OBJETIVO: Idosos usam a rede pública ou privada de atendimento de saúde de acordo com a sua situação econômica, social, demográfica e epidemiológica. Analisar como esses fatores influenciam a escolha do local de atendimento e comparar o impacto das rendas individual e familiar do idoso nessa decisão são os objetivos do estudo. MÉTODOS: Foram utilizados dados de um estudo realizado pelo Conselho Estadual do Idoso do Rio Grande do Sul, em 1995, com 7.920 idosos, com idade acima de 60 anos. A coleta de dados foi feito mediante questionário que incluía questões sobre influência do gênero, idade, escolaridade, renda individual e familiar, tamanho da família, participação na renda familiar e auto-avaliação da saúde do idoso. As chances de uso da rede privada de atendimento de saúde foi medida pela regressão logística. RESULTADOS: No acesso à rede privada de atendimento a renda familiar do idoso teve um impacto muito mais expressivo do que a individual. Com um aumento na renda familiar em um salário mínimo, as chances do idoso utilizar a rede privada aumentam 20% contra um acréscimo de apenas 7% no mesmo aumento na renda individual. Também influenciaram positivamente: gênero feminino, idade, escolaridade e tamanho menor da família. CONCLUSÕES: As decisões sobre onde o idoso recebe cuidados de saúde dependem das necessidades e recursos da família e não somente da situação individual do idoso. Conseqüentemente, a saúde do idoso de família de renda baixa recebe prioridade menor e é desproporcionalmente prejudicada pelo pouco recurso familiar e deficiências do sistema público de atendimento.

Background Results of the Women’s Health Initiative Randomized Controlled Dietary Modification Trial (WHI-DM) suggest that a low-fat diet may be associated with beneficial health outcomes for specific groups of women. Objective The objective is to assess how cost-effective the WHI-DM would be if implemented as a public health intervention and under the sponsorship of private health insurers and Medicare. Breast and ovarian cancers are the health outcomes of interest. Participants Two groups of WHI-DM participants form the target population for this analysis: participants consuming >36.8% of energy from fat at baseline, and participants at high risk for breast cancer with 32% or more of energy from fat at baseline. Methods This study uses Markov cohort modeling, following societal and health care payer perspectives, with Monte Carlo simulations and one-way sensitivity analyses. WHI-DM records, nationally representative prices, and published estimates of medical care costs were the sources of cost information. Simulations were performed for hypothetical cohorts of women aged 50, 55, 60, 65, or 70 years at the beginning of the intervention. Effectiveness was estimated by quality-adjusted life years (QALYs) and the main outcome measure was the incremental cost-effectiveness ratio (ICER). Results Following the societal perspective, the ICERs for the 50-year old cohort are $13,773/QALY (95% confidence interval $7,482 to $20,916) for women consuming >36.8% of energy from fat at baseline and $10,544/QALY ($2,096 to $23,673) for women at high risk for breast cancer. The comparable ICER from a private health care payer perspective is $66,059/QALY ($30,155 to $121,087) and from a Medicare perspective, it is $15,051/QALY ($6,565 to $25,105). Conclusions The WHI-DM is a cost-effective strategy for the prevention of breast and ovarian cancers in the target population, from both societal and Medicare perspectives. Private health care payers have a relative short time-frame to realize a return on investment, since after age 65 years the financial benefits associated with the prevention program would accrue to Medicare. For this reason, the intervention is not cost-effective from a private health care payer perspective.

Objectives. Current demographic trends point to the need for understanding the health challenges facing the elderly in Latin America today. This study assessed whether health care provider choice and household income impact utilization and health among the elderly in Conclusions. Brazil's public health system does not adequately provide for the health needs of the elderly population. Policy recommendations include further investments in the public health care infrastructure, full implementation of the National Plan for Elderly Health, and developing new programs for effective geriatric consultations at the primary care level.Health services for the aged, health transition, public health practice, geriatrics, Brazil. ABSTRACTLike most of Latin America, Brazil is experiencing a significant demographic transition. The percentage of the population over 60 years of age is expected to grow from 8.6% to 18.5% in the 30 years from 2000 to 2030 (1). Along with the rest of the population, the elderly are subject to the benefits and challenges of the Sistema Único de Saúde (SUS), Brazil's public health care system. Although SUS offers universal access and no-cost services, it suffers from a lack of adequate funding (2). SUS deficiencies are evident in both the quality and quantity of health care services offered. In terms of quality, deficiencies may be witnessed in short consultations, improper diag-

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Este artigo está licenciado sob forma de uma licença Creative Commons Atribuição 4.0 Internacional, que permite uso irrestrito, distribuição e reprodução em qualquer meio, desde que a publicação original seja corretamente citada. RESULTADOS: Os idosos do meio rural eram predominantemente homens, de cor parda, casados, analfabetos e com ocupação remunerada, apesar de terem classe econômica baixa. Entre os idosos do meio rural a autopercepção do estado de saúde foi mais frequentemente regular ou ruim, o domicílio era mais frequentemente cadastrado na Estratégia Saúde da Família e a maioria não tinha plano de saúde complementar. Os idosos do meio rural também apresentaram melhor desempenho nas Atividades Básicas de Vida Diária e pior desempenho nas Atividades Instrumentais de Vida Diária, tinham menos sintomas depressivos e menos multimorbidades. Os idosos do meio rural apresentaram menores chances de autopercepção do estado de saúde boa ou muito boa, mesmo ajustando para sexo, raça, estado conjugal, ocupação, classe socioeconômica, cobertura pela Estratégia Saúde da Família, sintomas depressivos, multimorbidade e desempenho nas Atividades Básicas de Vida Diária. CONCLUSÕES: Os idosos do meio rural apresentaram pior autopercepção do estado de saúde que os idosos do meio urbano, mesmo controlando as características sociodemográficas, econômicas, clínicas e de acesso à saúde. DESCRITORES: saúde do idoso; autopercepção; população rural; saúde pública; políticas públicas. ABSTRACT AIMS:To compare the self-perception of health status between rural and urban elderly and their possible associated factors. METHODS: The study consisted of a secondary analysis of data from the National Health Survey of 2013, conducted by the National Institute of Geography and Statistics, which included elderly who lived in rural and urban environments. The dependent variable was the self-perception of health status (evaluated as very good, good, fair, bad and very bad); and the independent variables were socio-demographic factors, clinical data, functionality of the elderly and household data. Relationships between the variables were tested by the chi-square test, and adjusted by self-perception of health status. The analysis were performed through the Epi InfoTM program version 7.2.1, accepting p<0.05 as significant. RESULTS: Rural elderly people were predominantly males, brown, married, illiterate and gainfully employed, despite having a low economic class. Among the rural elderly, self-perceived health status was more often regular or poor, the household was more often enrolled in the Family Health Strategy and most had no complementary health plan. Rural elderly also had better performance in the Basic Activities of Daily Living and worse performance in the Instrumental Activities of Daily Living, had less depressive symptoms and less multimorbidity. Rural elderly presented lower chances of self-perception of good or very good health, even adjusting for gender, race, marital status, occupation, socioeconomic class, coverage by the Famil...

Resumo O estudo explora a distribuição da aids, por meio de variáveis sócio demográficas, no âmbito da previdência e assistência social brasileira. Para a espacialização e análise dos dados foram utilizadas as 27 unidades federativas. Os dados foram estratificados de acordo com o sexo, faixa etária, zona de residência, forma de filiação na seguridade social, tipo de benefício recebido e a forma de concessão para os beneficiários. Os benefícios foram distribuídos em previdenciários (71.939; 72,4%), assistenciais (26.302; 26,5%) e acidentários (1.128; 1,1%), sendo grande parte concedida a indivíduos do sexo masculino (64.654; 65,1%). Os desempregados (50.404; 50,7%), residentes em área urbana (96.767; 97,4%), faixa etária entre 20-39 anos (49.508; 49,8%) e que tiveram a concessão do benefício baseado no artigo 27 do Decreto 3048/99 (51.985; 52,3%) foram os mais incidentes. Os resultados revelam que mais da metade dos benefícios concedidos foram para indivíduos desempregados ou que não possui estabilidade nos empregos e, por conseguinte não se mantém contribuindo com a previdência social por períodos contínuos. Esse fato reafirma a segregação no mercado de trabalho a que estes indivíduos estão submetidos. Além disso, destaca-se que a doença persiste em níveis elevados na fase da vida mais produtiva.

Studies in various countries have reported that older people who are married have better health than older widows. This paper reports a replication of these analyses with Brazilian data. The main objective was to explore the relationships between marital status, individual and household income, and the health of men and women using ordered logistic regression with self-assessed health as the dependent variable. The explanatory variables of interest were gender, marital status, and individual and family income. The data are from a survey of 7,920 non-institutionalised older people resident in the southern state of Rio Grande do Sul in 1995. The survey used a structured, multi-disciplinary questionnaire, which collected information on demographic attributes, household composition, social relations, occupation, income and health status. The results show that widows were 20 per cent more likely to report better health than married women. The women without individual income had worse health than those who did, even after controlling for family income. For men, there were no significant differences in health by marital status. The main recommendation is that the health status and economic circumstances of married elderly women should be given more attention in both research and policy, certainly in Brazil and probably in other Latin American countries. Programmes of income support to the poorest households should include specific transfers to these elderly women. Brazil's Family Health and Older People's Health public programmes should place more emphasis on the health of elderly home-makers.

This paper examines collusion among firms whose discount factors are private information. Mutual uncertainty regarding intentions to restrict competition might undermine the possibility of tacit collusion. Firms that want to collude may, however, reveal their intentions by consciously acting in breach of antitrust laws. As antitrust activity makes explicit collusion costly in expected terms, it can potentially be (ab)used as signaling device. We show that the fight against cartels may indeed facilitate collusion.