Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.
Costs and epidemiological changes of chronic diseases: implications and challenges for health systems.
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DOI：
10.1371/journal.pone.0118611
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发表时间：
2015
期刊：
影响因子：
3.7
通讯作者：
Aviles R
中科院分区：
文献类型：
--
作者：
Arredondo A;Aviles R
由于需要将经济和流行病学方面纳入临床观点，因此提出了一项关于分析健康差距和评价保健服务以及中等收入国家保健制度改革目前所面临的新挑战的建议。了解某中等收入县慢性病(糖尿病、高血压)的流行病学变化、卫生服务需求和经济负担。我们对墨西哥卫生系统中糖尿病和高血压的费用和流行病学变化进行了纵向分析。研究人群包括参保人群和未参保人群。采用基于仪表法和共识技术的成本评估方法。为了估计2014-2016年的流行病学变化和财务后果，根据Box-Jenkins技术，使用95%的可信区间和Box-Piells检验构建了6个模型。关于2014年这两种疾病与2016年相比预期的流行病学变化，预计会有所增加，尽管结果预测糖尿病的增长更大，在所有三个研究机构中都有8%-12%的增长(p<；0.05)。事实上，在糖尿病方面，未参保人群增加了41469例，参保人群增加了65737例。在高血压病例中，未参保的患者增加了38109，投保的患者增加了62895。糖尿病患者的每个患者的年度病例管理成本从699美元到748美元不等，高血压患者的成本从485美元到622美元不等。比较参保人群和未参保人群所需医疗服务的财务后果，参保人群的增长幅度更大(23%)(p<；0.05)。这两种疾病的财政需求将占未参保者总预算的19.5%，占参保者总预算的12.5%。如果风险因素和不同的卫生保健模式保持不变，预期的流行病学变化对社会保障制度的经济影响将特别强烈。另一个相关的挑战是，在使用和分配财政资源方面，出现了与其他慢性病和传染病方案的内部竞争。
The need to integrate economic and epidemiological aspects in the clinical perspective leads to a proposal for the analysis of health disparities and to an evaluation of the health services and of the new challenges which are now being faced by health system reforms in middle income countries. To identify the epidemiological changes, the demand for health services and economic burden from chronic diseases (diabetes and hypertension) in a middle income county. We conducted longitudinal analyses of costs and epidemiological changes for diabetes and hypertension in the Mexican health system. The study population included both the insured and uninsured populations. The cost-evaluation method was used, based on the instrumentation and consensus techniques. To estimate the epidemiological changes and financial consequences for 2014–2016, six models were constructed according to the Box-Jenkins technique, using confidence intervals of 95%, and the Box-Pierce test. Regarding epidemiological changes expected in both diseases for 2014 vs. 2016, an increase is expected, although results predict a greater increase for diabetes, 8–12% in all three studied institutions, (p < .05). Indeed, in the case of diabetes, the increase was 41469 cases for uninsured population (SSA) and 65737 for the insured population (IMSS and ISSSTE). On hypertension cases the increase was 38109 for uninsured vs 62895 for insured. Costs in US$ ranged from $699 to $748 for annual case management per patient in the case of diabetes, and from $485 to $622 in patients with hypertension. Comparing financial consequences of health services required by insured and uninsured populations, the greater increase (23%) will be for the insured population (p < .05). The financial requirements of both diseases will amount to 19.5% of the total budget for the uninsured and 12.5% for the insured population. If the risk factors and the different health care models remain as they currently are, the economic impact of expected epidemiological changes on the social security system will be particularly strong. Another relevant challenge is the appearance of internal competition in the use and allocation of financial resources with programs for other chronic and infectious diseases.
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影响因子：
3.7
作者：
Arredondo, Armando;Reyes, Gabriela
通讯作者：
Reyes, Gabriela
影响因子：
168.9
作者：
Lozano, Rafael;Naghavi, Mohsen;Murray, Christopher J. L.
通讯作者：
Murray, Christopher J. L.
影响因子：
0.9
作者：
dos Santos, Jenifa Cavalcante;Magalhaes Moreira, Thereza Maria
通讯作者：
Magalhaes Moreira, Thereza Maria
影响因子：
2.4
作者：
Johnson, Samuel;Delate, Thomas;Zager, Carol
通讯作者：
Zager, Carol
DOI：
10.21149/spm.v55s2.5108
发表时间：
2013-01-01
期刊：
Salud Pública de México
影响因子：
--
作者：
Hernández-Ávila, Mauricio;Gutiérrez, Juan Pablo;Reynoso-Noverón, Nancy
通讯作者：
Reynoso-Noverón, Nancy