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R L Robertson

Publications and source records attributed to R L Robertson.

47 records · Page 3Linked to original sources
PubMed1991

[Primary health care in Ecuador: services provided by the Ministry of Health and Rural Social security Services].

The present study will examine three common premises in the field of international public health: that the primary care services offered by agencies of the Ministries of Health (MH) are less costly than those offered by Social Security institutions, that the former services are inferior to the latter, and that funds are distributed more equitably by the MH centers among their various recipient populations. The 1986 study compared the costs, quality, and equity of the services in 15 primary care centers in Ecuador--eight Ministry of Health centers and seven rural Social Security (RSS) centers--examining budgetary data from 1985 and obtaining information through a questionnaire and interviews with the personnel at those centers. Average costs were calculated by standardized accounting techniques, and it was confirmed that for several important services, especially medical consultations, these costs were much lower in the Ministry centers than in the Social Security centers. However, no differences in the cost of dental care were detected. The evaluation of quality, based on an analysis of the production structure and process, did not yield uniform results. On the one hand, the distribution of personnel and the allocation of funds for drugs and other supplies indicated that the RSS agencies provided better quality services. On the other hand, a questionnaire revealed that the MH health workers' knowledge of various principles of primary care was superior to that of the RSS workers. Upon comparing the per capita budget of the two types of entities, it was confirmed that the Ministry of Health had more equitable per capita coverage than rural Social Security. The implications of these findings for Ecuador and other developing countries are discussed and several recommendations made.

Costs and Cost Analysis↗
PubMed1989

Cost-effectiveness of routine and campaign vaccination strategies in Ecuador.

A national household coverage survey of 3697 Ecuadorean children, carried out in July 1986, provided an opportunity for a cost-effectiveness analysis of (1) routine vaccination services based in fixed facilities and (2) mass immunization campaigns. A major purpose of the campaigns was to complement the routine services and to accelerate immunization activities. Based on the coverage survey, the Program for Reduction of Maternal and Childhood Illness (PREMI) and earlier campaigns increased the proportion of children under 5 years who were fully vaccinated from 43% to 64%. In one year, the PREMI campaign was responsible for fully vaccinating 11% of children under one year, 21% of 1-2-year-old children, and 13% of all children under 5 years. The campaign also helped ensure that vaccinations were completed when children were still very young and at greatest risk. The average cost per vaccination dose (in 1985 US$ prices) was approximately $0.29 for fixed facilities and $0.83 for the PREMI campaign. Total national costs were $675,000 and $1,665,000 for routine and campaign services respectively. The cost per fully vaccinated child (FVC) was $4.39 for routine vaccination services and $8.60 for the campaign. The cost per death averted was about $1900 for routine vaccination services, $4200 for the PREMI campaign, and $3200 for the combined programme. Because of Ecuador's lower mortality rates, the costs per death averted in Ecuador from both vaccination strategies are not as low as those from studies of vaccinations in Africa. The campaigns, though less cost-effective than routine services, significantly improved the vaccination coverage of younger children who had been missed by the routine services. The costs per FVC of both the campaign and the routine services compare favourably with such programmes in other countries.

Child↗
PubMed1985

Cost-effectiveness of immunization in The Gambia.

Cost-effectiveness studies were carried out in The Gambia to estimate costs of preventing childhood morbidity and mortality through immunization. For the four priority diseases--neonatal tetanus, pertussis, measles and poliomyelitis--costs per case prevented ranged from $1.30 for pertussis to $655.54 for poliomyelitis. In terms of preventing childhood deaths through immunization, measles at $40.83 per death prevented, pertussis at $99.85 per death prevented and neonatal tetanus at $152.53 per death prevented were most cost-effective. For developing countries, immunization is an efficient use of limited health resources.

Adolescent↗
PubMed1984

Service volume and other factors affecting the costs of immunizations in the Gambia.

The total cost of the Expanded Programme on Immunization and of its various components in the Gambia over a period of one year (from July 1980 to June 1981) was investigated, and the costs per immunization dose and per fully immunized child were calculated. The total costs were to a large extent (45%) due to the cost of personnel and fixed costs. Where there was efficient delivery of immunizations, the average cost per dose was about one-fifth of that in the most costly facilities (range: US$2.32 to $0.41). The lower costs were related to more intensive use of the facilities. The national average cost was $1.09. The implications of the results of this study for policies to reduce costs are discussed, and further areas of research are suggested that will provide improved information to guide decision-makers in the use of scarce immunization programme resources for better health in the world.

Child↗
PubMed1976

Health services, health status, and work loss.

The numbers of workdays lost because of illness, coupled with records of health service utilization patterns, were studied to establish possible links between health status and different forms of prepayment coverage. The records of industrial workers at four branches of the same company were analyzed. Records of employees with broad-benefit coverage were compared with those who had less-comprehensive indemnity coverage. A free choice of providers was available to the study population. Data for workers covered by the broader plans revealed fewer medical admissions to hospitals, more surgical admissions, and more outpatient physician visits. As hypothesized, their number of days absent from work were lower. Because few of these results were statistically significant, caution is necessary in their interpretation. Some aspects of the project warranting further consideration are discussed. Data suggest a positive correlation between breadth of health plan coverage and health status, with possible economic benefits to be derived from such coverage. The data also indicate the desirability of additional investigations to be based on employers' and health plan records, that involve other types of populations and other benefit options.

Absenteeism↗
PubMedDate not supplied

Nontuberculous mycobacterial infection of the head and neck in immunocompetent children: CT and MR findings.

BACKGROUND AND PURPOSE: Infections caused by nontuberculous mycobacteria (NTM) commonly manifest as cervicofacial adenitis in otherwise healthy children. The aim of this study was to characterize the imaging findings of NTM infection of the head and neck in immunocompetent children. METHODS: The medical records and imaging examinations (CT in 10, MR in two) were reviewed in 12 immunocompetent children with NTM infection of the head and neck. RESULTS: The usual presentation (n = 9) was of an enlarging, non-tender mass with violaceous skin discoloration, unresponsive to conventional antibiotics. The duration of symptoms was 6 days to 5 months. Imaging revealed asymmetric adenopathy with contiguous low-density ring-enhancing masses in all patients. There was cutaneous extension in 10 patients. Inflammatory stranding of the subcutaneous fat was minimal (n = 9) or absent (n = 2) in 11 patients. The masses involved the submandibular space (n = 3), the parotid space (n = 2), the cheek (n = 1), the anterior triangle of the neck (n = 2), the submandibular and parotid spaces (n = 2), the parotid space and neck (n = 1), and the neck and retropharyngeal space (n = 1). Surgical management included incision and drainage only (n = 2), incision and drainage with curettage (n = 2), excisional biopsy after incision and drainage (n = 1), excisional biopsy only (n = 5), superficial parotidectomy only (n = 1), and superficial parotidectomy with contralateral excisional biopsy (n = 1). All patients improved in response to surgery and long-term antimycobacterial antibiotics. CONCLUSION: NTM infection of the head and neck has a characteristic clinical presentation and imaging appearance. Recognition of this disease is important; appropriate treatment is excision and, in selected cases, antimycobacterial therapy.

Child↗