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Objective Cryoballoon ablation for pulmonary vein isolation is a time-efficient procedure that can alleviate stress on electrophysiology lab resources. This analysis modeled the impact of cryoballoon ablation on electrophysiology lab operation using data from Latin America. Methods Data from centers in Argentina, Mexico, Colombia, and Chile of the Cryo Global Registry were used as inputs for an electrophysiology lab efficiency simulation model. The model used the assumption that either two (today’s electrophysiology lab operations) or three (including electrophysiology lab operational changes) cryoballoon ablation procedures could be performed per day. The endpoints were the percentage of days that resulted in 1) overtime and 2) time left for an extra non-ablation electrophysiology procedure. Results Data from a total of 232 procedures from six Latin American centers were included in the analysis. The average electrophysiology lab occupancy time for all procedures in Latin America was 132 ± 62 minutes. In the Current Scenario (two procedures per day), 7.4% of simulated days resulted in overtime, and 81.4% had enough time for an extra electrophysiology procedure. In the Enhanced Productivity Scenario (three procedures per day), 16.4% of days used overtime, while 67.4% allowed time for an extra non-ablation electrophysiology procedure. Conclusions Using real-world, Latin American-specific data, we found that with operational changes, three ablation procedures could feasibly be performed daily, leaving time for an extra electrophysiology procedure on more than half of days. Thus, use of cryoballoon ablation is an effective tool to enhance electrophysiology lab efficiency in resource-constrained regions such as Latin America.

Introduction In the Chilean health system, difficulties complicate women’s access to health care and aggravate the complexity of health-illness processes in their interaction as users or caregivers. Objective In the national and international literature, we aimed to identify gaps in women’s access to health care derived from gender disparities and the exercise of gender roles in a prioritized set of health problems. These problems exacerbate gender gaps and should be considered in health reform. Methods We made a literature review through algorithms, snowball sampling, and reference lists from November 2020 to March 2021. The population included were women of all ages, including women users of the health system and women caregivers of specific pathologies. The search was conducted in parallel by four investigators divided into two groups. It was cross-validated to ensure inter-investigator reliability by standardizing evidence eligibility criteria. The analysis showed women users' and caregivers' dimensions for a set of pathologies prioritized by the extent of the disease burden. The pathologies analyzed included stroke, obesity, depression, musculoskeletal pain, and breast cancer. Results Among women users of the health system, problems of access, rates of use, experience, and outcome for the whole group of prioritized pathologies were observed. In the women caregiver dimension, we found that women are the primary health care providers. There is a knowledge gap concerning obesity and musculoskeletal conditions. However, both were reported as health consequences of women’s caregiving roles.

Introduction Several studies demonstrate the therapeutic superiority of thrombolysis plus mechanical thrombectomy versus thrombolysis alone to treat stroke. Objective To analyze the cost-utility of thrombolysis plus mechanical thrombectomy versus thrombolysis in patients with ischemic stroke due to large vessel occlusion. Methods Cost-utility analysis. The model used is blended: Decision Tree (first 90 days) and Markov in the long term, of seven health states based on a disease-specific scale, from the Chilean public insurance and societal perspective. Quality-Adjusted Life-Years and costs are evaluated. Deterministic (DSA) and probabilistic (PSA) analyses were carried out. Results From the public insurance perspective, in the base case, mechanical thrombectomy is associated with lower costs in a lifetime horizon, and with higher benefits (2.63 incremental QALYs, and 1.19 discounted incremental life years), at a Net Monetary Benefit (NMB) of CLP 37,289,874, and an Incremental Cost-Utility Ratio (ICUR) of CLP 3,807,413/QALY. For the scenario that incorporates access to rehabilitation, 2.54 incremental QALYs and 1.13 discounted life years were estimated, resulting in an NMB of CLP 35,670,319 and ICUR of CLP 3,960,624/QALY. In the scenario that incorporates access to long-term care from a societal perspective, the ICUR falls to CLP 951,911/QALY, and the NMB raises to CLP 43,318,072, improving the previous scenarios. In the DSA, health states, starting age, and relative risk of dying were the variables with the greatest influence. The PSA for the base case corroborated the estimates. Conclusions Thrombolysis plus mechanical thrombectomy adds quality of life at costs acceptable for decision-makers versus thrombolysis alone. The results are consistent with international studies.

Background Osteoarthritis is an important health condition due to its prevalence and functional deterioration, being the most common cause of disability in people over 65 years of age. The Chilean Explicit Health-Guarantees regime provides coverage for medical treatment in mild and moderate presentations, excluding surgical treatment in end-stage knee osteoarthritis. Objectives To evaluate the cost-utility of incorporating total knee replacement to the Explicit Health-Guarantees regime for over-65-years beneficiaries of the public insurance system, versus maintenance with medical treatment. Methods A Scoping review was coducted to identify model parameters and economic evaluation based in a 6 health states Markov Model, from the perspective of the public payer and lifetime horizon. The Incremental Cost-Utility Ratio (ICUR) was calculated, and deterministic and probabilistic uncertainty analysis were performed. Results Twenty-two articles were selected as reference sources. If the regime were to adopt the procedure, the implication would be a benefit of 9.8 Years of Life Adjusted by Quality (QALY) versus 2.4 QALY in the scenario without access to total knee replacement. The ICUR was $ -445 689 CLP/QALY (U$D -633.8/QALY), wherein the inclusion of total knee replacement to the regime becomes a dominant alternative versus the current scenario. Each quality-adjusted life-year gained by the surgery will save CLP 445 689. At a willingness to pay of CLP 502,596/QALY (U$D 714.7/QALY), access to surgery is cost-useful with a 99.9% certainty. Conclusion Total knee replacement in patients older than 65 years is a dominant alternative. Access to this procedure in the Chilean Explicit Health-Guarantees regime in the public system is cost-useful at a threshold of 1 GDP per capita.

Introduction Healthcare systems are developed in imperfect scenarios, in which there are constant failures (uncertainty, information asymmetry, agency relationship problem, and supply-induced demand). These failures, based on the imperfection of the sector, determine the relationships and incentives between the actors. It is within this context that payment mechanisms regulate aspects of the system behavior and incentives, acting as instruments for the purchasing of health care from providers, mediated by health insurance on behalf of users. Objective To characterize the basic elements of most frequent payment mechanisms to help providers in their relationship with payers. Methods A review of the evidence was conducted in PubMed, Google, Google Scholar, and strategic snowball selection. Payment mechanisms consist of three classical microeconomics variables, fixed or variable: price, quantity, and expense. Time dimensions are used to analyze their attributes and effects. Different mechanisms emerge from the combination of these variables. Results Among the most used are: Fee-For-Service, Global Budget, Bundled Payments, Diagnosis-Related Groups, Per-capita, Performance Pay, and Risk-Sharing Agreements. A fourth has also gained importance: Financial Risk. Conclusions Payment mechanisms are essential to link health efforts with clinical practice. They make it possible to regulate relationships between insurers, providers, and users, which, depending on the architecture of the mechanism, can become beneficial or hinder the fulfillment of the objectives of the health system.

Introduction Payment mechanisms serve to put into operation the function of purchasing in health. Payment mechanisms impact the decisions that healthcare providers make. Given this, we are interested in knowing how they affect the generalized increase of C-section rates globally. Objective The objective of this review is to describe existing payment mechanisms for childbirth in countries members of the Organization for Economic Co-operation and Development (OECD) and non-members. Methods We conducted a scoping review following the five methodological steps of the Joanna Briggs Institute. The search was conducted by researchers independently, achieving inter-reliability among raters (kappa index, 0.96). We searched electronic databases, grey literature, and governmental and non-governmental websites. We screened on three levels and included documents published in the last ten years, in English and Spanish. Results were analyzed considering the function of the reimbursement mechanism and its effects on providers, payers, and beneficiaries. Results Evidence from 34 countries was obtained (50% OECD members). Sixty-four percent of countries report the use of more than one payment mechanism for childbirth. Diagnosis-Related Groups (47.6%), Pay-for-performance (23.3%), Fee-for-service (16.6%) and Fixed-prospective systems (13.3%) are among the most frequently used mechanisms. Conclusion Countries use payment mechanism architecture to improve maternal-perinatal health indicators. Therefore, it is necessary to explore the best combination of mechanisms that improve the provision of health care and welfare of the population in the field of sexual and reproductive health.

Introduction More than 600 thousand people in Chile live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for healthcare systems and insurance schemes. In 2022, two bundled payment codes for bariatric surgery (gastric bypass and gastric sleeve) were incorporated into the National Health Fund's free-choice modality fee scheme. The objective was to characterize the execution of this payment mechanism program associated with bariatric surgery diagnosis in its first year of implementation.More than six hundred thousand people in Chile are estimated to live with morbid obesity. Effective, safe, cost-effective therapeutic interventions are critical for health systems and insurance schemes. In 2022, FONASA incorporated two Bariatric Surgery codes into the Free Choice Modality: Gastric Bypass and Sleeve Gastrectomy. Our objective was to characterize the execution of the Bariatric Surgery Bundled Payment Program in its first year of implementation. Methods Descriptive and observational study of the pragmatic approach of the national execution of the payment associated with diagnosis in bariatric surgery. We examined sociodemographic variables (sex, age brackets, and National Health Fund tranches) and characterization of surgeries by code broken down by public or private provider, period of issue, unit cost, co-payment, and medical loans between March and December 2022. Results We recorded n = 13 118 surgeries (45.81% bypass versus 54.19% sleeve), of which n = 2424 (18.48%) used medical loans. A total of 85.01% (p = 0.01) of the procedures were in women, in people between 35 and 39 years of age (20.15%), and 45.12% in beneficiaries of tranche B. Private providers performed a total of 99.21% of the surgeries. Ten accounted for 50% of the activity (range n = 1200 to 426 surgeries per year; n = 4.8 to 1.7 surgeries per working day). Total program expenditure was $71 626 948 350 CLP, accounting for 5.04% of the total activity of the national Diagnosis Associated Payment Program. Conclusions The implementation of this bariatric surgery voucher benefited more than 13 thousand people living with obesity, mostly women of productive ages and with purchasing capacity. As an equity strategy, regardless of the access route through the voucher, it will be important to safeguard the activity in the public network.