Costos de hospitalización por farmocodependencia para población no asegurada en México

• Autores: Irene Parada Toro, Sofía Arjonilla Alday, Armando Arredondo López
• Localización: Salud mental, ISSN 0185-3325, Vol. 26, Nº. 4, 2003, págs. 17-24
• Idioma: español
• Enlaces
  • Texto completo (pdf)
• Resumen
  • español

    En el campo de la salud el análisis de los aspectos económicos ha ido en aumento y un área que se ha desarrollado mucho es el estudio de los costos por demanda específica (según el tipo de enfermedad). La farmacodependencia constituye justamente, parte del incremento en la demanda de servicios como problema específico de salud, no sólo por el número sino por el tipo de adicciones, y asimismo, por la complejidad y duración de los servicios de tratamiento y rehabilitación.

    Objetivo: Analizar los costos de la atención hospitalaria en la población no asegurada en los Centros de Integración Juvenil.

    Material y métodos: Se trata de un estudio transversal realizado durante el periodo de 1997-1998 en las unidades de internamiento de los CIJ en los estados de Baja California (Tijuana) y Jalisco (Zapopan), en el que se comparan el costo a nivel institucional y el costo del servicio a los usuarios de los dos centros. La información se obtuvo por medio de los registros secundarios de los CIJ, de la oficina central en la ciudad de México, DF. La metodología económica que se utilizó para el cálculo se basa en los principales determinantes de los costos hospitalarios directos de los CIJ, relacionados en primer lugar con la práctica médica y, en segundo, con la gerencia o administración de los servicios.

    Resultados: En relación con las cuotas de recuperación establecidas por la institución, el día/cama oscila entre 1.10, 2.37 y 4.21 dólares de acuerdo con el estudio socioeconómico. El costo institucional promedio día/cama para el usuario es de 30.96 dólares. El costo del tratamiento por 30 días de hospitalización para el usuario en ambos centros fue de 765.4 dólares por 30 días y de 2,782,7 dólares por 90 días. Los costos institucionales calculados para los centros en Tijuana fueron: tratamiento de 30 días, 7,940.3 dólares; y 90 días, 23, 822.3 dólares; el costo para el centro de Zapopan (30 días de tratamiento) fue de 7,654.4 dólares y 90 días costaban 22,963.1 dólares. Las aportaciones al centro de Zapopan por cuotas de recuperación de los usuarios durante el año de 1997 fueron de 8,294.11 dólares, con un promedio por paciente de 47.4 dólares, y en Tijuana de 8,969.22 dólares con un promedio de 68.46 dólares por usuario. El tratamiento de 30 días de hospitalización cuesta al sector público 10 veces más de lo que realmente cobra al usuario en Tijuana y 8 veces más en Zapopan. En el tratamiento de 90 días de duración los costos para la institución del sector público se incrementan entre el 60 y 70% para ambos centros de atención. La cobertura documentada en Tijuana fue de 131 pacientes y en Zapopan de 175 pacientes.

    Discusión: El costo para los pacientes en el tratamiento de 30 días es de 7 salarios mínimos y el de 90 días asciende a 21 salarios mínimos. Con relación a la actual creciente demanda de servicios, la disponibilidad requerida sería de 560 camas/día para tratamientos de 30 días. Lamentablemente sólo se cuenta con 23 camas por centro. Para tratamientos de 90 días la disponibilidad requerida debería ser de 187 días/cama. Esto nos confirma que los centros no cuentan con las camas suficientes para satisfacer la demanda poblacional que cada día es mayor en el caso de la farmacodependencia. El total de la inversión por parte del sector público debería ser de 3 228,193 dólares (esta cifra representa la sumatoria para los dos centros), pero de acuerdo a los costos según informan los centros, el sector público invirtió en el tratamiento de la farmacodependencia en ambos centros durante 1997-1998 un total de 2 941,180 dólares. Lo anterior nos demuestra que a pesar de que hay una inversión fuerte por parte del sector público el programa de rehabilitación y de hospitalización no cubre la demanda existente. Otro de los hallazgos del estudio fue que las cuotas de recuperación establecidas para los usuarios corresponden a 11.63% en Tijuana y 12.31% en Zapopan con respecto al gasto invertido por el sector público para satisfacer la demanda. Consideramos que las cuotas de recuperación son insuficientes para cubrir los gastos de operación ocasionados por el tratamiento de la enfermedad. Concluiremos diciendo que no se puede dejar de lado el impacto que la problemática tiene sobre el rendimiento económico, social o productivo de los individuos. Este impacto puede medirse como tiempo ¿perdido¿ o años de vida perdidos, lo que a su vez representará, como un indicador de la carga de la enfermedad, los episodios de reclusión hospitalaria que genera el consumo de enervantes. También servirá para conocer el gasto que ocasiona al Estado y a la sociedad este tipo de tratamiento hasta la reincorporación del individuo en el ámbito social y económico

  • English

    One aspect related to health system planning and operation is economic analysis at the different medical care levels. Economic analysis incorporation is intended to help improve supplied service efficiency and effectiveness. Economic analysis is increasing in the health field, and one highly developing area is cost evaluation per specific demand (i.e. per illness type). Drug dependency is precisely one specific health problem with increasing demand in terms of quantity as well as addiction types, complexity, treatment and rehabilitation services duration. Within this context of increased medical care costs and increased service demand for drug dependent patients, this study intends to analyze hospital care costs for the non-insured population attended to in Youth Integration Centers (Centros de Integración Juvenil—CIJ). Background. CIJ data reported at the national level indicates alarming evolution between 1990 and 1995. In 1990, one of every 12 CIJ attended patients, had used drugs at least one time during their life (OT), while by 1995, one of every three patients had tried drugs. By these same years, 21 of the 54 regional centers reported higher OT consumption percentages than the 32.4% national average. Drug dependency hospitalization cost analysis will provide a very useful tool for intervention and program evaluation and planning, as well as organizational level decisionmaking and policy and research planning to address the problem. Material and methods. The present is a transversal study during 1997-1998 in CIJ in-patient units in the states of Baja California (Tijuana) and Jalisco (Zapopan), comparing the two centers’ institutional level costs and users’ service costs. Data was obtained through CIJ secondary registries in the CIJ Mexico City central office, and include users’ socio-economic data, service use, hospitalization treatment type, and cost. The study integrates all users treated over the study period by both centers. Economic methodology used for the calculation is based on CIJ direct hospitalization costs’ main determinants, related firstly to the medical practice, and secondly to service management or administration. The first case includes the medical procedure itself, direct inputs such as medications, and auxiliary services such as number and type of exams undertaken. The second case refers to internal organizational systems. In this case, analysis was undertaken considering by hospitalization motives, through evaluation of care protocols, and specific human resource hours employed: physicians, nurses, social workers, administrative personnel, etc. Administrative personnel time was calculated pro rata for each: director, under-director, etc. Input costs such as for medications and laboratory exams were adjusted equivalent to individual user direct market costs or institutional consolidated purchase costs. Results. Institutionally established cost recovery quotas range between 1.10, 2.37 and 4.21 dollars day/bed, according to the socio-economic study. Nevertheless, many patients were exempted from payment due to their economic condition. Users’ day/bed average institutional cost is 30.96 dollars. Complete hospitalization treatment costs for users in both centers was 765.40 dollars for 30-day treatments and 2,782.70 for 90-day treatments. Both periods include: medical care; detoxification; psychiatric treatment; individual and group psychological therapy, and occupational and family therapy. Institutional costs calculated for the centers were, in Tijuana: 7,940.30 dollars for 30-day treatment, and 23,822.30 dollars for 90-day treatment. Zapopan CIJ costs were: 7,654.40 dollars for 30-day treatment and 22,900.10 dollars for 90-day treatment. User recovery quotas received in 1997 in Zapopan were 8,294.11 dollars, with a per-patient average of 47.4 dollars. Quotas received in 1997 in Tijuana totaled 8,969.22 dollars, with a per-patient average of 68.46 dollars. Thirty-day hospitalization treatment costs the public sector ten times more than the real user cost in Tijuana and eight times more than in Zapopan. Public sector institutional costs for 90-day treatment increase between 60 and 70 percent for both care centers. Reported coverage in Tijuana was 131 patients, and 175 patients in Zapopan. Upon calculating the period’s occupation (75%), 47% and 63% occupation were calculated in Tijuana and Zapopan respectively, based on the assumption of 30-day treatments. With 90-day treatments, these centers would have presented 142.39% and 190.21% reported coverage for the year. Discussion. Patient cost for 30-day treatment amounts to seven monthly minimum wages, and to 21 monthly minimum wages for 90-day treatment. The type of patients demanding care — generally characterized by low or middle socio-economic conditions and often unemployed or with variable income— indicate a risk of lack of economic access to treatment. In regard to availability offered by both centers, 560 days/bed availability is required for 30-day treatments and 187 days/bed availability is required for 90-day treatments. This suggests that the centers lack sufficient beds to satisfy continually increasing population demand for drug dependency treatment. Yearly occupation calculations, with a 75% occupation rate and taking into account treatment duration, indicate that each center may provide 30-day treatments to 207 patients. Capacity would be limited to 69 patients in the case of 90-day treatments. If we analyze these figures in relation to CIJ costs, we find the public sector would need to invest 1,643,737 dollars per year and 1,584,456 dollars per year to meet demand for 30 and 90-day treatments respectively. Total public sector investment should therefore be 3,228,193 dollars (total amount for both centers). However, according to CIJ reported data, the public sector invested a total of 2,941,180 dollars for drug dependency treatment in both sectors during 1997-1998, assuming 75% occupation during the period. This indicates that despite strong public sector investment, the rehabilitation and hospitalization program does not meet existing demand. Another study finding was that recovery quotas established for users correspond to 11.63% in Tijuana and 12.31% in Zapopan with respect to public sector investment to satisfy this type of demand. We consider recovery quotas insufficient to cover treatment operation costs. However, considering the current economic dynamics and the service’s target population, and if we add the economic burdens borne by drug dependent CIJ users’ families, CIJ service demand would probably diminish if treatment cost payment were adjusted to these new health policies. This leads us to question why the treatment centers present such low occupation and demand, despite the phenomenon’s increasing dynamics both in consumption and in service demand, when it is supposed that those who can not afford to pay are not required to do so. Are these low occupation and demand rates due to insufficient information on CIJ services, deficient socio-economic studies, or to characteristics of the problem itself? We conclude by noting that the problem’s impact on individual economic, social or productive output can not be ignored. This impact may be measured in “lost” time or life years, which in turn represent, as an indicator or the illness’s burden, the hospitalization confinement events generated by drug use. Lost time calculations would also help establish the cost borne by government and society for this type of treatment until the individual’s resumed incorporation within social and economic life