Private Health Care System Research Articles

SUPERLOTAÇÃO DOS SERVIÇOS DE EMERGÊNCIA: IMPLICAÇÕES PARA A SEGURANÇA DO PACIENTE E PARA O TRABALHO DA EQUIPE DE SAÚDE

Introduction: Overcrowding in emergency services is a reality that is likely to worsen, making it necessary to implement measures to ensure patient safety in the care provided. Objective: To describe the implications of overcrowding for patient safety and the work/daily routine of the healthcare team. Methodology: This is a bibliographic review article in which an exploratory, qualitative approach was used. The search for articles, theses, dissertations, book chapters was conducted in databases such as Lilacs BDNF, Medline, Scielo, and university repositories containing scientific journals. Publications were sought that addressed the topic in Portuguese, within the period of 2015 to 2024. The results yielded 34 articles related to the topic, of which 12 were selected for this study, in addition to the book by the Joint Commission International (JCI), “Managing Patient Flow: Strategies and Solutions for Overcoming Overcrowding.” Results and Discussion: It is well known that patient safety is a globally discussed topic and a recurring requirement for institutions undergoing accreditation processes. In this context are healthcare professionals, who, due to the nature of their work, are subject to committing/experiencing adverse events within their professional environment. Final Considerations: The consequences of overcrowding bring numerous implications for the work of healthcare professionals and for patient safety, such as reduced quality of care, exhaustion of healthcare professionals, increased risk of infections, inequality in access to care, impact on the efficiency of the healthcare system, and increased costs, making it a critical challenge for both public and private healthcare systems.

Antimicrobial stewardship programs in a Mexican private healthcare system: a self-assessment of core elements

BackgroundAntimicrobial stewardship programs (ASPs) refer to a set of coordinated actions that improve the quality of care and combat antimicrobial resistance. Currently, information regarding the status of ASPs in Mexico is scarce. We aimed to describe the status of ASPs in 12 hospitals from Christus Muguerza Healthcare System.MethodsA cross-sectional study was conducted in 12 hospitals, with a previously developed self-assessment tool to calculate each hospital’s ASP development score. The self-assessment tool includes 7 standards with 23 items. Score categories were defined as; high, medium, low, or none. The overall ASP development score was calculated using the proportional weight of each standard. Participating hospitals were divided into 2 groups according to their bed count. Statistical analysis was conducted in Excel program (Microsoft, Redmont, Washington).Results12 hospitals completed the self-assessment survey. The median overall ASP development score was 32.3%. The highest overall development scores were observed for hospitals with > 40 beds. The core elements with the lowest development scores were Education and training, and Reporting and feedback. Unlike hospitals with over 40 beds, those with 40 beds or less had a low development score for Hospital leadership support. The core element with the highest development score was Infection prevention and control.ConclusionsThis is the first multicenter assessment of ASPs in Mexico, revealing a high proportion of low-score hospitals. National implementation of ASPs is required to combat antimicrobial resistance.

The negative impact of the COVID-19 pandemic on breast cancer tackle in Brazil’s public and private healthcare system: time series study between 2014 and 2022

BackgroundThe COVID-19 pandemic has overwhelmed the healthcare systems of many countries and negatively impacted the care of other diseases.ObjectiveTo evaluate the trend of screening mammograms, oncological breast surgeries, and breast cancer hospitalizations in Brazil’s public and private healthcare system between 2014 and 2022.MethodThis ecological time series study uses the inflection point regression model and semester percentage change (SPC). We use the open-access dataset of the different healthcare systems in Brazil. We analyzed the trend of the variables in the pre-pandemic and the effect of the pandemic on the total time series.ResultsIn 2020, compared to 2019, the decrease in screening mammograms, oncological breast surgeries, and breast cancer hospitalization was − 41.44%, -23.13%, and − 10.52% (public health system) and − 29.49%, -18.96%, and − 15.35% (private healthcare system). In the public healthcare system, the pandemic has enhanced the decreasing trend of mammograms (SPC − 1.6% before and − 3.4% after), has reverted the stationary trend of oncological breast surgeries to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer hospitalization (SPC 1.8% before and 0.9% after). In the private healthcare system, the pandemic has reverted the stationary trend of mammograms to decreasing (SPC − 1.0%), has slowed the increasing trend of breast cancer surgeries (SPC 2.3% before and 0.8% after), has reverted the growing trend of breast cancer hospitalization (SPC 3.9%) to stationary.ConclusionDuring the COVID-19 pandemic, there was an increase in inequalities between healthcare systems, especially in breast cancer screening.

Access to transition-related health care among transmasculine people in India: A mixed-methods investigation.

Little research has examined the health care experiences of transmasculine people in India, where government initiatives to improve access to transition-related (also called gender-affirmative) care have recently been announced. We draw on data from 'Our Health Matters', a mixed-methods community-based participatory research project, to characterize the transition-related care experiences of transmasculine people in India. Peer researchers conducted 40 virtual qualitative interviews in Hindi or Marathi from July to September 2021. Between November 2022 and January 2023, 377 transmasculine people participated in a multi-mode survey available in five languages. Qualitative data were analysed with a combination of framework analysis and grounded theory techniques. Data were mixed using a convergent parallel approach. Transmasculine persons' care journeys began with information-seeking, relying on peers and internet searches. In choosing between the public and private healthcare systems, they weighed issues of quality and affordability: the public system was perceived as lower-quality and difficult to access but most could not afford private care, leading to delays in care. Indeed, unmet need was common; 36.4% of survey participants were planning but had not begun to receive transition-related care and 80.2% wanted at least one transition-related surgery. Although some participants encountered stigma and refusal of care when seeking hormones, survey participants reported largely positive experiences with their hormone prescribers, which may reflect the influence of peer referrals. Participants underwent psychological assessments prior to transition-related care, which some experienced as disempowering and a barrier to disclosing mental health challenges. Finally, participants who were able to access care reported improved well-being, although surgical dissatisfaction was not uncommon (26.2%). Trans-inclusive medical training and continuing education are critical to enhancing access to high-quality transition-related care. Transmasculine people generally relied on peers and grassroots organizations for information, system navigation, and financial assistance. Strengthening these existing community resources may improve access to care.

New York City’s Public Health Approach to Reexamining Race-Based Clinical Algorithms

Clinical algorithms are utilized in clinical decision-making — whether for diagnosis or treatment — with the aim of accounting for pertinent biological factors. However, the use of race in some clinical algorithms disproportionately harms patients of color, often delaying necessary care. The erroneous use of race as a biological variable perpetuates the antiquated notion of race essentialism and demonstrates how medical racism is embedded in health care. In 2021, the New York City (NYC) Department of Health and Mental Hygiene launched the Coalition to End Racism in Clinical Algorithms (CERCA). To the authors’ knowledge, CERCA was the first citywide effort to convene seven safety-net and four private health care systems for the elimination of harmful race-based clinical algorithms, representing the health institutions in NYC serving the most patients. Focusing on estimated glomerular filtration rate, vaginal birth after cesarean, and pulmonary function testing, CERCA serves as a platform for health systems to discuss and strategize how to effectively de-implement these harmful race-based algorithms. NYC CERCA serves as a model for how a public health department can leverage its role as a convener by collaborating with health systems to address matters of racial inequities caused by systemic racism in medicine and supporting the swift implementation of reparative initiatives on a systems level.

Understanding medicine access strategies for innovator medicines registered in South Africa

BackgroundSouth Africa is composed of a two-tier healthcare system. One tier is a private healthcare system that is funded through medical insurance, and comprised of people who can afford to make monthly payments towards their medical insurance. Second tier is a government-funded public healthcare system, which covers the majority of the population. This study explored the perceived barriers and current strategies being utilised by the pharmaceutical industry to increase access to innovator medicines.ObjectivesThe objectives of the study were to: (1) quantify and classify innovator medicines registered between 2010 and 2020 by the South African Health Products Regulatory Authority (SAHPRA); (2) identify barriers to accessing innovator medicines in South Africa through interviews with market access managers from innovator companies; and (3) explore the current market access strategies used by the pharmaceutical industry.DesignThis study employed a quantitative and qualitative methodology. Whereby the former involved the extraction of a list of innovator medicines from the regulator database, and the latter involved 9 semi structured interviews. Purposive sampling was conducted through pharmaceutical association member companies. The interviews included seven market access managers and two medicine managers from one of the payers in South Africa. Thematic analysis was used to interpret the data collected from the study.ResultsAccording to the regulator database during the review period, 238 innovator medicines were registered. Only 14.77% were available in the public sector in the form of tenders, whereas in the private sector (based on the products having a SEP), 76.92% were available. From the interviews six themes emerged: reimbursement of medicines, types of reimbursement, partnerships, technology, legislative challenges, and other factors (e.g., real-world evidence).ConclusionAccess to innovator medicines in South Africa is a challenge, as the price of these therapies is high. Therefore, various stakeholders in the health sector must collaborate to identify and implement solutions that are locally relevant. The government needs to proactively update policies that would allow for alternative reimbursement methods to be explored.

Evaluation of Treatment and Recurrence-Free Survival in Patients with Early HER2-Positive Breast Cancer: Real-Life Data Comparing Public and Private Healthcare

Abstract Introduction The present study was designed to compare the treatment provided in private and public health care facilities for women positive for early breast cancer of the human epidermal growth factor receptor 2 (HER2) subtype, who received anti-HER2 therapy in neoadjuvant or adjuvant settings, with an evaluation of the recurrence-free survival (RFS) and pathological complete response (pCR) rates. Materials and Methods The current is a retrospective study carried out at the Instituto Brasileiro de Controle do Cancer (IBCC Oncologia), in the city of São Paulo, Brazil. We included patients treated between 2015 and 2020. Results The study included 472 medical records of early HER2-positive breast cancer patients treated in the public and private health care systems who received neoadjuvant or adjuvant treatments. The pathological complete response (pCR) was related to a lower recurrence rate and a longer recurrence-free survival (RFS). The results showed no statistically significant difference between the public and private health care systems in terms of RFS. Discussion Although the public health care patients were diagnosed with more advanced diseases than the private health care patients, both presented similar survival rates. In spite of the small number of patients evaluated, the dual HER2 blockade did not improve the clinical outcomes. These findings should be confirmed through studies with a larger number of patients and a longer follow-up period.

Formal Institution Networks and Coopetition: Insights from the Brazilian Private Healthcare Industry

This study demonstrates that formal institution networks are antecedent to firms adopting coopetition to improve performance. The influence of formal institution agents to foster coopetition within an industry is driven by fragilities in the institutions of emerging economies. We studied the Brazilian healthcare sector, which is characterized by strong regulation and government support. We analyzed how and to what extent coopetition relates to formal institution agents and the performance of private healthcare operators. The study employs a quantitative methodology with a sample of 149 firms from the Brazilian private healthcare system through partial least squares structural equation modelling (PLS-SEM). Our findings highlight that networks facilitated by formal institution agents precede firms’ adoption of coopetition to enhance performance. They also underscore the impact of regulatory policy on firms’ strategies and behaviors in the healthcare sector. Our findings emphasize that formal institution networks alone do not guarantee performance improvement. Healthcare firms must develop coopetitive strategies to create and capture value within these relationships. Our study sheds light on the organizational dynamics within the Brazilian private healthcare sector and provides insights for managers and policymakers. For policymakers, it highlights opportunities and challenges in enhancing healthcare sector competitiveness, emphasizing the importance of considering the institutional environment. For healthcare firm managers, it details opportunities for developing coopetitive strategies. Finally, the study is subject to boundary conditions potentially limiting the generalizability of its findings to a broader global context. Additionally, it is also limited by the cross-sectional design since respondents’ replies are specific to the current scenario in the healthcare sector.

Head and neck squamous cell carcinoma epidemiology at diagnosis: A description of public and private health care systems in Brazil regarding tumor location, staging and risk factors

ObjectivesThere is a limited number of updated epidemiological Brazilian data on head and neck squamous cell carcinoma (HNSCC). This study aimed to describe demographic and clinical characteristics of HNSCC patients from Brazilian public and private systems. MethodsThis is a retrospective observational study that included patients diagnosed with HNSCC from Brazilian public and private settings from 2016 to 2018. As for the public scenario, data were drawn from the public hospital national cancer registry database. As for the private sector, the data were extracted from medical records of patients from Oncoclinicas, a large Brazilian oncology group. ResultsA total of 37,121 patients were included in the study, with 36,914 from the public and 207 from the private system. Patients in the public sector were younger than those in the private sector, with medians ages of 61.2 and 66.9 years, respectively. In both cohorts, a predominance of men with a history of tobacco and alcohol consumption and an advanced locoregional stage at diagnosis was observed. The main site of the primary tumor was the oropharynx in the private sector and oral cavity in the public sector. Among patients with oropharyngeal cancer, only those in the private sector were tested for HPV, with the majority being positive. ConclusionsThis real-world data study provides epidemiologic characteristics of patients with HNSCC in two different Brazilian healthcare settings, presenting relevant insights into possible opportunities for improvements in the patient's journey with HNSCC.

Lipid Control and Medical Costs Among Patients With and Without Established Atherosclerotic Cardiovascular Disease Followed in a Brazilian Private Healthcare System.

There is limited real-world data of lipid control and healthcare costs among patients with and without Atherosclerotic Cardiovascular Disease (ASCVD) in Latin America. A retrospective cohort study including patients with LDL-cholesterol (LDL-C) assessment from 2015 to 2017 was performed in a health insurance database. Patient characteristics, comorbidities and laboratory data were collected, and International Classification of Diseases (ICD) codes were used to identify a subcohort of patients with ASCVD (secondary prevention) and assess the proportion of these patients with LDL-C controlled. Lipid control among patients without ASCVD (primary prevention) and healthcare costs in one year in the overall population were also assessed. From the 17,434 patients selected, 5,208 (29.8%) had ASCVD. The mean age of these patients in secondary prevention was 68.9 (±12.3) years and 47.8% were male patients. LDL-C < 70 mg/dL was identified in 19.1% of the ASCVD population and only 4.1% had an LDL-C < 50 mg/dL. LDL control was worse in women compared to men (13.1% vs. 25.7%; P < 0.01). The average cost in one year was 3,591 American dollars (USD) per patient in primary prevention compared to 8,210 dollars per year for patients in secondary prevention (P < 0.01). While outpatient costs accounted for 59.8% of the total cost in the primary prevention group, the main cost of the secondary prevention population was related to hospital costs (54.1%). Despite the favorable evidence for intensive cholesterol reduction, the evaluation of large real-world database with more than 17,000 individuals showed that the targets of guideline recommendations have not yet been adequately incorporated into clinical practice. Average annual cost per patient in secondary prevention is more than twice compared to primary prevention. Hospital expenses account for most of the cost in the secondary prevention group, while outpatient costs predominate in primary prevention.

Exploring the road to public healthcare accessibility: a qualitative study to understand healthcare utilization among hard-to-reach groups in Kerala, India

BackgroundKerala, a southern state in India, is known to be atypical due to its high literacy rate and advanced social development indicators. Facing competition from a dominant private healthcare system, recent government health system reforms have focused on providing free, high-quality universal healthcare in the public sector. We carried out an analysis to ascertain the initial impacts of these measures among ‘hard to reach groups’ as part of a larger health policy and systems research study, with a focus on public sector health service utilisation.MethodsWe conducted Focus Group Discussions (FGDs) among identified vulnerable groups across four districts of Kerala between March and August of 2022. The FGDs explored community perspectives on the use of public healthcare facilities including enablers and barriers to healthcare access. Transliterated English transcripts were coded using ATLAS.ti software and thematically analyzed using the AAAQ framework, supplemented with inductive code generation.ResultsA total of 34 FGDs were conducted. Availability and cost-effectiveness were major reasons for choosing public healthcare, with the availability of public insurance in inpatient facilities influencing this preference. However, accessibility of public sector facilities posed challenges due to long journeys and queues. Uneven roads and the non-availability of public transport further restricted access. Gaps in acceptability were also observed: participants noted the need for the availability of special treatments available, reduced waiting times for special groups like those from tribal communities or the elderly mindful of their relatively greater travel and need for prompt care. Although quality improvements resulting from health reform measures were acknowledged, participants articulated the need for further enhancements in the availability and accessibility of services so as to make public healthcare systems truly acceptable.ConclusionThe ‘Kerala Model of Development’ has been applauded internationally for its success in recent years. However, this has not inured the state from the typical barriers to public sector health care use articulated by participants in the study, which match global evidence. In order to deepen the impact of public sector reforms, the state must try to meet service user expectations– especially among those left behind. This requires attention to quality, timeliness, outreach and physical access. Longer term impacts of these reforms – as we move to a post-COVID scenario - should also be evaluated.

Impact of the COVID-19 pandemic on international cutaneous squamous cell carcinoma incidence: A systematic review and meta-analysis.

Non-melanoma skin cancer (NMSC) is the most common cancer globally in white ethinicity populations, and cutaneous squamous cell carcinoma (cSCC) is the second most common subtype. The COVID-19 pandemic severely impacted public and private healthcare systems. Many studies have reported reduced cancer diagnoses during the pandemic. The impact of the COVID-19 pandemic on global cSCC and NMSC incidence is poorly reported. The aim was to conduct a systematic review and meta-analysis to assess the impact of the COVID-19 pandemic on global cSCC and NMSC incidence rates, compared with 2019 incidence rates. Two primary outcome measures were used: crude incidence rate ratios (CIRR) and age-standardised incidence rate ratios (ASIRR). A structured search was undertaken on 23 March 2023 using grey literature and four electronic databases: MEDLINE, CINAHL, EMBASE and Web of Science. Studies published before January 2020 were excluded. A quality assessment was undertaken using A. Lomas quality assessment tool. CIRR outcomes were synthesised in a meta-analysis, while ASIRR outcomes were narratively synthesised. Fourteen cancer registries were included, capturing data from 13 countries across Europe. Variation was observed in NMSC and cSCC incidence across the cancer registries. Pooled cSCC crude incidence rates in 2020 were equal to crude incidence rates in 2019 (cSCC-CIRR 1.00 (95% confidence interval (CI) 0.94-1.06). In 2021, the pooled result indicated a non-significant 8% increase in cSCC crude incidence rates, compared with 2019 (cSCC-CIRR 1.08 (95% CI 0.98-1.19). Significant reductions were reported in NMSC incidence across all meta-analyses in 2020 and 2021 compared with 2019. Heterogeneity was observed across most pooled estimates (I 2>75%). There was a lack of high quality data on cSCC incidence rates recorded during the pandemic outside of Europe. The COVID-19 pandemic resulted in no significant changes in cSCC incidence across Europe. By contrast, NMSC incidence fell across Europe following the pandemic. Significant reductions in pooled NMSC incidence rates may reflect a delay in basal cell carcinoma presentation, diagnosis and treatment. Although annual incidence rates for cSCC were not affected by the pandemic, delays in treatment may still have occurred, which may result in poorer outcomes yet to be fully understood.

Procedure for licensing medical activities at the present stage: problems and ways to overcome them

BACKGROUND: One of the tools for ensuring the quality of medical care and medical services is licensing procedures for admission to medical activities, which include licensing. Licensing is indicated as a mandatory condition for carrying out medical activities in the list of types of activities for which licenses are required (clause 46 of Article 12 of the Federal Law “On Licensing of Certain Types of Activities”). Since life and health are the most important universal human values and are legally enshrined at the level of the Constitution of the Russian Federation, the study of the healthcare sector, including from the point of view of legal support for procedures for admitting individuals and legal entities to medical activities, is of exceptional scientific and practical interest. It should be noted that the institution of licensing of medical activities is one of the legal institutions that is constantly undergoing legislative changes, which allows us to speak about the relevance and relevance of this issue. Issues of licensing medical activities quite often come to the attention of researchers, however, due to the dynamic changes in the current legislation on the issue under study and the presence of quite extensive judicial practice, they require additional research in order to resolve problematic issues that arise in practice. OBJECTIVE OF THE STUDY: based on an analysis of the regulatory framework for licensing medical activities, to identify problematic procedural issues and determine ways to improve the current legislation regulating the provision of medical care and medical services. MATERIALS AND METHODS: Using the method of expert assessments, an analysis was carried out of the regulatory framework of the Russian Federation regulating legal relations during the procedure for licensing medical activities by organizations of the public and private healthcare system. RESULTS: Licensing as an institution of law is complex in terms of the legal relations it generates, combining at its core the legal norms of two broad branches of law — administrative and civil. At the same time, licensing is a mandatory criterion for the functioning of a medical organization and includes a number of requirements for such organizations. Despite the extensive regulatory framework on the issue under study, licensing requirements contain a number of problematic aspects that create obstacles for licensees and license applicants and require legislative approval. In this regard, the authors have proposed ways to resolve existing contradictions by making specific proposals to change the current legislation. The proposed optimization of the licensing procedure for all participants in this process, as well as minimizing the risks arising from these legal relations, according to the authors, fully meets the objectives of ensuring the rights of citizens to high-quality and safe medical care.

EE198 Cost-Utility of Belimumab in Treating Lupus Nephritis: A Brazilian Private Healthcare System Perspective

EE198 Cost-Utility of Belimumab in Treating Lupus Nephritis: A Brazilian Private Healthcare System Perspective

EE388 Economic Evaluation and Budget Impact of Brigatinib Versus Other ALK-Inhibitors for First-Line ALK-Positive Non-Small Cell Lung Cancer (NSCLC) Treatment in the Brazilian Private Healthcare System

EE388 Economic Evaluation and Budget Impact of Brigatinib Versus Other ALK-Inhibitors for First-Line ALK-Positive Non-Small Cell Lung Cancer (NSCLC) Treatment in the Brazilian Private Healthcare System

UK national newspapers' representation of cancer patients and their care during the early part of the COVID-19 pandemic: Invoking and undermining solidarity?

During the COVID-19 pandemic media narratives of solidarity often cast nations like the UK as if at war, while acclaiming health-care workers as heroic and beloved. However, this solidarity was often fragile and fleeting, as concerns and criticism about workers, citizens and services also circulated. In this article we explore these dynamics of solidarity in more depth, analysing framings of cancer patient suffering, private and public provision of health care in news media during the early part of the COVID-19 pandemic. We explore how cancer patients were positioned as victims of failure and abandonment by the state and its health-care providers, and how the private health-care system was presented in a saviour role. We conclude by reflecting on the implications of new media's alignment of appeals to solidarity with highly individualised forms of care and the consequences for state-based services founded on principles of solidarity.

Healthcare in Brazil: An Overview

This study examines the present comprehension of healthcare in Brazil, which accounts for 9.3% of GDP and is not viable in the long term. The research enhances the caliber and triumph of private healthcare initiatives in Brazil, as well as the entire Brazilian healthcare system. Our findings indicate that there are consistent concerns about the public healthcare system deteriorating due to the pandemic while the private healthcare system is seen as costly and a "necessary evil." Professionals in the Brazilian private healthcare system is encountering widespread discontent due to inadequate resources to meet the needs of the people. This research offers recommendations for future investigations.

Abstract PO1-09-09: The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey

Abstract Background: Breast cancer is the most common neoplasm in Brazilian women, with high percent of patients diagnosed in advanced stages. Metastatic breast cancer (mBC) is a challenge in the country, where 75% of the population is covered by public health system (Sistema Único de Saúde, SUS). We conducted an on-line survey to describe the journey of human epidermal growth factor receptor 2-negative (HER2-), hormone receptor positive (RH+) mBC patients across public scenario in Brazil. Methods: An on-line survey comprised of 39 to 48 (depending on the kind of some questions, which could open another question in case of affirmative answer) objective questions were sent by e-mail to180 oncologists working in public and private health care system. Questions were focused on assessing wait time for first treatment after admission in the hospital in both systems, availability of oncological drugs within SUS according to essential medicines list by World Health Organization, and presence of palliative and multidisciplinary teams in both systems. Continuous variables were measured by median and mean. The level of statistical significance adopted was 5% with Teste p two-sided. Analyses were performed using SAS statistical software (version 25.0). Results: We had 150 respondents working in SUS and private health system, which fulfilled the inclusion criteria to participate in this survey. The other 30 respondents were excluded from the study because they worked exclusively in SUS or exclusively in the private system, and their answers were not analyzed. Median wait time for surgery was 60 days in the SUS (N=150) and 30 days in the private health system (N=150) e (p &amp;lt; 0,0001). Regardless of chemotherapy provided, median waiting time was 30 and 15 days in the SUS (N=150) and the private health system (N=150), respectively (p &amp;lt; 0,0001). Most oncologists in the SUS (N=125, 83.3%) pointed to endocrine therapy as their first-choice treatment in mBC. Concerning endocrine therapy in the SUS, Gonadotropin-Releasing Hormone Agonist (GnRHa) was available, and it was prescribed by 54 (36.0%) and Fulvestrant for 72 (48.0%) of respondents. Considering chemotherapy, weekly paclitaxel alone or combined with platin were available and they were prescribed by 124 (82.6%) and 109 (72.6%) of oncologists respectively. Vinorelbine was available and it was prescribed according to oncologists’ report by 109 (72.6%) and Pegylated liposomal doxorubicin (PLD) by 38 (25.3%) of oncologists. Oncologists answered agree or strongly agree that they had a multidisciplinary care team in SUS 77,3% (N =116) versus 87,3% (N=131) in the private system (p=0.022). Concerning palliative care 66,09% (N= 99) in the SUS versus 82,0% (N=123) in the private system answered that they agreed or strongly agreed that this service was available (p=0.001). Conclusions: The Brazilian government has continuously improved delivery of services and medicines via the public system (SUS), but there are still significant differences within this system and versus the private sector. Unavailability of endocrine therapy agents as GnRHa and Fulvestrant, and some chemotherapy agents as PLD and Vinorelbine for high percentage of patients, raises the existence of disparities within SUS. Also, longer waiting times for treatment in the SUS, lower availability of support teams such multidisciplinary and palliative care, they point out disparities between SUS and private health systems. The lack of a National Cancer Control Program and low health investment by Brazilian government might explain the difference in cancer patients’ access. Citation Format: Heloísa Resende, Igor Soares, Angélica Renó, Ana Cunha, Vinícius Aguiar, Letícia Tureta, Viviane Pereira. The journey of HR positive, HER2 negative metastatic breast cancer’s patients: heterogeneities and barriers in Brazilian public health system- a national survey [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-09-09.

Assessing Household Catastrophic Healthcare Expenditure and its Associated Factors: A Study in a North-Eastern State of India

Background: Out-of-pocket expenses (OOPE) are the primary means of funding healthcare costs in developing nations, and when the cost is too high, it leads to catastrophic healthcare expenditures (CHE). Aim &amp; Objective: This study aimed to assess the proportion of households that faced CHE and also examined the associated factors that determine CHE at the household level. Methods and Material: Between September 2020 and February 2021, a cross-sectional study covering a sample of 771 households was conducted in four districts of Assam. A multistage sampling design was employed to select the sample households. Statistical analysis used: Binary logistic regression analysis has been performed to ascertain the factors that could determine household CHE. Results: 23% households had experienced CHE, high dependence on the private healthcare system. Monthly household income, duration of illness, presence of children under five years of age and elderly members, education of household head, and health insurance were the significant factors influencing CHE. Conclusions: The study identified the growing use of private healthcare services as a major concern that contributes to the prevalence of CHE. To make all healthcare services accessible and affordable and to lower OOP on healthcare, it is also crucial to improve the infrastructure and quality of the public healthcare system in rural and remote locations.

ГОТОВНОСТЬ ВРАЧЕЙ-СТОМАТОЛОГОВ К ИСПОЛЬЗОВАНИЮ НАВИГАЦИОННЫХ ХИРУРГИЧЕСКИХ ШАБЛОНОВ ПРИ ПЛАНИРОВАНИИ ДЕНТАЛЬНОЙ ИМПЛАНТАЦИИ

Dental implantation surgery is becoming an increasingly demanded dental procedure. Along with the growing number of installed dental implants, the number of complications inevitably increases, including those associated with planning errors in both the surgical intervention itself and subsequent orthopedic treatment. Despite the wide awareness among practicing dentists about the possibilities of navigational surgery, its prevalence remains insufficient. This paper analyzes the frequency of use and reasons for refusal to use navigational surgical templates among dental surgeons and orthopedists from different regions of Russia working in both public and private healthcare systems.