Papers by Bernard Couttolenc
Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impac... more Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). Methods: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. Results: The sample consisted of 90 TRD+ and 122 TRD-patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD-patients. Furthermore, TRD+ patients were significantly more likely to require hospitalizations. Overall, TRD+ patients imposed significantly higher (81.
Agradeço primeiramente a Deus por estar sempre ao meu lado. Ao meu orientador Prof. Dr. Bemard Fr... more Agradeço primeiramente a Deus por estar sempre ao meu lado. Ao meu orientador Prof. Dr. Bemard François Couttolenc pela confiança e oportunidade dada para elaborar este estudo. A Prof. Dra. Maria do Rosário Dias de Oliveira Latorre que não mediu esforços para ajudar nesta pesquisa sendo também responsável por esta finalização. Ao Prof. Dr. Heron Carlos Esvael do Carmo que ajudou na hora que eu mais prectsava. Ao Dr. Paulo Roberto Pereira que facilitou e estimulou o meu ingresso no mestrado. Ao Dr. Ulysses Dória Filho que me ajudou nos momentos mais dificeis, e me fez refletir com a elaboração desta pesquisa. Ao Dr. Anísio de Moura pela compreensão e estimulo para concluir esta pesquisa.
Rationale: Private health insurance (PHI) covers 45 million people in Brazil, which makes it one ... more Rationale: Private health insurance (PHI) covers 45 million people in Brazil, which makes it one of the largest market in the world. It was until recently unregulated, and little information was available on its characteristics and impact. Recently available data make it possible to assess its impact. Objectives: Assess the characteristics of enrollees in private health insurance and evalutate its impact on access to and utilization of health care. Methodology: The study uses national household-level data to assess the socioeconomic characteristics of individuals covered by private voluntary insurance, and applies the two-step Heckman regression model to estimate the impact of PHI on access to health services. Results: Individuals enrolled in a PHI plan have a significantly higher probability of seeking care and tend to go to the doctor more often than those not covered by private insurance and relying on the universal and free public system. Income and formal employment are also as...
Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impac... more Objective: Major Depressive Disorder (MDD) is a debilitating condition with a marked social impact. The impact of MDD and Treatment-Resistant Depression (TRD+) within the Brazilian health system is largely unknown. The goal of this study was to compare resource utilization and costs of care for treatment-resistant MDD relative to non-treatment-resistant depression (TRD-). Methods: We retrospectively analyzed the records of 212 patients who had been diagnosed with MDD according to the ICD-10 criteria. Specific criteria were used to identify patients with TRD+. Resource utilization was estimated, and the consumption of medication was annualized. We obtained information on medical visits, procedures, hospitalizations, emergency department visits and medication use related or not to MDD. Results: The sample consisted of 90 TRD+ and 122 TRD- patients. TRD+ patients used significantly more resources from the psychiatric service, but not from non-psychiatric clinics, compared to TRD- patie...
Health Financing in the Republic of Gabon, 2014
Health Financing in the Republic of Gabon, 2014
This is a policy note following from the book Health Financing in the Republic of Gabon. The book... more This is a policy note following from the book Health Financing in the Republic of Gabon. The book is a comprehensive assessment of health financing in the Republic of Gabon. The book reviews the health financing situation in light of the government’s introduction of a national health insurance program and its commitment to achieving universal health insurance coverage in the medium term. The book provides a diagnostic of the situation in light of recent data from the demographic and health survey, updated national health accounts, and a review of public expenditures in the health sector. Additionally, it performs a benchmarking exercise to assess how Gabon performs in its health spending and health outcomes compared to countries of similar income and compared to countries in the region. A forthcoming household survey is expected to provide better information on financial protection against illness costs. This book attempts to diagnose Gabon’s current situation in regards to achievin...
A nova Ramb passará a publicar nas próximas edições a seção " Imagem em Medicina". Será um espaço... more A nova Ramb passará a publicar nas próximas edições a seção " Imagem em Medicina". Será um espaço aberto ao leitor, que poderá participar enviando material de interesse educativo, como fotos, ilustrações e exames, acrescido de três linhas explicativas contendo ainda nome do autor e serviço onde foi realizado. O material poderá ser enviado para a Rua São Carlos do Pinhal,
The report assesses how the processes of allocation, transfer, and utilization of resources are c... more The report assesses how the processes of allocation, transfer, and utilization of resources are conducted at the different levels of the system. The study provides valuable information regarding the reality of the executing units of the system and how these relate to the central levels. It also seeks to identify problems related to financial flows, analyze how resources are used at the local level, and estimate their impact on the efficiency and quality of health services in general. In this respect, the study provides a basis for improving the entire cycle of public resource management processes (i.e., planning, budgeting, budget execution, input management, and health service production) in the health sector, which together help to bolster good governance in health care delivery. This report referenced in this note assesses resource allocation and management, planning and budgeting functions, and budget execution at different levels of government for public expenditures on health ...
Alcoholism: Clinical and Experimental Research, 1988
This is a policy note following from the book Health Financing in the Republic of Gabon. The book... more This is a policy note following from the book Health Financing in the Republic of Gabon. The book is a comprehensive assessment of health financing in the Republic of Gabon. The book reviews the health financing situation in light of the government’s introduction of a national health insurance program and its commitment to achieving universal health insurance coverage in the medium term. The book provides a diagnostic of the situation in light of recent data from the demographic and health survey, updated national health accounts, and a review of public expenditures in the health sector. Additionally, it performs a benchmarking exercise to assess how Gabon performs in its health spending and health outcomes compared to countries of similar income and compared to countries in the region. A forthcoming household survey is expected to provide better information on financial protection against illness costs. This book attempts to diagnose Gabon’s current situation in regards to achievin...
The report assesses how the processes of allocation, transfer, and utilization of resources are c... more The report assesses how the processes of allocation, transfer, and utilization of resources are conducted at the different levels of the system. The study provides valuable information regarding the reality of the executing units of the system and how these relate to the central levels. It also seeks to identify problems related to financial flows, analyze how resources are used at the local level, and estimate their impact on the efficiency and quality of health services in general. In this respect, the study provides a basis for improving the entire cycle of public resource management processes (i.e., planning, budgeting, budget execution, input management, and health service production) in the health sector, which together help to bolster good governance in health care delivery. This report referenced in this note assesses resource allocation and management, planning and budgeting functions, and budget execution at different levels of government for public expenditures on health ...
The fight against HIV and AIDS has long been at the center of many programs in lower-income count... more The fight against HIV and AIDS has long been at the center of many programs in lower-income countries and international donor funding for health. More recently, particularly with the advent of the Sustainable Development Goals (SDGs), health practitioners, policy makers, and funders are emphasizing an integrated approach to health services, with a focus on universal access within each country to a set of critical health services as part of a minimum health benefits package (MHBP). However, programming and planning for HIV and universal health coverage (UHC) have often been handled separately. This study has taken on this challenge, conducting research and analysis for three countries (Cote d’Ivoire, Kenya, and Tanzania) and in Nasarawa State in Nigeria. It quantifies each one’s current costs and financial needs for UHC and HIV and then creates projections looking to the 2030 deadline. The study generated concrete findings related to the resources needed to meet the goals, the curren...
A regular series of notes highlighting recent lessons emerging from the operational and analytica... more A regular series of notes highlighting recent lessons emerging from the operational and analytical program of the World Bank's Latin America and Caribbean Region.
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Papers by Bernard Couttolenc