Revista Panamericana de Salud Pública/Pan American Journal of Public Health

Direct medical costs of invasive pneumococcal disease and radiologicallydiagnosed pneumonia among Chilean children

Objectives. To determine the direct medical costs of health care services for cases of invasive pneumococcal disease (IPD) and pneumonia acquired in the community and confirmed by radiology (NAC-Rx) among Chilean children.
Methods. A prospective follow-up study of the health services delivered to 594 children 0–35 months of age with IPD and 1 489 children 1–35 months with NAC-Rx, diagnosed and treated by organizations within public health network of the Región Metropolitana de Chile. The value of the health services was established according to rates supplied by the Fondo Nacional de Salud (FONASA, the National Health Fund) and prices charged by two private clinics. The national IPD and NAC-Rx rates were estimated to calculate the total national economic burden for the population covered by state health insurance.
Results. The mean cost of cases requiring hospitalization was US$ 1 056.20 for IPD and US$ 594.80 for NAC-Rx, while that of cases treated by out-patient services was US$ 77.70 and US$ 65.20, respectively. The cost of the same services for in-patient care at the private clinics was US$ 4 484.10 and US$ 2 962.70 at one clinic and US$ 9 967.50 and US$ 6 578.40 at the other. The estimated national annual cost of services for children under 5 years of age, according to FONASA rates, was US$ 789 045 for IPD and US$ 13 823 289 for NAC-Rx.
Conclusions. The high demand for services and financial resources for NAC-Rx in children 0–3 years of age is a tremendously powerful public health reason to support the routine use of pneumococcal vaccination in Chilean children.

Objetivos. Determinar los costos médicos directos relacionados con la atención sanitaria de los casos de enfermedades neumocócicas invasoras (ENI) y neumonías adquiridas en la comunidad confirmadas mediante radiología (NAC-Rx) en niños chilenos.
Métodos. Estudio de seguimiento prospectivo de las prestaciones de salud entregadas a 594 niños de 0 a 35 meses con ENI y 1 489 niños de 1 a 35 meses con NAC-Rx, diagnosticados y tratados en establecimientos de la red pública de salud de la Región Metropolitana de Chile. Las prestaciones se valoraron según las tarifas del Fondo Nacional de Salud (FONASA) y los precios de dos clínicas privadas. Se estimó la incidencia nacional anual de ENI y NAC-Rx para calcular la carga económica total nacional de la población afiliada al seguro de salud estatal.
Resultados. Los costos promedio de los casos que requirieron hospitalización fueron US$ 1 056,20 para las ENI y US$ 594,80 para las NAC-Rx, mientras que para los casos tratados en forma ambulatoria fueron US$ 77,70 y US$ 65,20, respectivamente. Los precios por los mismos servicios de internación fueron US$ 4 484,10 y US$ 2 962,70 en una de las clínicas privadas y US$ 9 967,50 y US$ 6 578,40 en la otra. El costo anual nacional estimado de la atención de los niños menores de 5 años según las tarifas de FONASA fue de US$ 789 045 para las ENI y US$ 13 823 289 para las NAC-Rx.
Conclusiones. La alta demanda asistencial y económica por NAC-Rx en niños de 0 a 3 años es una razón de salud pública tremendamente poderosa que apoya el uso sistemático de la vacunación antineumocócica en niños chilenos.

National public health institutes: a coordinated and comprehensive approach toward influenza A H1N1 and other threats to public health

The current influenza A H1N1 epidemic has demonstrated once again the importance of being able to count on robust, coordinated, and comprehensive public health systems. Countries that do rely on such health systems have proven to recognize, diagnose, and treat influenza in a timely manner, and to provide the public with the education needed to minimize the number of deaths and acute cases. The International Association of National Public Health Institutes (IANPHI) recommends that all countries begin to coordinate their national public health efforts. IANPHI offers its support and guidance to all who would create or strengthen their national public health institutes. By strengthening national public health systems, the ability to collaborate and the security of all countries is heightened. These institutions exist for the public good, and any improvements made to them are also a contribution toward better health for the population.

Por lo general, el público no reconoce en su justa medida el papel que desempeñan los sistemas nacionales de salud y sus instituciones de salud pública, especialmente cuando funcionan bien. Solamente cuando se presenta un desafío o una crisis de salud pública —como los brotes de enfermedades infecciosas, los desastres naturales o los aumentos alarmantes en las tasas de enfermedades crónicas o de lesiones— quedan expuestos los puntos débiles de los sistemas nacionales de salud pública y se hace notar la necesidad de robustecerlos y de establecer enfoques coordinados para la prevención y el control de las enfermedades (1, 2).

Development of primary health care competencies

Given that the lack of qualified human resources devoted to primary health care (PHC) is one of the reasons why Alma Ata goals are as yet unattained, PAHO/WHO sponsored the design and implementation of a virtual course for training health care professionals at this level. The course was designed around competencies identified as being necessary for renewing primary care, founded on the premise that providing quality, sustainable services amenable to the public must emanate from professionals who lead the change process at all levels in the system. In this first phase, instruction is aimed at PHC leaders, managers, and other decision makers. The course is offered through the Virtual Public Health Campus and is 27 weeks long.

Han pasado más de 30 años desde que se introdujo4 en Alma Ata el concepto de atención primaria de salud (APS), una iniciativa dirigida a mejorar la equidad en el acceso a los servicios y la eficiencia en el uso de los recursos de salud, con un fuerte énfasis en la atención preventiva y en las poblaciones menos favorecidas. Una de sus premisas era que en muchos casos las causas de las enfermedades trascienden al sector de la salud y por lo tanto deben abordarse con un enfoque en el cual participe toda la sociedad (1).

Encouraged by a solid commercial structure and growing cultural influence, information and communication technologies for health (ICTH) appear as a natural reference point for matters of self-care. As a first trend, ICTH involved end user consultations to websites specializing in health. Soon after, the development of algorithms focused on the identification of illnesses to meet the needs of consumers seeking distant, impersonal technical advice. Despite the comfort and confidentiality, there is evidence that such resources have generated more doubt and anxiety than meaningful clarifications. According to the literature, users seem to have difficulties in identifying and naming their own symptoms, in addition to having to choose between shallow or alarmist advice. Despite the investments made in providing information, most sources of information do not rely on previous cultural studies about how users interpret their health conditions when resorting to selfdiagnosis, which ends up by pushing them, paradoxically, to look for specialists.

A Internet tem se apresentado como recurso valioso no acesso às informações necessárias ao autocuidado, assim como na interação entre profissionais e seus clientes (1–3). Encorajadas por um aparato comercial de crescente influência nessa área de produção e por teóricos entusiastas (4), as tecnologias de informação e comunicação em saúde (TICS) buscam alcançar a qualidade da informação e se aprimoram quanto ao empoderamento do consumidor (1, 5). O contexto da elevação exponencial dos custos assistenciais, associado ao acesso hierarquizado, não-universal, aos serviços de saúde (sobretudo no cenário norte-americano) parece ter gerado demandas em saúde mal contempladas em uma sociedade cada vez mais conectada à “grande rede de informação” (4). Perante tais perspectivas, surgiram os primeiros sites de saúde direcionados à população leiga. A disponibilização de informações técnicas na Internet prenunciou o surgimento de uma nova saúde pública (6), centrada no autoesclarecimento e na autorresponsabilização dos usuários em questões ligadas à sua saúde (7). Entretanto, a disseminação de sites de duvidosa qualificação, a oferecer informações enviesadas para a divulgação de produtos comerciais, levantou questionamentos sobre a qualidade educacional das informações disseminadas nesses formatos (8).

Objective. The nominal registration system of Uruguay’s national immunization program (NIP) tracks administered vaccines on a paper form filled out after each vaccination and collated into a national database, thus allowing for individual follow-up. This study performed a comprehensive assessment of the quality of Uruguay’s immunization data in November 2006 to evaluate the validity of the information and to confirm the high national immunization coverage reported by the program.
Methods. The research team analyzed the concordance of the operational-level numerators (infant immunization data from 18 public and private vaccination centers in six country departments) with department- and national-level data, and compared the national-level (NIP) infant denominators with other official sources. A standardized questionnaire was used to evaluate system performance at the operational (vaccination center), department, and national level. Rapid house-to-house monitoring was conducted to generate additional coverage estimates.
Results. Numerator accuracy throughout the data flow was 100%, and national-level denominators appeared to be exhaustive. Overall system performance was excellent (proper archiving and recording of form data, sufficient supply of forms, timely flow of information, adequate defaulter tracing practices and computer system security). The main weaknesses were the degree of data analysis and feedback to peripheral levels. House-to-house monitoring showed high overall immunization coverage (97%).
Conclusion. Uruguay’s NIP registration system produces remarkably reliable information, ensuring valid measurement of immunization coverage. In addition, by allowing for monitoring of each child’s current vaccination status, it facilitates management of interventions designed to reduce vaccination default and thus helps achieve the country’s high level of coverage.

Evaluación de la calidad de los datos de vacunación generados por el sistema nacional de registro individual en Uruguay, 2006

Objetivos. El sistema de registro nominal del programa nacional de vacunación (PNV) de Uruguay registra las vacunas administradas en un modelo en papel que se llena después de cada vacunación y se introduce en una base de datos nacional, lo que permite el seguimiento individual. En este estudio, realizado en noviembre de 2006, se hizo un análisis integral de la calidad de los datos de vacunación en Uruguay para evaluar la validez de la información y confirmar la alta cobertura nacional de vacunación informada por el programa.
Métodos. Se analizó la concordancia de los numeradores operacionales (datos de vacunación infantil de 18 centros de vacunación públicos y privados de seis departamentos del país) con los datos departamentales y nacionales, y se compararon los denominadores del PNV infantil a nivel nacional con los de otras fuentes oficiales. Se empleó un cuestionario estandarizado para evaluar el desempeño del sistema en los niveles operacional (centros de vacunación), departamental y nacional. Se realizó un monitoreo rápido de casa en casa para obtener estimados adicionales de la cobertura.
Resultados. La precisión de los numeradores en todo el flujo de datos fue de 100% y los denominadores a nivel nacional al parecer eran exhaustivos. El desempeño general del sistema fue excelente (archivo y registro adecuados de los datos, suministro suficiente de modelos, flujo oportuno de información, práctica adecuada de rastreo de fallas y sistema apropiado de seguridad informática). Las principales debilidades fueron el grado de análisis de los datos y la retroalimentación a las instancias periféricas. El monitoreo de casa en casa mostró una alta cobertura general de vacunación (97%).
Conclusiones. El sistema uruguayo de registro del PNV genera una información notablemente confiable, lo que asegura la validez de la medición de la cobertura de vacunación. Además, al permitir el monitoreo del estado de vacunación actual de cada niño, facilita la aplicación y el control de intervenciones diseñadas para reducir las omisiones en la vacunación y ayudar así a alcanzar un alto nivel de cobertura en el país.

Objectives. In a pilot implementation project of the microscopic-observation drugsusceptibility methodology, we conducted a process evaluation to identify health system and logistic challenges that need to be addressed in order to harness the benefits of rolling out promising new diagnostic tools for multidrug-resistant tuberculosis (MDRTB).
Methods. Regional data relating to health system practices and performance related to the MDRTB diagnostic algorithm were collected at health center, local, and regional laboratories.
Results. Parallel implementation of a new test and an existing method creates demands on funds, personnel, sample transport, and information systems in addition to new test startup costs. Obviating the need for primary culture at intermediate laboratories through direct drug susceptibility testing (DST) at the regional reference laboratory significantly reduces delay. Field application of well-defined national guidelines for DST is patchy. If fidelity to national guidelines were perfect, DST requests would increase more than 50-fold, with important implications for laboratory capacity.
Conclusions. Implementing a new MDRTB diagnostic presents challenges to the laboratory environment, the existing DST process, and the application of national guidelines in peripheral clinics. Assessing each element can maximize efficient use of a new tool. Specifically, strengthening systems for transferring samples to the laboratory and delivering results to the requesting clinic in addition to investing in personnel and laboratory resources are integral to harnessing the benefits of high-performance new diagnostic tests and can bring added value to other programs in the health care system.

Preparativos de campo y laboratorio: retos para la introducción de nuevos diagnósticos de la tuberculosis multirresistente

Objetivos. En un proyecto piloto para la implementación de la metodología de observación microscópica para determinar la susceptibilidad a medicamentos se identificaron los retos logísticos y del sistema de salud que se deben atender para aprovechar los beneficios de nuevas y prometedoras herramientas diagnósticas para la tuberculosis resistente a múltiples medicamentos (TRMM).
Métodos. Los datos regionales sobre las prácticas y el desempeño del sistema de salud relacionados con los algoritmos de diagnóstico de la TRMM se recogieron en los centros de salud y los laboratorios locales.
Resultados. La implementación paralela de una nueva prueba y el método actual crea demandas de recursos, personal, transportación de las muestras y sistemas de información adicionales a los costos de introducción de la nueva prueba. Eliminar la necesidad de cultivos primarios en laboratorios intermedios mediante la prueba de susceptibilidad a los medicamentos (PSM) directa en el laboratorio regional de referencia reduce significativamente la demora. La aplicación en el terreno de directivas nacionales bien definidas para las PSM es desigual. Si la fidelidad a las directivas nacionales fuera perfecta, la demanda de PSM aumentaría más de 50 veces, con implicaciones importantes para la capacidad de laboratorio.
Conclusiones. La implementación de un nuevo diagnóstico de TRMM presenta retos para el sistema de laboratorio, el proceso actual de PSM y la aplicación de las directivas nacionales en las clínicas periféricas. La evaluación de cada elemento puede optimizar el uso eficiente de una nueva herramienta diagnóstica. En particular, el fortalecimiento de los sistemas de transportación de muestras al laboratorio y el envío de los resultados a las clínicas solicitantes, además de la inversión en personal y recursos de laboratorio, son requisitos para aprovechar los beneficios de las nuevas pruebas diagnósticas de alto rendimiento y pueden brindar valor añadido a otros programas del sistema de atención sanitaria.

Structural equation model for predicting well-being and functional dependency of the elderly in the Dominican Republic

Objective. To produce a multivariate structural model that explains functional dependence and well-being in terms of certain related sociodemographic factors among elderly adults in the Dominican Republic.
Methods. A cross-sectional study that surveyed a sample of 1 397 individuals 65 or more years of age, representing the Dominican Republic’s elderly population. Those surveyed were asked for sociodemographic information (sex, age, level of education, employment status, and income level), data needed to determine their Barthel Index, and responses to questions from Ryff’s Scale of Psychological Well-being. Three structural equation models were used to identify relationships among the key variables.
Results. The most fitting structural adjustment model linked sociodemographics to the ability to perform basic activities of daily living (BADL) and the Ryff’s Scale of Psychological Well-being, without suggesting latent factors. With regard to endogenous variables, the model’s predictive power was weak. Age was negatively associated with some areas of well-being and with the ability to perform BADL; sex was related to the area of positive relationships with others; and educational level positively influenced environment, personal growth, and having a sense of purpose, as well as the ability to perform BADL.
Conclusions. The proven models provide information necessary for developing policies aimed at two levels of coordinated action: promoting autonomy among elderly adults and expanding enrollment in formal education programs. These results support efforts to increase investment in social policies.

Objetivo. Generar un modelo estructural multifactorial que explique la dependencia funcional y el bienestar a partir de algunas características sociodemográficas asociadas con esos dominios, en adultos mayores de la República Dominicana.
Métodos. Estudio transversal mediante encuesta en una muestra de 1 397 personas de 65 años o más representativa de la población de adultos mayores de la República Dominicana. Se recabó información sociodemográfica de los entrevistados (sexo, edad, nivel de estudios, si realizaba alguna actividad remunerada y nivel de ingresos) y los datos necesarios para calcular el índice de Barthel y las respuestas a las preguntas de las escalas del bienestar psicológico de Ryff. Para identificar las relaciones entre las variables de interés se probaron tres modelos de ecuaciones estructurales.
Resultados. El modelo estructural de ajuste más satisfactorio relacionó las características sociodemográficas con la capacidad para realizar las actividades básicas de la vida diaria (ABVD) y las dimensiones del bienestar psicológico de las escalas de Ryff sin proponer factores latentes. La capacidad predictiva del modelo para las variables endógenas fue débil. La edad se relacionó negativamente con algunas dimensiones del bienestar y con la capacidad para realizar las ABVD; el sexo se relacionó con la dimensión de relaciones positivas con otros; y el nivel de estudios influyó positivamente sobre el dominio del ambiente, el crecimiento personal y el propósito en la vida, así como en la capacidad para realizar las ABVD.
Conclusiones. Los modelos validados brindan información necesaria para desarrollar políticas orientadas a dos niveles de acción complementarios: la promoción de la autonomía de los adultos mayores y el aumento de la cobertura de los sistemas de enseñanza formal. Estos resultados respaldan la conveniencia de aumentar las inversiones en políticas sociales.

Sociodemographic factors associated with symptoms of depression in a sample of women held at two prisons in Mexico

Objectives. To determine the prevalence of depressive symptoms among a sample of women held in two Mexican prisons and to identify the sociodemographic factors associated with these symptoms.
Methods. An exploratory, descriptive study was conducted of women 18–50 years of age in two prisons in the state of Veracruz, Mexico: the Pacho Viejo (PV) facility and Fortaleza San Carlos (FSC) facility. The Hamilton scale for depressive illness was applied and relationships were found between the participants’ scores and their sociodemographic traits (age, marital status, number of children, jail work assignment, and number/frequency of visitors), legal status, type of crime committed, and length of sentence. The analysis employed Student’s T test, Chi-squared test, and Student- Newman-Keuls’ post hoc test, depending on the variable.
Results. All of the women studied at both facilities presented with symptoms of depression. Women at the PV facility had a lower score for depressive symptoms than those at FSC (20.8 ± 0.8 versus 25.2 ± 0.9; P < 0.001). A higher score was found among women with children than among those without children (25.3 ± 0.9 versus 21.8 ± 1.3; P < 0.05); the group of women receiving weekly visits scored (15.0 ± 1.3) significantly lower than the other groups (F[4.46] = 30.7; P < 0.0001). No significant differences were found to be related to marital status, work assignment, age, type of crime, or the length of sentence.
Conclusions. Symptoms of depression were prevalent among the study sample, and were most powerfully related to having children and infrequent visits. Social adaptation programs should encourage continuous contact between women and their children, family, and friends.

Objectives. To determine the prevalence of depressive symptoms among a sample of women held in two Mexican prisons and to identify the sociodemographic factors associated with these symptoms.
Methods. An exploratory, descriptive study was conducted of women 18–50 years of age in two prisons in the state of Veracruz, Mexico: the Pacho Viejo (PV) facility and Fortaleza San Carlos (FSC) facility. The Hamilton scale for depressive illness was applied and relationships were found between the participants’ scores and their sociodemographic traits (age, marital status, number of children, jail work assignment, and number/frequency of visitors), legal status, type of crime committed, and length of sentence. The analysis employed Student’s T test, Chi-squared test, and Student- Newman-Keuls’ post hoc test, depending on the variable.
Results. All of the women studied at both facilities presented with symptoms of depression. Women at the PV facility had a lower score for depressive symptoms than those at FSC (20.8 ± 0.8 versus 25.2 ± 0.9; P < 0.001). A higher score was found among women with children than among those without children (25.3 ± 0.9 versus 21.8 ± 1.3; P < 0.05); the group of women receiving weekly visits scored (15.0 ± 1.3) significantly lower than the other groups (F[4.46] = 30.7; P < 0.0001). No significant differences were found to be related to marital status, work assignment, age, type of crime, or the length of sentence.
Conclusions. Symptoms of depression were prevalent among the study sample, and were most powerfully related to having children and infrequent visits. Social adaptation programs should encourage continuous contact between women and their children, family, and friends.

Reasons for and barriers to exercising and sports participation in Madrid

Objectives. To analyze the motivators and barriers to physical activity and sports among the population of metropolitan Madrid, as well as any correlations with gender, age, and social status.
Methods. A cross-sectional study of a sample of 625 individuals whose data were representative of the whole population, with a + 4% margin of error and a 95.5% confidence interval (95%CI). The sampling type selected was multistage, utilizing an ad hoc questionnaire.
Results. The most frequently cited motivations for exercising were: for fun (29.9%), to stay in shape (26.4%), and health (16.1%), differing according to gender (÷2(8) = 19.635; P = 0.009; 95%CI: 0.007–0.011) and age (÷2(32) = 55.671; P = 0.006; 95%CI: 0.005–0.0080). With regard to activity cessation, the demands of work and family (24.1%) and lack of time (22.2%) were the most common reasons, correlating with age (÷2(24) = 36.955; P = 0.041; 95%CI: 0.037–0.044) and slightly with gender (÷2(6) = 11.753; P = 0.069; 95%CI: 0.063–0.074). The reasons most often cited for never exercising were lack of time (24.4%) and not enjoying it (24.4%), uncorrelated with any of the study variables.
Conclusions. Among the study sample, the purpose of sports and exercise was for fun and recreation, aimed at maintaining and improving health and acquiring an attractive figure. Motivators driving activity and discontinuation were correlated with age and gender. Conversely, the reasons for never exercising were independent of the study variables.

Objetivos. Analizar los motivos y barreras de la poblacion metropolitana de Madrid para realizar actividad fisica y/o deporte, asi como sus relaciones con el genero, la edad y la posicion social.
Metodos. Estudio transversal realizado con una muestra de 625 personas, con datos representativos a nivel global, con un margen de error del + 4% y un intervalo de confianza del 95,5%. El tipo de muestreo fue polietapico, utilizandose un cuestionario ad hoc.
Resultados. Diversion (29,9%), mantenimiento de la forma (26,4%) y salud (16,1%), fueron los motivos de practica mas frecuentes, mostrando diferencias segun genero [ƒÔ2(8) = 19,635; p = 0,009; IC95%: 0,007.0,011] y edad [ƒÔ2(32) = 55,671; p = 0,006; IC95%: 0,005.0,008]. Respecto al abandono de la practica, las exigencias laborales y familiares (24,1%) y la falta de tiempo (22,2%), fueron las causas mas habituales, relacionandose con la edad [ƒÔ2(24) = 36,955; p = 0,041; IC95%: 0,037.0,044] y marginalmente con el genero [ƒÔ2(6) = 11,753; p = 0,069; IC95%: 0,063.0,074]. Los motivos mas frecuentes para no haber practicado nunca fueron la falta de tiempo (24,4%) y el hecho de no gustarles (24,4%), no existiendo relaciones con las variables analizadas.
Conclusiones. La practica fisico-deportiva en la muestra estudiada tiene un caracter ludico y recreativo y esta dirigida al mantenimiento y mejora de la salud y a la adquisicion de un buen aspecto fisico. Los motivos que conducen a la practica y a su abandono estan relacionados con la edad y el genero. En cambio, las razones para no haber practicado nunca son independientes de las variables analizadas.

Objective. This report aims to 1) explain and illustrate the use of the subjective well-being (SWB) approach as an alternative health-valuation methodology by estimating the monetary value of five general categories of illness in Costa Rica, and 2) foster comparative research on the advantages and limitations of alternative approaches to health valuation.
Method. Use of the SWB valuation approach to measure the monetary value of illness (MVI), based on empirical data from a representative survey in Costa Rica carried out in 2004. The MVI is defined as the estimated percentage of monthly income that would be required to compensate for the loss in life satisfaction (LS)—a primary SWB conception—that is expected to occur with the onset of illness. The five general categories of illnesses studied were cancer, cardiovascular disease, thyroid disease, arthritis, and infectious disease.
Results. There was wide disparity in the monetary values of the different illnesses. Some illnesses had relatively high monetary value compared to persons’ mean income, indicating the high value of good health and of programs that aim to prevent the emergence of illnesses or abate their negative impact on people’s well-being.
Conclusions. The SWB valuation approach can be used to estimate illnesses’ monetary value and thus can contribute to the design of health policies related to resource allocation and compensation, and revenue-generating schemes.

Estimación del valor monetario de las enfermedades en Costa Rica: enfoque del bienestar subjetivo

Objetivos. Explicar e ilustrar el uso del enfoque del bienestar subjetivo (BS) como metodología alternativa para evaluar la salud mediante la estimación del valor monetario de cinco categorías de enfermedades en Costa Rica y promover investigaciones comparativas sobre las ventajas y las limitaciones de enfoques alternativos para la valoración de la salud.
Métodos. Se utilizó el enfoque de valoración del BS para calcular el valor monetario de la enfermedad a partir de los datos empíricos de una encuesta representativa de Costa Rica realizada en 2004. El valor monetario se definió como el porcentaje estimado de los ingresos mensuales requeridos para compensar las pérdidas en satisfacción de vida —una noción primaria del BS— que ocurrirían una vez que comienza una enfermedad. Las cinco categorías generales de enfermedades estudiadas fueron: cáncer, enfermedad cardiovascular, enfermedad tiroidea, artritis y enfermedad infecciosa.
Resultados. Se observó una amplia heterogeneidad en los valores monetarios de las diferentes enfermedades. Algunas enfermedades presentaron un valor monetario relativamente alto en relación con el ingreso medio de las personas, lo que indica el elevado valor de la buena salud y de los programas dirigidos a prevenir la emergencia de enfermedades o reducir su impacto negativo sobre el bienestar de las personas.
Conclusiones. El enfoque de valoración del BS puede emplearse para estimar el valor monetario de las enfermedades y contribuir así al diseño de políticas de salud relacionadas con la asignación y la compensación de recursos y esquemas generadores de utilidades.