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      Gastos asumidos por la familia durante el ingreso en el hogar Translated title: Costs of home-based care for the family

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          Abstract

          Introducción El ingreso en el hogar como alternativa asistencial del nivel primario de atención de salud tiene ventajas en términos de la calidad del servicio así como en relación con la utilización de los recursos estatales, sin embargo, representa un gasto para las economías familiares. Objetivos Estimar y caracterizar el gasto de bolsillo de pacientes ingresados en el hogar en cuatro grupos básicos de trabajo representativos de diferentes áreas geográficas. Métodos Se analizó la información de los pacientes en régimen de ingreso en el hogar, entre julio de 2002 y junio de 2003 en un área del municipio Playa, una del municipio Cruces, otra del municipio Unión de Reyes y una de Fomento. Se estimó el gasto de bolsillo por paciente, por día de estadía y para las causas de ingreso más frecuentes. Se expresó en pesos cubanos no convertibles y en moneda libremente convertible. Resultados El 80 % o más de las familias tuvieron algún gasto adicional. En las áreas urbanas el mayor gasto fue en la alimentación y en las áreas rurales los medicamentos. El gasto por trasporte fue importante en el área rural. La mediana del gasto de bolsillo por paciente estuvo entre 109,17 y 31,75 pesos cubanos no convertibles. Por día de estadía el gasto de bolsillo,osciló entre 16,79 y 3,14 pesos cubanos no convertibles. El gasto de bolsillo en moneda libremente convertible no fue importante. Conclusiones El ingreso en el hogar es una carga económica adicional para la familia en especial para el área urbana metropolitana. Se debe profundizar en la razón costo efectividad de los esquemas terapéuticos indicados, así como en el aseguramiento de los medios de diagnósticos en el área de salud

          Translated abstract

          Introduction Home care as an alternative for primary health care is advantageous in terms of quality of service and governmental resource utilization, but it also represents an expenditure for the family. Objectives To estimate and to characterize the costs of home care for patients in different geographic areas. Methods Data on patients under home care conditions from July 2002 to June 2003 in different areas located in Playa municipality, Cruces municipality, Union de Reyes municipality and Fomento municipality were analyzed. Expenditures per patient, per stay day and per most frequent causes of home care were estimated and given in Cuban domestic currency and in foreign currency. Results Eighty percent or more of the families faced some extra expenditure. Food represented the highest cost in urban areas whereas drugs were the main line of expenditure in rural areas. Transportation cost was an important aspect in the rural setting. The median of expenditure per patient ranged from 109.17 to 31.75 Cuban pesos. Expenditure per stay day ranged from 16. 79 to 3.14 Cuban pesos. Foreign currency cost was not significant. Conclusions Home care is an additional economic burden for the family, particularly in the metropolitan urban setting. Cost-effectiveness of the prescribed therapeutic schemes as well as availability of diagnostic means in the health area should be in-depth analyzed

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          Clasificación Internacional de Enfermedades

          (1978)
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            Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial.

            To compare the costs of admission to a hospital at home scheme with those of acute hospital admission. Cost minimisation analysis within a pragmatic randomised controlled trial. Hospital at home scheme in Leicester and the city's three acute hospitals. 199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period (median age 84 years). Hospital at home or hospital inpatient care. Costs to NHS, social services, patients, and families during the initial episode of treatment and the three months after admission. Mean (median) costs per episode (including any transfer from hospital at home to hospital) were similar when analysed by intention to treat-hospital at home 2569 pounds sterling (1655 pounds sterling), hospital ward 2881 pounds sterling (2031 pounds sterling), bootstrap mean difference -305 (95% confidence interval -1112 to 448). When analysis was restricted to those who accepted their allocated place of care, hospital at home was significantly cheaper-hospital at home 2557 pounds sterling(1710 pounds sterling), hospital ward 3660 pounds sterling (2903 pounds sterling), bootstrap mean difference -1071 (-1843 to -246). At three months the cost differences were sustained. Costs with all cases included were hospital at home 3671 pounds sterling (2491 pounds sterling), hospital ward 3877 pounds sterling (3405 pounds sterling), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were included the costs were hospital at home 3698 pounds sterling (2493 pounds sterling), hospital ward 4761 pounds sterling (3940 pounds sterling), bootstrap mean difference -1063 (-2044 to -163); P=0.009. About 25% of the costs for episodes of hospital at home were incurred through transfer to hospital. Costs per day of care were higher in the hospital at home arm (mean 207 pounds sterling v 134 pounds sterling in the hospital arm, excluding refusers, P<0.001). Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.
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              Cost-effectiveness of home-based care versus hospital care for chronically ill tuberculosis patients, Francistown, Botswana.

              Francistown, Botswana, 1999. To determine the affordability and cost-effectiveness of home-based directly observed therapy (DOT) compared to hospital-based DOT for chronically ill tuberculosis (TB) patients, and to describe the characteristics of patients and their caregivers. Costs for each alternative strategy were analysed from the perspective of the health system and caregivers, in 1998 US dollars. Caregiver costs were assessed using a structured questionnaire administered to a sample of 50 caregivers. Health system costs were assessed using interviews with relevant staff and documentary data such as medical records and expenditure files. These data were used to calculate the average cost of individual components of care, and, for each alternative strategy, the average cost per patient treated. Cost-effectiveness was calculated as the cost per patient compliant with treatment. The characteristics of caregivers and patients were assessed using demographic and socio-economic data collected during interviews, and medical records. Overall, home-based care reduced the cost per patient treated by 44% compared with hospital-based treatment (dollars 1657 vs. dollars 2970). The cost to the caregiver was reduced by 23% (dollars 551 vs. dollars 720), while the cost to the health system was reduced by 50% (dollars 1106 vs. dollars 2206). The cost per patient complying with treatment was dollars 1726 for home-based care and dollars 2970 for hospitalisation. Caregivers were predominantly female relatives (88%), unemployed (48%), with primary school education or less (82%), and with an income of less than dollars 1000 per annum (71%). Of those patients with an HIV test result, 98% were HIV-positive. Home-based care is more affordable and cost-effective than hospital-based care for chronically ill TB patients, although costs to caregivers remain high in relation to their incomes. Structured home-based DOT should be included as a component of the National Tuberculosis Control Programme in Botswana.
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                Author and article information

                Journal
                rcsp
                Revista Cubana de Salud Pública
                Rev. cub. salud pública
                Centro Nacional de Información de Ciencias Médicas (La Habana, La Habana, Cuba )
                0864-3466
                1561-3127
                June 2008
                : 34
                : 2
                Affiliations
                [01] La Habana orgnameInstituto Nacional de Higiene, Epidemiología y Microbiología Cuba
                Article
                S0864-34662008000200007 S0864-3466(08)03400207
                b7e2b88c-feb5-4a9c-800f-a656990ea1d8

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 10 April 2007
                : 07 September 2007
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 0
                Product

                SciELO Public Health

                Categories
                INVESTIGACION

                Expenditure,home care,Gasto de bolsillo,ingreso en el hogar

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