Asociación entre la cuota moderadora y la frecuencia en la consulta a los servicios de urgencias en pacientes adultos con asma, usuarios del Régimen Contributivo en Colombia
Publicado
jun 30, 2021
Almetrics
Dimensions
Google Scholar
##plugins.themes.bootstrap3.article.details##
Resumen
Objetivo. Determinar la relación entre el nivel de cuota moderadora y la frecuencia de consulta a los servicios de urgencias en pacientes con asma que pertenecen al régimen contributivo en Colombia. Métodos. Se llevó a cabo un estudio observacional analítico de cohorte retrospectivo en el cual se incluyeron las personas mayores de 18 años cotizantes con diagnóstico de asma, usuarios del régimen contributivo registrados en la base de datos para el cálculo de la Unidad por Capitación entre los años 2012 y 2014. Se hizo reclutamiento de los pacientes durante el año 2013 y posterior seguimiento a la cohorte durante un año, desde la fecha de ingreso. Se tomó como variable de desenlace la frecuencia de consulta al servicio de urgencias, se evaluó la influencia de las principales variables de confusión y se aplicó un modelo de regresión binomial negativa para el análisis de los datos. Resultados. Se incluyeron 54 516 pacientes asmáticos con sus comorbilidades, de los cuales un 13,69% consultó a urgencias. Luego de controlar por el índice de Charlson y la edad de consulta a urgencias, el riesgo de consultar a urgencias es 1,1 veces más frecuente en el nivel 3 de cuota moderadora con respecto al nivel 1. Conclusiones. Se sugiere que las cuotas moderadoras podrían comportarse como una barrera de acceso a los servicios de salud en pacientes asmáticos. Se recomienda la realización de estudios que evalúen de modo más preciso esta hipótesis.
Keywords
Asma, servicio de urgencias, cuota moderadora, régimen contributivo, ColombiaAsma, serviço de urgências, taxa moderadora, regime contributivo, ColômbiaAsthma, emergency services, moderating fee, contributive regimen, Colombia
References
1. Blanco J, Maya J. Administración de servicios de salud. 2ª ed. Medellín: Fondo Editorial CIB; 2005.
2. Arrow K. Uncertainty and the welfare economics of medical care. Am Econ Rev. 1963;53(5):941-973. http://www.jstor.org/stable/1812044
3. Rothschild M, Stiglitz J. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. Q J Econ. 1976;(90):629-649. https://doi.org/10.2307/1885326
4. Acuerdo 260 de 2004. Consejo Nacional de Seguridad Social en Salud. Por el cual se define el régimen de pagos compartidos y cuotas moderadoras dentro del Sistema General de Seguridad Social en Salud.
5. Eaddy M, Cook C, O’Day K, Burch S, Cantrell C. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012;37(1):45-55. https://pubmed.ncbi.nlm.nih.gov/22346336/
6. Cutler DM, Zeckhauser RJ. The anatomy of health insurance. In: Culyer AJ, Newhouse JP (eds). Handbook of Health Economics; 2000. p.629-631.
7. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA.2007;298(1):61-69. https://doi.org/10.1001/jama.298.1.61
8. Dormuth C, Glynn R, Neumann P, Maclure M, Brookhart A, Schneeweiss S. Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clinical Therapeutics. 2006;28(6):964-978. https://doi.org/10.1016/j.clinthera.2006.06.007
9. Karaca Mandic P, Anupam J, Geoffrey F, Goldman D. Out-of-pocket medication costs, medication utilization, and use of healthcare services among children with asthma. JAMA. 2012;307(12):1284-1291. https://doi.org/10.1001/jama.2012.340
10. Mann B, Barnieh L, Tang K, Campbell D, Clement F. Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: A systematic review. PLoS One. 2014;9(3):e89168. https://doi.org/10.1371/journal.pone.0089168
11. Chandra A, Gruber J, McKnigth R. The impact of patient cost-sharing on low-income populations: Evidence from Massachusetts. J Health Econ. 2014;33:57-66. https://doi.org/10.1016/j.jhealeco.2013.10.008
12. Chernew M, Gibson T, Yu-Isenberg K, Sokol M, Rosen A, Fendrick M. Effects of increased patient cost sharing on socioeconomic disparities in health care. J Gen Intern Med. 2008;23(8):1131-1136. https://doi.org/10.1007/s11606-008-0614-0
13. Gourzoulidis G, Kourlaba G, Stafylas P, Giamouzis G, Parissis J, Maniadakis N. Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy. 2017;121(4):363-377. http://dx.doi.org/10.1016/j.healthpol.2017.02.008
14. Landsem MM, Magnussen J. The effect of copayments on the utilization of the GP service in Norway. Soc Sci Med. 2018;205(March):99-106. https://doi.org/10.1016/j.socscimed.2018.03.034
15. Jakobsson N, Svensson M. Copayments and physicians visits: A panel data study of Swedish regions 2003-2012. Health Policy (New York). 2016;120(9):1095-1099. http://dx.doi.org/10.1016/j.healthpol.2016.07.010
16. Goldman D, Joyce G, Zheng Y. Prescription drug cost sharing. Associations with medication and medical utilization and spending and health. JAMA. 2007;298(1):61-69. https://doi.org/10.1001/jama.298.1.61
17. Global Strategy for Asthma Management and Prevention, 2016. http://www.ginasthma.org
18. Harver A, Kotses H. Asthma, Health and Society A Public Health Perspective. Charlotte, North Carolina. Springer; 2010.
19. Ungar W, Kozyrskyl A, Paterson M, Ahmad F. Effect of cost- sharing on use of asthma medication in children. Arch Pediatr Adolesc Med. 2008;162(2):104-110. https://doi.org/10.1001/archpediatrics.2007.21
20. Campbell J, Allen-Ramey F, Sajjan S, Maiese E, Sullivan S. Increasing Pharmaceutical copayments: Impact on asthma medication utilization and outcomes. Am J Manag Care. 2011;17(10):703-710. https://pubmed.ncbi.nlm.nih.gov/22106463/
21. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288-1294. https://doi.org/10.1016/j.jclinepi.2004.03.012
22. Stagg V. Charlson: Stata module to calculate Charlson index of comorbidity, Statistical Software Components S456719, Boston College Department of Economics, 2006, revised 13 Sep 2017.
23. Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol. 2015;68(1):3-14. http://dx.doi.org/10.1016/j.jclinepi.2014.09.010
24. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003;56(3):221-229. http://www.ncbi.nlm.nih.gov/pubmed/12725876
25. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. Available from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2015_ed_web_tables.pdf
26. DANE. Indicadores demográficos según departamento 1985-2020. Conciliación Censal 1985-2005 y Proyecciones de Población 2005-2020. www.dane.gov.co
27. Cadarette SM, Wong L. An introduction to health care administrative data. Can J Hosp Pharm. 2015;68(3):232-237. https://doi.org/10.4212/cjhp.v68i3.1457
28. Harbaugh CM, Cooper JN. Administrative databases. Semin Pediatr Surg. 2018;27(6):353-360. https://doi.org/10.1053/j.sempedsurg.2018.10.001
29. Harron K, Dibben C, Boyd J, Hjern A, Azimaee M, Barreto ML, et al. Challenges in administrative data linkage for research. Big Data Soc. 2017;4(2). https://doi.org/10.1177/2053951717745678
30. Saczynski JS, Andrade SE, Harrold LR, Tjia J, Cutrona SL, Dodd KS, et al. Mini-Sentinel systematic evaluation of health outcome of interest definitions for studies using administrative and claims data: Heart failure. Pharmacoepidemiol Drug Saf. 2013;21(1):1-22. http://minisentinel.org/foundational_activities/related_projects/
31. Sinha S, Peach G, Poloniecki JD, Thompson MM, Holt PJ. Studies using english administrative data (hospital episode statistics) to assess health-care outcomes-systematic review and recommendations for reporting. Eur J Public Health. 2013;23(1):86-92. https://doi.org/10.1093/eurpub/cks046
32. Gini R, Schuemie M, Brown J, Ryan P, Vacchi E, Coppola M, et al. Data extraction and management in networks of observational health care databases for scientific research: A comparison among EU-ADR, OMOP, Mini-Sentinel And MATRICE Strategies. eGEMs (Generating Evid Methods to Improv patient outcomes). 2016;4(1):2. http://dx.doi.org/10.13063/2327-9214.1189
33. Zhan C, Miller M. Administrative data based patient safety research: A critical review BMJ. BMJ Qual Saf. 2003;12(ii):58-63. https://doi.org/10.1136/qhc.12.suppl_2.ii58
34. Mazzali C, Paganoni AM, Ieva F, Masella C, Maistrello M, Agostoni O, et al. Methodological issues on the use of administrative data in healthcare research: The case of heart failure hospitalizations in Lombardy region, 2000 to 2012. BMC Health Serv Res. 2016;16(1):1-10. http://dx.doi.org/10.1186/s12913-016-1489-0
35. Jones N, Schneider G, Kachroo S, Rotella P, Avetisyan R, Reynolds MW. A systematic review of validated methods for identifying acute respiratory failure using administrative and claims data. Pharmacoepidemiol Drug Saf. 2012;21(S1):261-264. https://doi.org/10.1002/pds.2326
36. Sharifi M, Krishanswami S, McPheeters ML. A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine. 2013;31(S10):K12-K20. http://dx.doi.org/10.1016/j.vaccine.2013.06.091
37. Maringe C, Fowler H, Rachet B, Luque-Fernandez MA. Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities. PLoS One. 2017;12(3):1-14. https://doi.org/10.1371/journal.pone.0172814
38. McPheeters ML, Sathe NA, Jerome RN, Carnahan RM. Methods for systematic reviews of administrative database studies capturing health outcomes of interest. Vaccine. 2013;31(S10):K2-K6. http://dx.doi.org/10.1016/j.vaccine.2013.06.048
2. Arrow K. Uncertainty and the welfare economics of medical care. Am Econ Rev. 1963;53(5):941-973. http://www.jstor.org/stable/1812044
3. Rothschild M, Stiglitz J. Equilibrium in competitive insurance markets: An essay on the economics of imperfect information. Q J Econ. 1976;(90):629-649. https://doi.org/10.2307/1885326
4. Acuerdo 260 de 2004. Consejo Nacional de Seguridad Social en Salud. Por el cual se define el régimen de pagos compartidos y cuotas moderadoras dentro del Sistema General de Seguridad Social en Salud.
5. Eaddy M, Cook C, O’Day K, Burch S, Cantrell C. How patient cost-sharing trends affect adherence and outcomes: A literature review. P T. 2012;37(1):45-55. https://pubmed.ncbi.nlm.nih.gov/22346336/
6. Cutler DM, Zeckhauser RJ. The anatomy of health insurance. In: Culyer AJ, Newhouse JP (eds). Handbook of Health Economics; 2000. p.629-631.
7. Goldman DP, Joyce GF, Zheng Y. Prescription drug cost sharing: Associations with medication and medical utilization and spending and health. JAMA.2007;298(1):61-69. https://doi.org/10.1001/jama.298.1.61
8. Dormuth C, Glynn R, Neumann P, Maclure M, Brookhart A, Schneeweiss S. Impact of two sequential drug cost-sharing policies on the use of inhaled medications in older patients with chronic obstructive pulmonary disease or asthma. Clinical Therapeutics. 2006;28(6):964-978. https://doi.org/10.1016/j.clinthera.2006.06.007
9. Karaca Mandic P, Anupam J, Geoffrey F, Goldman D. Out-of-pocket medication costs, medication utilization, and use of healthcare services among children with asthma. JAMA. 2012;307(12):1284-1291. https://doi.org/10.1001/jama.2012.340
10. Mann B, Barnieh L, Tang K, Campbell D, Clement F. Association between drug insurance cost sharing strategies and outcomes in patients with chronic diseases: A systematic review. PLoS One. 2014;9(3):e89168. https://doi.org/10.1371/journal.pone.0089168
11. Chandra A, Gruber J, McKnigth R. The impact of patient cost-sharing on low-income populations: Evidence from Massachusetts. J Health Econ. 2014;33:57-66. https://doi.org/10.1016/j.jhealeco.2013.10.008
12. Chernew M, Gibson T, Yu-Isenberg K, Sokol M, Rosen A, Fendrick M. Effects of increased patient cost sharing on socioeconomic disparities in health care. J Gen Intern Med. 2008;23(8):1131-1136. https://doi.org/10.1007/s11606-008-0614-0
13. Gourzoulidis G, Kourlaba G, Stafylas P, Giamouzis G, Parissis J, Maniadakis N. Association between copayment, medication adherence and outcomes in the management of patients with diabetes and heart failure. Health Policy. 2017;121(4):363-377. http://dx.doi.org/10.1016/j.healthpol.2017.02.008
14. Landsem MM, Magnussen J. The effect of copayments on the utilization of the GP service in Norway. Soc Sci Med. 2018;205(March):99-106. https://doi.org/10.1016/j.socscimed.2018.03.034
15. Jakobsson N, Svensson M. Copayments and physicians visits: A panel data study of Swedish regions 2003-2012. Health Policy (New York). 2016;120(9):1095-1099. http://dx.doi.org/10.1016/j.healthpol.2016.07.010
16. Goldman D, Joyce G, Zheng Y. Prescription drug cost sharing. Associations with medication and medical utilization and spending and health. JAMA. 2007;298(1):61-69. https://doi.org/10.1001/jama.298.1.61
17. Global Strategy for Asthma Management and Prevention, 2016. http://www.ginasthma.org
18. Harver A, Kotses H. Asthma, Health and Society A Public Health Perspective. Charlotte, North Carolina. Springer; 2010.
19. Ungar W, Kozyrskyl A, Paterson M, Ahmad F. Effect of cost- sharing on use of asthma medication in children. Arch Pediatr Adolesc Med. 2008;162(2):104-110. https://doi.org/10.1001/archpediatrics.2007.21
20. Campbell J, Allen-Ramey F, Sajjan S, Maiese E, Sullivan S. Increasing Pharmaceutical copayments: Impact on asthma medication utilization and outcomes. Am J Manag Care. 2011;17(10):703-710. https://pubmed.ncbi.nlm.nih.gov/22106463/
21. Sundararajan V, Henderson T, Perry C, Muggivan A, Quan H, Ghali WA. New ICD-10 version of the Charlson comorbidity index predicted in-hospital mortality. J Clin Epidemiol. 2004;57(12):1288-1294. https://doi.org/10.1016/j.jclinepi.2004.03.012
22. Stagg V. Charlson: Stata module to calculate Charlson index of comorbidity, Statistical Software Components S456719, Boston College Department of Economics, 2006, revised 13 Sep 2017.
23. Yurkovich M, Avina-Zubieta JA, Thomas J, Gorenchtein M, Lacaille D. A systematic review identifies valid comorbidity indices derived from administrative health data. J Clin Epidemiol. 2015;68(1):3-14. http://dx.doi.org/10.1016/j.jclinepi.2014.09.010
24. de Groot V, Beckerman H, Lankhorst GJ, Bouter LM. How to measure comorbidity. A critical review of available methods. J Clin Epidemiol. 2003;56(3):221-229. http://www.ncbi.nlm.nih.gov/pubmed/12725876
25. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2015 Emergency Department Summary Tables. Available from: http://www.cdc.gov/nchs/data/ahcd/nhamcs_emergency/2015_ed_web_tables.pdf
26. DANE. Indicadores demográficos según departamento 1985-2020. Conciliación Censal 1985-2005 y Proyecciones de Población 2005-2020. www.dane.gov.co
27. Cadarette SM, Wong L. An introduction to health care administrative data. Can J Hosp Pharm. 2015;68(3):232-237. https://doi.org/10.4212/cjhp.v68i3.1457
28. Harbaugh CM, Cooper JN. Administrative databases. Semin Pediatr Surg. 2018;27(6):353-360. https://doi.org/10.1053/j.sempedsurg.2018.10.001
29. Harron K, Dibben C, Boyd J, Hjern A, Azimaee M, Barreto ML, et al. Challenges in administrative data linkage for research. Big Data Soc. 2017;4(2). https://doi.org/10.1177/2053951717745678
30. Saczynski JS, Andrade SE, Harrold LR, Tjia J, Cutrona SL, Dodd KS, et al. Mini-Sentinel systematic evaluation of health outcome of interest definitions for studies using administrative and claims data: Heart failure. Pharmacoepidemiol Drug Saf. 2013;21(1):1-22. http://minisentinel.org/foundational_activities/related_projects/
31. Sinha S, Peach G, Poloniecki JD, Thompson MM, Holt PJ. Studies using english administrative data (hospital episode statistics) to assess health-care outcomes-systematic review and recommendations for reporting. Eur J Public Health. 2013;23(1):86-92. https://doi.org/10.1093/eurpub/cks046
32. Gini R, Schuemie M, Brown J, Ryan P, Vacchi E, Coppola M, et al. Data extraction and management in networks of observational health care databases for scientific research: A comparison among EU-ADR, OMOP, Mini-Sentinel And MATRICE Strategies. eGEMs (Generating Evid Methods to Improv patient outcomes). 2016;4(1):2. http://dx.doi.org/10.13063/2327-9214.1189
33. Zhan C, Miller M. Administrative data based patient safety research: A critical review BMJ. BMJ Qual Saf. 2003;12(ii):58-63. https://doi.org/10.1136/qhc.12.suppl_2.ii58
34. Mazzali C, Paganoni AM, Ieva F, Masella C, Maistrello M, Agostoni O, et al. Methodological issues on the use of administrative data in healthcare research: The case of heart failure hospitalizations in Lombardy region, 2000 to 2012. BMC Health Serv Res. 2016;16(1):1-10. http://dx.doi.org/10.1186/s12913-016-1489-0
35. Jones N, Schneider G, Kachroo S, Rotella P, Avetisyan R, Reynolds MW. A systematic review of validated methods for identifying acute respiratory failure using administrative and claims data. Pharmacoepidemiol Drug Saf. 2012;21(S1):261-264. https://doi.org/10.1002/pds.2326
36. Sharifi M, Krishanswami S, McPheeters ML. A systematic review of validated methods to capture acute bronchospasm using administrative or claims data. Vaccine. 2013;31(S10):K12-K20. http://dx.doi.org/10.1016/j.vaccine.2013.06.091
37. Maringe C, Fowler H, Rachet B, Luque-Fernandez MA. Reproducibility, reliability and validity of population-based administrative health data for the assessment of cancer non-related comorbidities. PLoS One. 2017;12(3):1-14. https://doi.org/10.1371/journal.pone.0172814
38. McPheeters ML, Sathe NA, Jerome RN, Carnahan RM. Methods for systematic reviews of administrative database studies capturing health outcomes of interest. Vaccine. 2013;31(S10):K2-K6. http://dx.doi.org/10.1016/j.vaccine.2013.06.048
Cómo citar
Aranguren Bello, H. C., Buitrago Gutiérrez, G. ., & Ruiz Morales, Álvaro . (2021). Asociación entre la cuota moderadora y la frecuencia en la consulta a los servicios de urgencias en pacientes adultos con asma, usuarios del Régimen Contributivo en Colombia. Gerencia Y Políticas De Salud, 20. https://doi.org/10.11144/Javeriana.rgps20.acmf
Sección
Artículos
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.