versus a public one; the preference for a private choice of hospital admission versus a public one and the preference for a private choice of emergency admission versus a public one. The dependent variables are binary (1=private; 0=public). The sample consisted of more than 4,500 individuals older than 18years old distributed representatively throughout Spain.
    The probability of choosing private rather than public is correlated with the age of the individual: those over 50years are less likely to opt for a private alternative (P<.01), as well as by ideology and satisfaction with the way that the national health system (NHS) works. Patients with a conservative ideology are more likely to choose private options (P<.01) and individuals with greater satisfaction with the NHS are less likely to choose private ones (P<.01).
    Satisfaction with the NHS and patient ideology are the most relevant factors for private versus public choice.
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  • 文章类型: Journal Article
    背景:巴西登革热的负担记录很少,并且基于公共卫生保健机构的数据。这项研究使用Orizon的大型索赔数据库估算了2015年至2020年巴西私人医疗保健系统中登革热管理的患病率和成本。
    方法:我们选择了2015年1月至2020年12月使用登革热ICD编码(ICD-10A90或A91)的索赔。患病率是根据给定年份参加健康保险计划的人口估算的。成本根据截至2021年12月的通货膨胀进行了调整,并通过集中趋势和分散措施进行了评估。
    结果:共包括63,882名独特受益人,登革热病例共64,186例。患病率最高的年份是2015年(使用健康计划的患者占1.6%),2016年和2019年病例也有所增加。2015年的每次住院费用中位数为486.17美元,2020年达到696.72美元。在急诊室看到的病例的平均费用从2015年的97.78美元到2017年的118.16美元不等。
    结论:估计登革热在私人医疗保险患者人群中的患病率遵循巴西普通人群的流行病学趋势,率最高的是2015年、2016年和2019年。多年来,私人医疗保健环境中登革热管理的成本有所增加。
    BACKGROUND: The burden of dengue in Brazil is poorly documented and is based on data from the public health care setting. This study estimated the prevalence and costs of dengue management in the private health care system in Brazil from 2015 to 2020 using a large claims database from Orizon.
    METHODS: We selected claims with dengue ICD codes (ICD-10 A90 or A91) from January 2015 to December 2020. Prevalence was estimated based on the population enrolled in health insurance plans in the given year. Costs were adjusted for the inflation up to December 2021 and evaluated by measures of central tendency and dispersion.
    RESULTS: A total of 63,882 unique beneficiaries were included, with a total of 64,186 dengue cases. The year with the highest prevalence was 2015 (1.6% of patients who used health plans), and there was also an increase in cases in 2016 and 2019. The median cost per hospitalization in 2015 was US$486.17, and in 2020, it reached US$696.72. The median cost of a case seen at an emergency room ranged from US$ 97.78 in 2015 to US$ 118.16 in 2017.
    CONCLUSIONS: The estimated prevalence of dengue in this population of private health-insured patients followed the epidemiological trends of the general population in Brazil, with the highest rates in 2015, 2016, and 2019. The cost of dengue management has increased in the private health care setting over the years.
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  • 文章类型: Journal Article
    BACKGROUND: Compare demographic data, mortality and intensive care unit length of stay (ICU LOS) in patients coming from public hospitals of the Brazilian Unified Health System and patients coming from private hospitals of the Brazilian Supplementary Health System in a single private general ICU.
    METHODS: A retrospective cohort study was performed on patients in the ICU of Hospital Anchieta in Brasilia, DF, Brazil, over a period of 2 years. The patients were divided into 2 groups: patients from public hospitals of the Unified Health System group (PUBH, N = 75) and patients from private hospitals of the Brazilian Supplementary Health System group (PRIH, N = 1,614).
    RESULTS: In total, 1,689 patients were admitted. For the entire cohort, the median age was 62 ± 17 years, and the mean APACHE II score was 13 ± 7. The PUBH had a higher APACHE II score (18 ± 9 versus 12 ± 7, P = 0.00), were younger (53 ± 2 versus 63 ± 16 years, P = 0.00), and had higher incidence of circulatory shock (19.2 versus 11.4%, P = 0.01), and kidney injury or renal failure (38.4 versus 25.5%, P = 0.01) at the time of ICU admission, compared to the PRIH. The ICU LOS was longer for the PUBH compared to the PRIH (18 ± 18 versus 6 ± 14 days, P = 0.00). The overall mortality rate was higher for the PUBH compared to the PRIH (33.3 versus 9.7%, P = 0.00).
    CONCLUSIONS: In a single ICU, where patients had access to the same human and technological resources, patients from the PUBH had a higher APACHE II score, ICU LOS, and mortality rate than those from the PRIH.
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