Atención primaria: evaluación del costo-efectividad

Abstract

Results of cost-effectiveness estimates in an outpatient clinic from the Northern part of Santiago area are presented. An aleatory group of 1.000 patients assisted in 1997 were visited at their homes 30 days after medical care visit. They were classified as healthy, symptomatic, worsened, hospital admission, or death. All the performed medical care activities (visits, diagnostic procedures, laboratory exams, hospitalization costs) were estimated according to the values of the third level of medical care approved by the National Health Fund (FONASA). All the medical or pharmaceutical expenses during the next 30 days were registered. The cases had the usual features of primary care patients with a majority of respiratory, communicable and bone and joint diseases. Low standard of living, public medical insurance, a majority of women, children and old age persons were main features of the group. Average medical care cost was US$ 28. An 87% out of total expenditure was institutional cost and the remaining 13% a personal cost. Patients on the average had 1,5 medical visits and rates of 11 % of specialist visit; 19% required diagnostic procedures and exams and 1,2% of hospital admissions. Thirty days after the visits 65% out of total cases were healthy and recovered. Average cost- effectiveness was $ 192, being the amount of money required for bettering in 1 % the rate of patient’s recovery. Cost-effectiveness values were lower in respiratory and communicable diseases and higher in digestive illnesses. They also were higher for medical care of women, population overs 40 year of age and socioeconomic status population.