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

English

Costo estimado anual del tratamiento de la hipertensión arterial en Brasil

Objetivos. Estimar el costo directo anual del tratamiento de la hipertensión arterial sistémica (HAS) en los sistemas sanitarios público y privado de Brasil, evaluar su impacto económico en el presupuesto total de salud y determinar la proporción del producto interno bruto (PIB) que ocupó en 2005.
Métodos. Se empleó un modelo de árbol de decisión para determinar los costos directos según el uso estimado de varios recursos en el diagnóstico y la atención de la HAS, incluidos el tratamiento (con medicamentos y sin ellos), los exámenes complementarios, las visitas del médico, las evaluaciones nutricionales y las visitas a servicios de emergencia.
Resultados. El costo anual directo estimado del tratamiento de la HAS fue de aproximadamente US$ 398,9 millones en el sistema público y US$ 272,7 millones en el privado, lo que representó 0,08% del PIB en 2005 (mínimo: 0,05%; máximo: 0,16%). Con un gasto total en salud de cerca de 7,6% del PIB de Brasil, este costo representó 1,11% del costo total en salud (de 0,62% a 2,06%): 1,43% de los gastos totales del Sistema Único de Salud (de 0,79% a 2,75%) y 0,83% de los gastos del sistema privado (de 0,47% a 1,48%).
Conclusiones. Para garantizar servicios públicos o privados de salud basados en los principios de universalidad y equidad, con recursos limitados, los esfuerzos se deben enfocar en educar a la población en el cumplimiento de las medidas de prevención y el tratamiento de enfermedades, que como la HAS, requieren considerables recursos sanitarios.

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Objectives. To estimate the direct annual cost of systemic arterial hypertension (SAH) treatment in Brazil’s public and private health care systems, assess its economic impact on the total health care budget, and determine its proportion of the 2005 gross domestic product (GDP).
Methods. A decision tree model was used to determine direct costs based on estimated use of various resources in SAH diagnosis and care, including treatment (medication and nonmedication), complementary exams, doctor visits, nutritional assessments, and emergency room visits.
Results. Estimated direct annual cost of SAH treatment was approximately US$ 398.9 million for the public health care system and US$ 272.7 million for the private system, representing 0.08% of the 2005 GDP (ranging from 0.05% to 0.16%). With total health care expenses comprising about 7.6% of Brazil’s GDP, this cost represented 1.11% of overall health care costs (0.62% to 2.06%)—1.43% of total expenses for the Unified Healthcare System (Sistema Único de Saúde, SUS) (0.79% to 2.75%) and 0.83% of expenses for the private health care system (0.47% to 1.48%).
Conclusion. To guarantee public or private health care based on the principles of universality and equality, with limited available resources, efforts must be focused on educating the population on prevention and treatment compliance in diseases such as SAH that require significant health resources.

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Community participation in health: the challenge in Chile

Health care reforms implemented in Latin America and the Caribbean over the last 20 years have viewed community participation as a system-wide component. Nonetheless, these reform efforts have yet to break through the conceptual and operational barriers holding back the development and expansion of community participation.
In Chile, changes introduced to the health care system are far from achieving any real participation from the community. Therefore, the consumer’s role needs to be redefined from merely controlling the parts, to reaching across the whole system in a way that consumer input might identify and quickly correct any posible shortcomings in the health system’s design, as well as its operations.
With this in mind, the main challenges are to strengthen coordination among the various promotion and participation commitments, as well as community control, and to generate data and other evidence to assess the impact of community participation in health strategies.

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En la década de los ochenta, la mayoría de los países de América Latina y el Caribe fueron tanto actores como testigos de un proceso de reformas del sector salud, impulsado principalmente por cambios epidemiológicos, demográficos y sociopolíticos, así como por propuestas de organismos internacionales dirigidas a reducir el gasto en salud. En los años noventa, las reformas se orientaron a promover la equidad, la calidad y la eficiencia en la utilización de los recursos, descentralizar los servicios y fortalecer las instancias de participación social en el sector. Hasta hoy, sin embargo, las evaluaciones en materia de participación social y su impacto en los sistemas de salud han sido escasas.

English

SYNOPSIS

Pharmaceutical assistance in the Brazilian public health care system

This article deals with the organization of pharmaceutical assistance within the Brazilian Public Unified Health System (Sistema Único de Saúde, SUS) by analyzing the progress made so far and the challenges that still must be faced to ensure the right to universal therapeutic and pharmaceutical coverage in Brazil. Among the improvements, the article discusses the National List of Essential Drugs and its role to guide the supply, prescription, and dispensing of drugs within SUS. The structure of federal funding and the existing pharmaceutical programs are described, as well as the responsibilities of the Federal Government, states, and municipalities concerning allocation of financial resources. Despite the progress made, the model of access to SUS drugs has not been successful in securing universal therapeutic assistance. It is essential to consider a type of funding and organization of pharmaceutical assistance that is driven by a notion of regionalization, with financing based on health care flows rather than on the population circumscribed to a given territory. It is also essential to qualify pharmaceutical management by hiring pharmacists and support personnel, professionalizing workers, and setting up facilities with appropriate information systems and equipment.

Português

SINOPSE

Trata-se neste artigo da organização da assistência farmacêutica no Sistema Único de Saúde (SUS) no Brasil, analisando-se os avanços e desafios que se apresentam para que o direito à assistência terapêutica integral e farmacêutica seja garantido à população. Entre os avanços, é discutida a Relação Nacional de Medicamentos Essenciais, esclarecendo seu caráter norteador para a oferta, prescrição e dispensação de medicamentos no SUS. A estrutura do financiamento federal e os programas de assistência farmacêutica são apresentados, bem como as responsabilidades da União, estados e municípios quanto à alocação de recursos financeiros. Embora tenha trazido reconhecidos avanços, o modelo de acesso a medicamentos no SUS ainda não foi bem-sucedido em garantir a assistência terapêutica integral. É imprescindível contemplar um tipo de financiamento e organização da assistência farmacêutica que se oriente pela lógica da regionalização, com financiamento fundamentado em fluxos assistenciais, e não apenas com base na população adstrita a determinado território. Também é fundamental a qualificação da gestão farmacêutica, com contratação de farmacêuticos e pessoal auxiliar, profissionalização de trabalhadores e preparação de instalações com equipamentos e sistemas informatizados adequados.

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Counterfeit pharmaceuticals in Peru

Objective. To determine the quantity of counterfeit pharmaceutical drugs found by the National Quality Control Center (Centro Nacional de Control de Calidad (CNCC), Instituto Nacional de Salud, Peru) during the period from 2005–2008, and the types and properties of these drugs.
Methods. A form was created to amass the relevant data collected directly from CNCC reports. The reports underwent a review and analysis process, and where counterfeiting was confirmed, it was categorized by type into one of four groups.
Results. The percentage of counterfeit drugs relative to the total drugs evaluated was: 3.0% in 2005, 5.0% in 2006, 7.3% in 2007, and 9.2% in 2008. The main groups of counterfeit drugs, classified according to the World Health Organization Anatomical Therapeutic Chemical Classification System, were: alimentary tract and metabolism, 34.5% (29.1%–39.8%); antiinfectives for systemic use, 21.1% (16.5%–25.7%); nervous system, 17.1% (12.8%–21.3%); and musculo-skeletal system, 15.4% (11.3%–19.5%). The most common type of forgery occurred in cases where the drug contained the correct amount of active ingredients, but the manufacturer was one other than the one indicated (62.4% of the total counterfeit drugs); and medications that did not contain any active ingredient (22.4%). Of the counterfeit drugs, 61.0% (56.0%–67.0%) were national brands and 39.0%, (33.0%–44.0%) were imported. The pharmaceutical formulations with the highest rate of forgery were tablets, 66.0% (60.0%–71.0%); injectables, 19.0% (14.0%–23.0%); and capsules 7.0% (4.0%–10.0%).
Conclusions. From 2005–2008, drug counterfeiting had an average annual variation of 45%. Drug counterfeiting was shown to be most prevalent among national brands— as opposed to imported medications—although the types and formulations of the fake drugs attest to a certain level of sophistication employed in the forgery process. The counterfeiting of life-saving drugs, such as antimicrobials, signifies a serious public health threat.

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Objetivo. Determinar la cantidad de medicamentos falsificados detectados en el Centro Nacional de Control de Calidad (CNCC) (Instituto Nacional de Salud, Perú) en el periodo 2005- 2008 y determinar sus tipos y características.
Métodos. Se preparó una ficha para la recolección de los datos pertinentes, los cuales fueron tomados directamente de los informes emitidos por el CNCC. Estos informes fueron sometidos a un proceso de revisión y evaluación, y aquellos en los que se confirmó la falsificación fueron clasificados en cuatro grupos, según el tipo de falsificación.
Resultados. El porcentaje de medicamentos falsificados con relación al total de medicamentos analizados fue de 3,0% en 2005, 5,0% en 2006, 7,3% en 2007 y 9,2% en 2008. Los principales grupos de medicamentos falsificados según la clasificación ATC de la OMS fueron: tracto alimentario y metabolismo, 34,5% (29,1%–39,8%); antiinfecciosos para uso sistémico, 21,1% (16,5%–25,7%); sistema nervioso, 17,1% (12,8%–21,3%); y sistema musculoesquelético, 15,4% (11,3%–19,5%). Los tipos de falsificación predominantes fueron aquellos donde el medicamento contenía la dosis correcta del principio activo pero el fabricante era distinto al declarado (62,4%, sobre el total de medicamentos falsificados), y aquellos donde el medicamento no contenía ningún principio activo (22,4%). El 61,0% (56,0%–67,0%) de los medicamentos falsificados fueron nacionales y 39,0% (33,0%–44,0%), importados. Las formas farmacéuticas con mayores tasas de falsificación incluyeron comprimidos, 66,0% (60,0%–71,0%), inyectables, 19,0% (14,0%–23,0%) y cápsulas, 7,0% (4,0%–10,0%).
Conclusiones. Entre los años 2005 y 2008, la falsificación de medicamentos registró una variación promedio anual de 45%. Se comprobó un predominio de la falsificación de medicamentos de producción nacional —en contraste con los medicamentos importados—, si bien los tipos y formas farmacéuticas de los medicamentos adulterados evidencian cierta sofisticación en el proceso de falsificación. La falsificación de medicamentos que salvan vidas, como los antimicrobianos, representa un peligro serio de salud pública.

English

Objectives. To assess the challenges in reducing tuberculosis (TB) in prisons in Bolivia, Ecuador, and Paraguay and propose ways to address them through communication interventions.
Methods. Challenges to two central goals of TB control—early diagnosis of positive cases and successful application of the directly observed treatment, short course (DOTS) strategy— were examined. Data were gathered (through in-depth, structured interviews) and focus groups were conducted in the prisons that housed the largest number of male inmates in each country. Interviewees and focus group participants included program directors, administrative personnel, correctional health and security staff, and incarcerated people who were or had been under treatment for TB and had participated as “peers” in health services.
Results. The findings showed a range of entrenched obstacles for adequate TB control. Stigmatizing attitudes and low knowledge about TB among inmates and key prison personnel discouraged people living in prisons from seeking diagnosis and treatment. Systemic problems in prison health services, along with squalid living conditions, lack of coordination between national TB programs and prison health systems, and insufficient allocation of resources to health prevented the provision of adequate TB prevention and care.
Conclusion. In addressing the barriers to effective TB control in prison systems in Bolivia, Ecuador, and Paraguay, a participatory approach to communication is necessary.

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Comunicación participativa para el control de la tuberculosis en cárceles de Bolivia, Ecuador y Paraguay

Objetivos. Identificar los desafíos para reducir la tuberculosis (TB) en cárceles de Bolivia, Ecuador y Paraguay y recomendar vías para solucionarlos mediante intervenciones informativas.
Métodos. Se analizaron las dificultades para alcanzar dos metas centrales del control de la TB: el diagnóstico temprano de los casos positivos y la aplicación exitosa del tratamiento bajo supervisión directa de curso corto. Se obtuvieron datos (mediante entrevistas estructuradas en profundidad) y se convocaron grupos focales en las cárceles con más reclusos hombres en cada país. Entre los entrevistados y el grupo focal había directores de programas, personal administrativo, sanitario y de seguridad de las cárceles, así como reclusos que recibían o habían recibido tratamiento contra la TB y que habían participado como “pares” en los servicios de salud.
Resultados. Se detectaron obstáculos arraigados que impedían el control adecuado de la TB. Las actitudes estigmatizadoras y el escaso conocimiento sobre la TB entre los reclusos y el personal clave de las prisiones desestimulaban la búsqueda de diagnóstico y tratamiento en las cárceles. Los problemas sistémicos de los servicios de salud de las prisiones, junto con las insalubres condiciones de vida, la falta de coordinación entre los programas nacionales de TB y los sistemas de salud de las prisiones, y la insuficiente asignación de recursos sanitarios impidieron brindar una prevención adecuada y un cuidado eficaz de la TB.
Conclusión. Para eliminar las barreras al control eficaz de la TB en los sistemas carcelarios de Bolivia, Ecuador y Paraguay se requiere de un enfoque participativo de comunicación.

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Direct costs of the dengue fever control and prevention program in 2005 in the City of São Paulo

Objective. To estimate the direct costs associated with the control of Aedes aegypti and prevention of dengue fever in the City of São Paulo Dengue Control Program, Brazil, in 2005.
Method. The following items were considered: human resources, uniforms, field materials, individual protection equipment, spraying equipment, strategic supplies (insecticides and larvicides), and vehicles. The costs associated with laboratory tests for entomological surveillance and dengue fever diagnosis were also calculated, as well as costs relating to information and printed materials for educational campaigns.
Results. The total direct costs of the City of São Paulo Dengue Fever Program in 2005 were R$ 21 774 282.82 (US$ 12 486 941.34 considering the dollar/real exchange rate in December 2009). Of this amount, 59.4% were directed to human resources, 38.3% to epidemic control measures, and 2.2% to capital expenditure. The cost per capita was R$ 1.99 in 2005.
Conclusions. The control of dengue fever is essential given the growth of epidemics. Knowledge about the costs of strategies and priority items employed in dengue fever control and prevention programs can guide decision-making regarding the application of budget resources in both the City of São Paulo and Brazil as a whole.

Português

Objetivo. Estimar o custo direto da prevenção e controle do Aedes aegypti no Programa Municipal de Controle da Dengue (PMCD) no Município de São Paulo, Brasil, em 2005.
Métodos. Os seguintes itens foram considerados: recursos humanos, uniformes, material de campo, equipamento de proteção individual, equipamentos de pulverização e nebulização, insumos estratégicos (inseticidas e larvicidas) e veículos. Foram calculados os custos das ações de laboratório destinadas à vigilância entomológica e diagnóstico da doença, os custos do sistema de informação e material gráfico destinado às campanhas educativas e de informação.
Resultados. O custo total do PMCD foi de R$ 21 774 282,82 em 2005 (US$ 12 486 941,34 considerando-se a taxa de câmbio dólar/real vigente em dezembro de 2009). Desse total, 59,4, 38,3 e 2,2%, respectivamente, foram utilizados em gastos de pessoal, custeio e capital. O valor per capita gasto no combate ao vetor foi de R$ 1,99.
Conclusões. O controle da dengue é imperativo diante do crescimento das epidemias. O conhecimento acerca dos custos das estratégias de ação e dos componentes prioritários dos programas de prevenção e controle da dengue pode orientar a tomada de decisões quanto à aplicação dos recursos orçamentários disponíveis tanto no Município de São Paulo como em todo o Brasil.

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Computer modeling and simulation of the patient-visit network within a Chilean public health service

Objective. To create a computerized model and simulation of the patient visit/ referrals process for a health care services organization within Chile’s public health care system.
Methods. The study was performed with a “system dynamics” focus. Data were collected from the health care service centers, and a referrals model was created. Specialty areas to be modeled were chosen based on the length of their waiting times.
Equations were defined for calculating care visits, referrals, and waiting times. Databases were designed and populated with centers’ data. The model was programmed and validated through comparisons with actual data. Scenarios were simulated that would reduce patient waiting time by increasing staff hours or improving diagnostic resolution at the primary care and specialty centers, or both.
Results. The modeling included 22 centers, 1 451 referral flows, and 12 medical specialty areas, in addition to general medicine. A total of 686 869 registered office visits, referrals, and waiting logs were processed. The validation yielded high determinant coefficients and a 10.43% percentage error regarding actual waiting time logs.
Conclusions. This methodology proved to be useful for modeling a health care network. An auto-referral process was observed where options were available, with opportunities for improvement in diagnostic resolution at the primary health care centers, as well as at the specialty centers. Moderate increases in diagnostic accuracy and office hours would completely eliminate waiting times at the specialty centers.

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Objetivo. Modelizar y simular por computadora la red de atención de consultas médicas de un servicio de salud del sistema público chileno.
Métodos. El estudio se realizó bajo el enfoque de la “dinámica de sistemas”. Se recolectó información de los establecimientos del servicio de salud y se construyó un modelo de derivaciones. Se determinaron las especialidades a modelizar de acuerdo con la extensión de sus listas de espera. Se definieron las ecuaciones para el cálculo de las atenciones, las derivaciones y la espera. Se diseñaron las bases de datos y se volcó en ellas la información proveniente del servicio. Se programó y validó el modelo, comparándolo con los datos reales. Se simularon escenarios que permitieran reducir la espera mediante el aumento de las horas médicas, el mejoramiento de la capacidad resolutiva en atención primaria y compleja, o ambos.
Resultados. Se modelizaron 22 establecimientos, 1 451 flujos de derivaciones y 12 especialidades médicas además de medicina general. Se procesaron 686 869 registros de atenciones, derivaciones y listas de espera. La validación arrojó altos coeficientes de determinación y un error porcentual de 10,43% respecto de las listas de espera reales.
Conclusiones. La metodología mostró su utilidad para modelizar una red asistencial. Se observó un funcionamiento autorreferencial —según la capacidad instalada—, con posibilidades de intervención para mejorar la resolutividad, tanto en los centros de salud primarios como en los centros de especialidades. Un aumento moderado de la capacidad resolutiva y de las horas médicas permitiría la eliminación total de las listas de espera por consulta médica de especialidad.

English

SYNOPSIS

Results-oriented management and accountability in the Brazilian Unified Health System

By examining normative instruments, the present article evaluates if the discourse of results-oriented management and accountability has become a reality within the Brazilian health care system following the reform started in the 1990s with the establishment of the Unified Health System (SUS). The analysis shows that there is, in fact, an effort aimed at the construction of results-oriented management, with the incorporation of many management tools (plans, reports, agendas, indicators, joint goals-setting). Also, the health care system has strived to adopt performance indicators and views evaluation as an essential management tool. However, difficulties are also evident, such as the absence of citizens in the construction of the system, due to an institutional design that only provides space for official bodies (Health Councils); accountability mechanisms that are limited to bureaucratic aspects typical of public administration, following the traditional accountability path of audit and controllership; no engagement of health care system users in the decisionmaking about health care policies and operating arrangements; and no evaluation of the efficacy and effectiveness of contracts, placing the current management systems far from results-oriented management. It is possible to state that the conditions for accountability are slowly being created; however, it is still not possible to foresee the consolidation of resultsoriented management and accountability within the SUS.

English

Objective. The aim of this study was to assess the caries prevalence and treatment needs of Brazilian indigenous residents on an Indian reservation. Methods. This cross-sectional study comprised 1 461 individuals of ages 18–36 months and 5, 12, 15–19, 35–44, and 65–74 years living in the Potiguara Indian villages of Brazil. Decayed, missing, or filled permanent teeth (DMFT) and deciduous teeth (dmft) were determined by calibrated examiners using the methodology recommended by the World Health Organization. Treatment needs were assessed with the guidelines of the 2003 Brazilian Oral Health Survey. Results. Means ± standard deviations (SD) for dmft of 18- to 36-month-old and 5-year-old children were 2.5 ± 3.7 and 5.8 ± 4.3, respectively. For the age groups 12, 15–19, 35–44, and 65–74 years, mean ± SD values of DMFT were 3.6 ± 3.1, 7.1 ± 4.9, 16.4 ± 7.5, and 22.8 ± 8.6. The mean ± SD number of deciduous teeth requiring treatment varied from 2.4 ± 3.5 to 5.0 ± 4.0 in the 18- to 36-month and 5-year-old age groups, respectively. Among adolescents and adults, it was observed that on average at least three permanent teeth required dental treatment such as fillings, crowns, endodontic treatment, and extractions. Conclusions. High prevalence of caries and many teeth needing treatment were observed in all age groups of the Potiguara Indians.

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Caries dental y necesidades de tratamiento en los indígenas de la reserva india Potiguara de Brasil

Objetivo. El objetivo de este estudio fue evaluar la prevalencia de caries y las necesidades de tratamiento en los residentes indígenas brasileños de una reserva india.
Métodos. En este estudio transversal se incluyó a 1 461 personas de 18 a 36 meses de edad, y de 5, 12, 15–19, 35–44, y 65–74 años, que vivían en aldeas indias Potiguara de Brasil. Se determinaron los dientes permanentes cariados, perdidos y obturados (CPO) y los dientes deciduos mediante examinadores calibrados, con ayuda del método recomendado por la Organización Mundial de la Salud. Las necesidades de tratamiento se evaluaron con las directrices de la Encuesta Brasileña de Salud Bucodental de 2003.
Resultados. Las medias ± desviaciones estándar (DE) de los dientes deciduos de los niños de 18 a 36 meses, y de cinco años fueron 2,5 ± 3,7 y 5,8 ± 4,3, respectivamente. En los grupos de edad de 12, 15–19, 35–44, y 65–74 años, los valores de la media ± DE de los dientes CPO fueron 3,6 ± 3,1, 7,1 ± 4,9, 16,4 ± 7,5, y 22,8 ± 8,6. La media ± DE del número de dientes deciduos que precisaron tratamiento varió de 2,4 ± 3,5 a 5,0 ± 4,0 en los grupos de edad de 18 a 36 meses, y 5 años, respectivamente. En los adolescentes y adultos, se observó que, en promedio, por lo menos tres dientes permanentes precisaron tratamiento dental en forma de obturaciones, coronas, endodoncia y extracciones.
Conclusiones. En todos los grupos de edad de los indios Potiguara se observaron una prevalencia alta de caries y muchos dientes que precisaban tratamiento.

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**This article has been corrected, please see erratum RPSP/PAJPH, Vol. 27, No. 6, June 2010**

Objectives. To assess the possibility of bias due to the limited target list and geographic sampling of the World Health Organization (WHO)/Health Action International (HAI) Medicine Prices and Availability survey used in more than 70 rapid sample surveys since 2001.
Methods. A survey was conducted in Peru in 2005 using an expanded sample of medicine outlets, including remote areas. Comprehensive data were gathered on medicines in three therapeutic classes to assess the adequacy of WHO/HAI’s target medicines list and the focus on only two product versions. WHO/HAI median retail prices were compared with average wholesale prices from global pharmaceutical sales data supplier IMS Health.
Results. No significant differences were found in overall availability or prices of target list medicines by retail location. The comprehensive survey of angiotensin-converting enzyme inhibitor, anti-diabetic, and anti-ulcer products revealed that some treatments not on the target list were costlier for patients and more likely to be unavailable, particularly in remote areas. WHO/HAI retail prices and IMS wholesale prices were strongly correlated for higher priced products, and weakly correlated for lower priced products (which had higher estimated retailer markups).
Conclusions. The WHO/HAI survey approach strikes an appropriate balance between modest research costs and optimal information for policy. Focusing on commonly used medicines yields sufficient and valid results. Surveyors elsewhere should consider the limits of the survey data as well as any local circumstances, such as scarcity, that may call for extra field efforts.

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Determinación de los precios de los medicamentos en Perú: validación de aspectos fundamentales del método de encuesta de la OMS/HAI

Objetivos. Evaluar la posibilidad de sesgo debido a la limitación de la lista de referencia y del muestreo geográfico de la encuesta de precios y disponibilidad de medicamentos de la Organización Mundial de la Salud/Health Action International (OMS/HAI) usada en más de 70 muestras de encuestas rápidas desde el 2001.
Métodos. En el año 2005, se realizó una encuesta en Perú, con una muestra ampliada de puntos de venta de medicamento, incluso en zonas remotas. Se recogieron datos integrales acerca de los medicamentos de tres clases terapéuticas, con el fin de evaluar la idoneidad de la lista de referencia de medicamentos de la OMS/HAI y el énfasis únicamente en dos versiones del producto. Las medianas de los precios al por menor de la OMS/HAI se compararon con el promedio de precios al por mayor del proveedor de datos mundiales de ventas farmacéuticas IMS Health.
Resultados. No se observó ninguna diferencia significativa en la disponibilidad general ni en los precios de los medicamentos de la lista de referencia por localización de venta al por menor. La encuesta integral de los inhibidores de la enzima convertidora de la angiotensina, los antidiabéticos y los productos antiulcerosos reveló que algunos tratamientos que no están en la lista destinataria eran más caros para los pacientes y era más probable que no estuvieran a la venta, sobre todo en las regiones remotas. Los precios al por menor de la OMS/HAI y los precios al por mayor de IMS presentaron una correlación intensa en el caso de los productos de precio más alto, y la correlación fue débil en el caso de los productos de precio más bajo (que tuvieron márgenes de beneficio calculados más altos para el minorista).
Conclusiones. El método de la encuesta de la OMS/HAI logra un equilibrio adecuado entre los costos de investigación moderados y la información óptima para la política. El énfasis en los medicamentos de uso frecuente produce unos resultados válidos y suficientes. Los encuestadores de otros lugares deberían tener en cuenta los límites de los datos de la encuesta, así como las circunstancias locales, como la escasez, que puede requerir mayores esfuerzos en el campo.