Health promotion, disease prevention, and health service use: evaluation of the actions of a Brazilian private health plan operator

Abstract Introduction This article describes a case study which aimed to explore the association between health promotion actions and the prevention of cardiovascular diseases (CD). These actions were developed by a Brazilian health maintenance organization that has adopted the Family Health Strategy and the use of health services and their related costs. Methods The method involved the selection of beneficiaries from two capitals, aged 30 years or older, who subscribed until Dec 31, 2004. A description of the demographic profile and risk factors for CD was performed, as well as an evaluation of the profile of use of services and their corresponding costs between 2004 and 2007. Results There was a reduction in the average number of appointments per beneficiary and in the average cost of these appointments. There was an increase in the number of exams per capita, increasing assistance costs. In Curitiba, there was an increase in the average number of hospitalizations per beneficiary and in their average cost, whereas in Goiania a reduction of such numbers was observed. Conclusion Considering that approximately 25% of the Brazilian population is currently covered by health maintenance organizations, it is important to encourage the adoption of these programs, in agreement with the policies undertaken by the Ministry of Health, in addition to evaluating the use of health services and the outcomes in the health of individuals.

摘要：本研究为一项案例研究，旨在探讨健康促进举措与心血管疾病（cardiovascular diseases, CD）预防之间的关联。上述健康促进举措由采用家庭健康战略（Family Health Strategy）的巴西健康维护组织（health maintenance organization）制定，研究同时涵盖该组织的卫生服务使用情况及其相关成本。
方法：本研究选取2004年12月31日前参保、年龄30岁及以上的两座州首府城市的参保受益人作为研究对象。研究对该人群的人口统计学特征及心血管疾病危险因素进行了描述，并对2004年至2007年间的卫生服务使用情况及其对应成本开展了评估分析。
结果：研究发现，每位受益人的平均就诊次数及单次就诊平均成本均有所降低；但人均检查次数有所增加，带动医疗辅助服务成本上升。在库里提巴（Curitiba），每位受益人的平均住院次数及住院平均成本均出现增长，而在戈亚尼亚（Goiania），上述两项指标均呈现下降趋势。
结论：考虑到目前巴西约25%的人口由健康维护组织覆盖，因此在契合巴西卫生部既定政策的前提下，鼓励采纳此类健康促进项目具有重要意义，同时还需对卫生服务使用情况及个体健康结局进行评估。