scholarly journals Cost of schizophrenia: direct costs and use of resources in the State of São Paulo

2006 ◽  
Vol 40 (2) ◽  
pp. 304-309 ◽  
Author(s):  
Raquel Jales Leitão ◽  
Marcos Bosi Ferraz ◽  
Ana Cristina Chaves ◽  
Jair J Mari

OBJECTIVE: To estimate the direct costs of schizophrenia for the public sector. METHODS: A study was carried out in the state of São Paulo, Brazil, during 1998. Data from the medical literature and governmental research bodies were gathered for estimating the total number of schizophrenia patients covered by the Brazilian Unified Health System. A decision tree was built based on an estimated distribution of patients under different types of psychiatric care. Medical charts from public hospitals and outpatient services were used to estimate the resources used over a one-year period. Direct costs were calculated by attributing monetary values for each resource used. RESULTS: Of all patients, 81.5% were covered by the public sector and distributed as follows: 6.0% in psychiatric hospital admissions, 23.0% in outpatient care, and 71.0% without regular treatment. The total direct cost of schizophrenia was US$191,781,327 (2.2% of the total health care expenditure in the state). Of this total, 11.0% was spent on outpatient care and 79.2% went for inpatient care. CONCLUSIONS: Most schizophrenia patients in the state of São Paulo receive no regular treatment. The study findings point out to the importance of investing in research aimed at improving the resource allocation for the treatment of mental disorders in Brazil.

2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Polyradiculoneuritis is considered to be the biggest cause of flaccid paralysis in the world and even after the progression phase, some patients may present with disabling residual deficits, both sensory and motor. Objectives: Analyze the current panorama of treatment procedures for acute demyelinating polyradiculoneuritis performed in the State of São Paulo and correlate the current epidemiology with the results obtained. Methods: A literature review and an observational, descriptive and transversal data collect on treatment for acute demyelinating polyradiculoneuritis, available at DATASUS from January 2008 to December 2020, and articles available at Scielo and PubMed. Results: There were 7,917 hospitalizations, representing a total expenditure of R$ 9,392,552.04, 2009 being the year with the highest number of hospitalizations (809) and 2017 with the highest amount spent during the period (R$ 967,284.65). 805 are elective and 7,109 are urgent, with 1,736 occurring in the public sector and 3,506 in the private sector. All of them were considered medium complexity. The total mortality rate was 1.57, corresponding to 124 deaths, 2019 being the year with the highest mortality rate, 2.94, and 2015 with the lowest rate, 0.53. The mortality rate for elective procedures was 0.99 compared to 1.63 for urgent procedures, whereas in the public sector it was 1.61 compared to 1.23 for the private sector. The average total hospital stay was 8.3 days, with an average cost of R$ 1,186.38. Conclusion: It is important to correctly notify the procedures performed, improving the epidemiological analysis and directing investments in health more appropriately.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Muscular dystrophies are degenerative and genetic diseases characterized by progressive weakness and muscle atrophies. Objectives: To analyze the current panorama of muscular dystrophy treatment procedures performed in the State of São Paulo, correlating it with current epidemiology. Methods: literature review and observational, descriptive, and transversal data collect on the treatment of muscular dystrophies, available on the DATASUS website, from January 2008 to December 2020, and articles from Scielo and PubMed. Results: There were 2,600 hospitalizations with a total expenditure of R$ 28,004,202.59, with 2015 being the year with the highest number of hospitalizations (248), although 2014 was the year responsible for the highest amount spent during the period (R$ 2,858,500 , 87). Of the total procedures, 1,849 were carried out on an elective basis and 749 were urgent, with 1,330 occurring in the public sector and 286 in the private sector. The total mortality rate was 1.08, corresponding to 28 deaths, with 2016 being the year with the highest mortality rate, 4.91, while 2014 had the lowest rate, 0.41. The mortality rate for elective procedures was 0.54 compared to 2.40 for urgent procedures, whereas in the public sector it was 0.53 compared to 1.75 for the private sector. The average total hospital stay was 27.7 days, with an average cost of R$ 10,770.85. Conclusion: the treatment of muscular dystrophies usually occurs in an elective regime and in the public sector, with the mortality rate being lower in the public service compared to the private one.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Intracerebral Hematoma has a high mortality rate. However, those who survive may experience sequelae, such as severe neurological deficits. Objectives: To analyze the current panorama of surgical treatment procedures for intracerebral hematoma performed in the State of São Paulo and to correlate the current epidemiology. Methods: A literature review and observational, descriptive and transversal data collect on surgical treatment of intracerebral hematoma, available at DATASUS from January 2008 to December 2020, and articles available at Scielo and PubMed, were carried out. Results: There were 7,716 hospitalizations, representing a total expenditure of R$ 43,880,884.82, with 2009 being the year with the highest number of hospitalizations (758) and 2010 the year with the highest amount spent (R$ 3,961,287.80). 777 procedures were carried out on an elective basis and 6,447 and on an urgent basis, with 3,074 occurring in the public sector and 2,004 in the private sector. All 7,716 considered to be of medium complexity. The total mortality rate was 35.82, corresponding to 2,764 deaths, with 2015 being the year with the highest mortality rate, 38.36, while 2020 had the lowest rate, 32.58. The mortality rate for elective procedures was 22.52 compared to 38.67 for urgent procedures, whereas in the public sector it was 34.39 compared to 37.77 for the private sector. The average total hospital stay was 15.7 days, with an average cost of R$ 5,687.00. Conclusion: There was a predominance of the emergency service and the public sector, and the mortality rate was higher in the private service.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Polyneuropathy is the simultaneous dysfunction of several peripheral nerves that normally occurs as a result of diabetes. Objectives: To analyze the current panorama of treatment of polyneuropathies performed in the State of São Paulo and to correlate with the epidemiology. Methods: literature review and observational, descriptive and transversal data collect on treatment of polyneuropathies, available at DATASUS from January 2008 to December 2020, assessing the number of hospitalizations, the amount of public spending, complexity, mortality rate, deaths, permanence and character of service, and articles available in Scielo, Lilacs and PubMed. Results: There were 19,099 hospitalizations for polyneuropathy treatment procedures with a total expense of R$ 21,870,767.84, with 2014 being the year with the highest number of hospitalizations (1,740) and with the highest amount spent (R$ 2,034,880.25) . Of the total procedures, 3,732 were carried out on an elective basis and 15,362 in urgency, with 5,774 in the public sector and 6,396 in the private sector. All 19,099 considered to be of medium complexity. The total mortality rate was 1.63, corresponding to 312 deaths, with 2020 being the year with the highest mortality rate, 2.42, while 2014 had the lowest rate, 1.26. The mortality rate for elective procedures was 0.38 compared to 1.94 for urgent procedures, whereas in the public sector it was 1.25 compared to 1.77 for the private sector. The average total hospital stay was 9.3 days, with an average cost of R$ 1,145.13. Conclusion: Polyneuropathy is a disease that has a low mortality rate.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
Tiago Veiga Gomes ◽  
...  

Background: Polyneuropathy is the simultaneous dysfunction of several peripheral nerves that normally occurs as a result of diabetes. Objectives: To analyze the current panorama of treatment of polyneuropathies performed in the State of São Paulo and to correlate with the epidemiology. Methods: literature review and observational, descriptive and transversal data collect on treatment of polyneuropathies, available at DATASUS from January 2008 to December 2020, assessing the number of hospitalizations, the amount of public spending, complexity, mortality rate, deaths, permanence and character of service, and articles available in Scielo, Lilacs and PubMed. Results: There were 19,099 hospitalizations for polyneuropathy treatment procedures with a total expense of R$ 21,870,767.84, with 2014 being the year with the highest number of hospitalizations (1,740) and with the highest amount spent (R$ 2,034,880.25) . Of the total procedures, 3,732 were carried out on an elective basis and 15,362 in urgency, with 5,774 in the public sector and 6,396 in the private sector. All 19,099 considered to be of medium complexity. The total mortality rate was 1.63, corresponding to 312 deaths, with 2020 being the year with the highest mortality rate, 2.42, while 2014 had the lowest rate, 1.26. The mortality rate for elective procedures was 0.38 compared to 1.94 for urgent procedures, whereas in the public sector it was 1.25 compared to 1.77 for the private sector. The average total hospital stay was 9.3 days, with an average cost of R$ 1,145.13. Conclusion: Polyneuropathy is a disease that has a low mortality rate.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Multiple sclerosis is a chronic disease of the central nervous system, it has an inflammatory and autoimmune character. Objectives: Analyze the current panorama of multiple sclerosis treatment procedures carried out in the State of São Paulo for 13 years and correlate the current epidemiology with the results obtained. Methods: A literature review and observational, descriptive and transversal data collect on the treatment data for multiple sclerosis outbreaks, available at DATASUS from January 2008 to December 2020, and articles available at Scielo and PubMed, were carried out. Results: There were 13,282 hospitalizations, representing a total expenditure of R$ 6,493,227.03, with 2019 being the year with the highest number of hospitalizations (2,250) and with the highest amount spent during the period (R$ 915,299.20). Of the total procedures, 9,104 were performed on an elective basis and 4,178 on an urgent basis, with 1,897 occurring in the public sector and 1,493 in the private sector. All 13,282 considered to be of medium complexity. The total mortality rate was 0.62, corresponding to 83 deaths. The mortality rate for elective procedures was 0.05 compared to 1.87 for urgent procedures, whereas in the public sector it was 1.00 compared to 2.41 for the private sector. The average total hospital stay was 2.6 days, with an average cost of R$ 488.87. Conclusion: It is possible to note, therefore, that the procedures have a predominance of the elective character and the public sector, with the highest mortality rates occurring in the private and emergency services.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Muscular dystrophies are degenerative and genetic diseases characterized by progressive weakness and muscle atrophies. Objectives: To analyze the current panorama of muscular dystrophy treatment procedures performed in the State of São Paulo, correlating it with current epidemiology. Methods: literature review and observational, descriptive, and transversal data collect on the treatment of muscular dystrophies, available on the DATASUS website, from January 2008 to December 2020, and articles from Scielo and PubMed. Results: There were 2,600 hospitalizations with a total expenditure of R$ 28,004,202.59, with 2015 being the year with the highest number of hospitalizations (248), although 2014 was the year responsible for the highest amount spent during the period (R$ 2,858,500 , 87). Of the total procedures, 1,849 were carried out on an elective basis and 749 were urgent, with 1,330 occurring in the public sector and 286 in the private sector. The total mortality rate was 1.08, corresponding to 28 deaths, with 2016 being the year with the highest mortality rate, 4.91, while 2014 had the lowest rate, 0.41. The mortality rate for elective procedures was 0.54 compared to 2.40 for urgent procedures, whereas in the public sector it was 0.53 compared to 1.75 for the private sector. The average total hospital stay was 27.7 days, with an average cost of R$ 10,770.85. Conclusion: the treatment of muscular dystrophies usually occurs in an elective regime and in the public sector, with the mortality rate being lower in the public service compared to the private one.


Author(s):  
Alessandra Freire Reis ◽  
Odaléia Telles Marcondes Machado Queiroz

A discussão sobre a concessão das unidades de conservação é extremamente importante e tem gerado polêmica no Estado de São Paulo, devido à aprovação da Lei Nº 16.260, de 29 de junho de 2016, que “autoriza a Fazenda do Estado a conceder a exploração de serviços ou o uso, total ou parcial, de áreas em próprios estaduais”. A pesquisa e o debate sobre o tema são fundamentais para compreensão e reflexão das possibilidades e consequências da escolha deste caminho para as UCs, ainda que estes devessem anteceder a tomada de decisão. As atividades turísticas e de lazer estão dentre os principais serviços a serem concedidos a iniciativa privada nos Parques Estaduais. Embora essas atividades estejam dentre os objetivos deste tipo de categoria de UC é preeminente ressaltar que a conservação deve nortear a gestão. O Estado é responsável por proteger importantes fragmentos de Mata Atlântica e Cerrado, em áreas com diferentes tipos de ocupação e pressão. Para tanto, necessita de investimento em pessoal capacitado, infraestrutura e equipamentos, além do apoio e diálogo com comunidades tradicionais, que tenham relação com as áreas. O que se observa atualmente é a precarização dos serviços prestados, em que os servidores públicos não têm plano de carreira e os guarda-parques, funcionários primordiais para essas áreas, estão se extinguindo e com eles todo um rico conhecimento. A maioria dos gestores é comissionada e em alguns casos não tem formação adequada para função. A fiscalização é terceirizada e patrimonial deixando que a Floresta propriamente dita, fique a mercê de usos indevidos e inadequados como ocupação irregular, extração de flora, caça, depósito de entulhos, entre outros. É fato que as atividades de uso público realizadas atualmente estão aquém das possibilidades dos parques. A concessão de serviços como alimentação, hospedagem, aluguel de equipamentos e implantação de estruturas para atividades de ecoturismo podem sim ser uma alternativa para dinamizar o uso desses espaços e gerar recursos. Há diversos exemplos de sucesso no exterior e no Brasil, que podem ser inspiradores. Porém, é necessário fundamentalmente que o Estado assuma a responsabilidade legal de salvaguardar as UCs, valorizando a carreira dos servidores públicos investindo em concursos e capacitações. Somente com uma estrutura organizacional fortalecida será possível conduzir com eficiência processos de concessão, que contribuam com a otimização de uso adequado desses espaços. As UCs fornecem serviços ambientais imensuráveis e dentre eles estão às oportunidades turismo, lazer e recreação. Tourism Concessions in Protected Areas of São Paulo state (Brazil): reflections, opportunities and challenges ABSTRACT The discussion on the concession of protected areas is extremely important and has generated controversy in the State of São Paulo, due to the approval of the draft law Nº 16.260, that "authorizes the State Treasury to grant the exploitation of services or use of all or part of areas in state themselves." Research and debate on the subject are fundamental to understanding and reflection of the possibilities and consequences of choosing this way for protected area, even if they were to precede decision-making. Tourist and leisure activities are among the main services to be granted to private initiative in the State Parks. Although these activities are among the goals of that category of PA is paramount to emphasize that conservation should guide the management. The State is responsible for protecting important fragments of Atlantic Forest and Savannah, in areas with different types of occupation and pressure. Therefore, it needs investment in trained personnel, infrastructure and equipment, and support and dialogue with traditional communities that relate to the areas. What we currently see is the precariousness of services, where public servants have no career plan and park rangers, primary staff to these areas, they are dying off and with them a whole wealth of knowledge. Most managers are commissioned and in some cases do not have adequate training to function. The inspection is outsourced and property letting the forest itself, be at the mercy of undue and inappropriate uses such as illegal occupation, flora extraction, hunting, debris deposit, among others. It is true that the public use activities currently performed are beyond the means of the parks. The concession of services such as food, lodging, equipment rental and implementation of ecotourism activities to structures can indeed be an alternative to boost the use of these spaces and generate resources. There are many examples of success in Brazil and abroad, which can be inspiring. However, it is fundamentally necessary that the State assumes the legal responsibility to safeguard the protected areas, enhancing the careers of public servants investing in competitions and training. Only with a strengthened organizational structure will be possible to drive efficiently concession processes that contribute to the optimization of appropriate use of these spaces. PAs provide immeasurable environmental services and among them are the opportunities tourism, leisure and recreation. KEYWORDS: State Parks; Public Use; Management; Conservation.


2021 ◽  
Author(s):  
Paulo Roberto Hernandes Júnior ◽  
Juliana de Souza Rosa ◽  
Patrick de Abreu Cunha Lopes ◽  
Bárbara Tisse da Silva ◽  
Heloá Santos Faria da Silva ◽  
...  

Background: Cerebral hemorrhage represents 10% to 15% of all strokes, with the worst prognosis and the highest rate of morbimortality. Objectives: To analyze the panorama of conservative treatment procedures for cerebral hemorrhage in the State of São Paulo and correlate it with the current epidemiology. Methods: observational, descriptive and cross-sectional collection of conservative treatment data for cerebral hemorrhage, available at DATASUS website, from January 2008 up to December 2020 - evaluating the number of hospitalizations, public spending, complexity, mortality rate, deaths, permanence and character of care. Results: 15,327 hospitalizations were observed for such procedures in this period, representing a total expenditure of R$ 30,258,539.39. 2008 was the year with the highest number of hospitalizations (1,373), and 2020 was the year with the greatest expenditure (R$ 3,008,526.38). 552 of the were elective and 14,606 were urgent, with 4,102 occurring in the public sector and 4,510 in private one. All 15,327 considered to be of medium complexity. The mortality rate was 29.68, corresponding to 4,549 deaths, 2009 was the year with the highest mortality, 33.33 and 2008 the lowest, 24.33. Mortality rate was lower in elective procedures (15.40 versus 30.48 in urgent ones) and when carried out in public sector (27.16 versus 30.07 in private care). The hospital stay was 11.0 days, with a cost of R$ 1,974.20. Conclusion: The conservative treatment of cerebral hemorrhage represents a procedure of medium complexity with a long period of hospital stay. Higher mortality was observed in emergency care and the private sector.


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