Ana Lorena Prieto | Universidad del Pacifico (original) (raw)

Papers by Ana Lorena Prieto

El objetivo del estudio es analizar alternativas de asignacion de recursos que logren maximizar r... more El objetivo del estudio es analizar alternativas de asignacion de recursos que logren maximizar resultados de salud, asi como estimar el costo de algunas de las metas planteadas en el Plan Estrategico Multianual VIH de Peru. Para el analisis se utiliza el modelo OPTIMA-VIH Optima VIH-desarrollado por el “Optima Consortium of Decision Science”, de la University of New South Wales y el Banco Mundial. OPTIMA-VIHOptimao VIH es un modelo matematico sobre la transmision y progresion del VIH, integrado en un marco de analisis economico y programas orientados a VIH. El modelo se basa en el concepto de eficiencia distributiva referido a la maximizacion de los resultados de salud con la combinacion de las intervenciones sanitarias menos costosas. Para el Peru, el modelo fue calibrado con la informacion disponible, desde la definicion de poblaciones y programas que conforman la respuesta a VIH. Asimismo, se establecieron relaciones entre el costo, cobertura y resultados en salud. Solo los prog...

UNICEF, UN Plaza, New York, NY, USA (C Carrera MA, T O’Connell MSc, P Doughty MPH, K Rasanathan F... more UNICEF, UN Plaza, New York, NY, USA (C Carrera MA, T O’Connell MSc, P Doughty MPH, K Rasanathan FAFPHM, A Sharkey PhD, M Chopra MD, R Knippenberg DrPH); UNICEF Ghana, Accra, Ghana (A Azrack ScM); UNICEF South Asia Regional Offi ce, Kathmandu, Nepal (G Begkoyian MD); UNICEF West and Central Africa Offi ce, Dakar, Senegal (J Pfaff mann MSc); UNICEF East and Southern Africa Offi ce, Nairobi, Kenya (E Ribaira MPH); UNICEF East Asia and Pacifi c Regional Offi ce, Bangkok, Thailand (K Myint Aung MD); and Universidad ESAN, Lima, Peru (L Prieto PhD)

OECD Journal on Budgeting, 2018

Peru has made substantial progress towards achieving UHC. Increases in access to healthcare and f... more Peru has made substantial progress towards achieving UHC. Increases in access to healthcare and financial protection had a positive impact in health outcomes. Despite this progress, major efforts are needed to reduce fragmentation and increase efficiency in the health system as a whole. Creating formal coordination mechanisms and improving capacity at the subnational level are key elements to ensure that any additional resource spent has a great positive impact in Peru’s health care system. The well-developed and highly institutionalised PPR methodology in Peru can inspire other countries in the LAC region. However, other budgetary practices could be better aligned with OECD recommendations of good budgetary governance. In particular, making the approved budget closer to what is expected to be executed would greatly increase the usefulness of the budget, showing how resources are prioritised and how annual policy objectives are to be achieved. JEL codes: H5, H60, I11, I18 Keywords: Universal health coverage UHC, Peru, health expenditures, budget formulation, budget execution, budget monitoring, fiscal sustainability of health systems

Revista Panamericana de Salud Pública, 2018

Este es un artículo de acceso abierto distribuido bajo los términos de la licencia Creative Commo... more Este es un artículo de acceso abierto distribuido bajo los términos de la licencia Creative Commons Attribution-NonCommercial-NoDerivs 3.0 IGO, que permite su uso, distribución y reproducción en cualquier medio, siempre que el trabajo original se cite de la manera adecuada. No se permiten modificaciones a los artículos ni su uso comercial. Al reproducir un artículo no debe haber ningún indicio de que la OPS o el artículo avalan a una organización o un producto específico. El uso del logo de la OPS no está permitido. Esta leyenda debe conservarse, junto con la URL original del artículo.

Revista Panamericana de Salud Pública, 2018

The Lancet, 2012

This is the second in a Series of two papers about equity in child survival, health, and nutrition

Revista Panamericana de Salud Pública, 2019

The articles published in this series show that it is possible to create fiscal space for health ... more The articles published in this series show that it is possible to create fiscal space for health in countries. This requires specific decisions since economic growth is not enough to generate the additional resources needed. The studies analyze the benefits of reviewing tax expenditures to identify exemptions, which are generally outdated and of low benefit for the countries; arguments in favor of increasing taxes on products harmful to health; and credits and donations, which do not result in a viable source of income for governments. Fiscal efforts must be accompanied by an improvement in efficiency, and the progressive creation of new revenues is key to improving equity. It is necessary to improve the collection of fiscal resources. It is necessary to develop a research and action agenda that includes the analysis of fiscal space within the processes of health system transformation and reform, including technical aspects not yet addressed and studies of the social efficiency of fiscal space for major development objectives such as the Sustainable Development Goals 2030. In the countries of the Region of the Americas it is essential to have efficient management to do more and better with more resources, even during adverse economic cycles. This should be evident at all levels, including solidarity for achieving better health outcomes, the strategic purchase of goods and services for health, and the strengthening of budget planning systems.

Garantizar el derecho a la salud en igualdad de condiciones para todos es una meta hacia la que t... more Garantizar el derecho a la salud en igualdad de condiciones para todos es una meta hacia la que toda sociedad quiere avanzar, maxime en una region tan desigual como America Latina y el Caribe. La cobertura universal es un objetivo importante para la mayoria de los paises; sin embargo, el contexto para lograr una cobertura universal es dificil: cada dia aumenta la presion sobre el gasto en salud. Entonces, ?que incluir o no incluir en un plan de beneficios en salud?

PloS one, 2017

Prioritizing investments across health interventions is complicated by the nonlinear relationship... more Prioritizing investments across health interventions is complicated by the nonlinear relationship between intervention coverage and epidemiological outcomes. It can be difficult for countries to know which interventions to prioritize for greatest epidemiological impact, particularly when budgets are uncertain. We examined four case studies of HIV epidemics in diverse settings, each with different characteristics. These case studies were based on public data available for Belarus, Peru, Togo, and Myanmar. The Optima HIV model and software package was used to estimate the optimal distribution of resources across interventions associated with a range of budget envelopes. We constructed "investment staircases", a useful tool for understanding investment priorities. These were used to estimate the best attainable cost-effectiveness of the response at each investment level. We find that when budgets are very limited, the optimal HIV response consists of a smaller number of '...

Salud Pública de México, 2016

Objetivo. Analizar las diferencias en los resultados en salud según condiciones observadas de los... more Objetivo. Analizar las diferencias en los resultados en salud según condiciones observadas de los hospitales, en particular su tipo de propiedad: hospitales públicos, privados sin fines de lucro (PSL) y privados con fines de lucro (PCL). Material y métodos. Se utilizó información de egresos hospitalarios en Chile entre 2001 y 2010 con un total de 16 205 314 altas de 20 hospitales públicos, 6 de PSL y 15 de PCL. Se seleccionó una muestra de pacientes con infarto al miocardio (IAM) y accidente cerebrovascular (ACV). Se estimó una regresión probit utilizando como variable dependiente la mortalidad intrahospitalaria y controlando por variables como estado de salud, nivel socioeconómico y características del hospital. Resultados. Los hospitales privados tienen menor riesgo de mortalidad intrahospitalaria: 1.3% en PSL y 0.7% en PCL, mientras que en los hospitales públicos el riesgo llega a 3.5%. Conclusiones. Este análisis muestra las inequidades que el sector público tiene respecto de los demás sectores. Palabras clave: hospitales privados; hospitales públicos; desempeño; Chile

This chapter examines how Peru's eight-year-old Integral Health Insurance (Seguro Integral de... more This chapter examines how Peru's eight-year-old Integral Health Insurance (Seguro Integral de Salud, or SIS) has affected access to health services and out-of-pocket spending by its beneficiaries. We use data from the Demographic and Health Survey (DHS), which contains two crosssectional samples, one for 2000 and another for 2004-07, with a sample spread over five years. We also use data from the National Household Survey (ENAHO), a panel collected over 2002-06.

Guaranteeing the right to health care under equal conditions for all is a goal that every society... more Guaranteeing the right to health care under equal conditions for all is a goal that every society desires to achieve, particularly in a region as unequal as Latin America and the Caribbean. Universal coverage is an important objective for most countries; however, the context for attaining universal coverage is difficult, as the pressure on health spending mounts with each passing day. So, what to leave in or out of a health benefit plan?

Health policy and planning, 2015

Public, private not-for-profit (PNFP) and private for-profit (PFP) hospitals may have different b... more Public, private not-for-profit (PNFP) and private for-profit (PFP) hospitals may have different behaviour and performance in different indicators such as health outcomes, cost-efficiency and quality. Chile has a mixed healthcare system both in financing and service delivery. The public National Health Fund (Fondo Nacional de Salud) covers 76% of the population-poorer and with higher health risks-whereas private health insurers cover 16% of the population-richer and with lower health risks. The aim of the study was to analyse the in-patient mortality outcomes by hospital ownership in Chile. We use hospital discharge data in Chile for the period 2001-10 with a total of 16 205 314 discharges in 20 public, 6 PNFP and 15 PFP hospitals. We analyse in-patient mortality considering all diagnoses and a subsample considering only myocardial infarction and stroke diagnoses. Using a probit regression, we estimate how hospital ownership explains in-patient mortality controlling for other confoun...

The opinions expressed in this publication are those of the authors and do not necessarily reflec... more The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent. The unauthorized commercial use of Bank documents is prohibited and may be punishable under the Bank's policies and/or applicable laws.

Revista Panamericana de Salud Pública, 2012

IDB Publications, 2010

In this paper we present a vision-based approach to mobile robot localization, that integrates an... more In this paper we present a vision-based approach to mobile robot localization, that integrates an image retrieval system with Monte-Carlo localization. The image retrieval process is based on features that are invariant with respect to image translations, rotations, and limited scale. Since it furthermore uses local features, the system is robust against distortion and occlusions which is especially important in populated environments. By using the sample-based Monte-Carlo localization technique our robot is able to globally localize itself, to reliably keep track of its position, and to recover from localization failures. Both techniques are combined by extracting for each image a set of possible viewpoints using a two-dimensional map of the environment. Our technique has been implemented and tested extensively. We present several experiments demonstrating the reliability and robustness of our approach even in the context of dynamics in the environment and larger errors in the odometry.

World Scientific Handbook of Global Health Economics and Public Policy, 2016

Global health care payment systems reflect enormous differences in provider characteristics, heal... more Global health care payment systems reflect enormous differences in provider characteristics, health systems, and development levels. Risk adjustment is used for payment and performance measurement to correct for demand heterogeneity and incentives for plans and providers to prefer healthy, low-cost patients, and to provide quality care. This article reviews the practical, theoretical, and statistical aspects of risk adjustment models, which use socio-demographic variables and more recently morbidity and pharmaceuticals, to predict outcomes. Diverse uses of risk adjustment include geographical budget allocations, health plan premium equalization, pay for performance, primary care provider payment, integrated provider networks, and rewards for good doctor performance. Settings in more than 30 countries are examined, which include high-, middle-and low-income countries, competitive health plans and single payer systems, integrated provider networks, clinics, and solo practice primary care doctors. Recent concepts in health economics are highlighted that hold potential for improving efficiency and equitable patient access to health care.

Revista Panamericana de Salud Pública, 2018

[RESUMEN]. Los artículos publicados en esta serie muestran que es posible crear espacio fiscal pa... more [RESUMEN]. Los artículos publicados en esta serie muestran que es posible crear espacio fiscal para la salud en los países. Para esto se requieren decisiones específicas, ya que el crecimiento económico no es suficiente para generar los recursos adicionales necesarios. Los estudios analizan la conveniencia de revisar los gastos tributarios para identificar las exenciones —en general desactualizadas y de escasos beneficios para los países—; los argumentos para aumentar los impuestos sobre productos dañinos para la salud; y los créditos y donaciones, que no resultan una fuente de ingresos viable para los gobiernos. Los esfuerzos fiscales deben ser acompañados por una mejora de la eficiencia, y la creación progresiva de nuevos ingresos es clave para mejorar la equidad. Es necesario mejorar la recaudación de los recursos fiscales. Para esto se requiere desarrollar una agenda de investigación y acción que entienda el análisis del espacio fiscal inserto en los procesos de transformación y reforma de los sistemas de salud, que abarque los aspectos técnicos no abordados aún y estudios de la eficiencia social del espacio fiscal para los grandes objetivos de desarrollo como los Objetivos de Desarrollo Sostenible 2030. En los países de la Región de las Américas es imprescindible contar con una gestión eficiente para hacer más y mejor con más recursos, incluso durante los ciclos económicos adversos. Esta debe evidenciarse en todos los niveles, incluidas la solidaridad que logra mejores resultados en salud, los sistemas de asignación de recursos a los proveedores, la compra estratégica de bienes y servicios de salud y el fortalecimiento de los sistemas de planificación presupuestaria.

[ABSTRACT]. The articles published in this series show that it is possible to create fiscal space for health in the countries. This requires specific decisions since economic growth is not enough to generate the additional resources needed. The studies analyze the benefit of reviewing the tax expenditures to identify exemptions — generally outdated and of low benefit for the countries —; arguments to increase taxes on products harmful to health; and credits and donations, which do not result in a viable source of income for governments. Fiscal efforts must be accompanied by an improvement in efficiency, and the progressive creation of new revenues is key to improving equity. It is necessary to improve the collection of fiscal resources. To this end, it is necessary to develop a research and action agenda that understands the analysis of the fiscal space inserted in the processes of transformation and reform of health systems, including the technical aspects not yet addressed and studies of the social efficiency of the fiscal space for major development objectives such as the Sustainable Development Goals 2030. In the countries of the Region of the Americas it is essential to have efficient management to do more and better with more resources, even during adverse economic cycles. This should be evident at all levels, including solidarity for achieving better health outcomes, strategic purchase of health goods and services, and strengthening of budget planning systems.

[RESUMO]. Os artigos publicados nesta série mostram que é possível criar espaço fiscal para a saúde nos países. Isso requer decisões específicas, já que o crescimento econômico não é suficiente para gerar os recursos adicionais necessários. Os estudos analisam o benefício de rever as despesas fiscais para identificar isenções—geralmente desatualizadas e de baixo benefício para os países—; argumentos para aumentar os impostos sobre os produtos prejudiciais à saúde; e créditos e doações, que não resultam em uma fonte viável de renda para os governos. Os esforços fiscais devem ser acompanhados por uma melhoria na eficiência, e a criação progressiva de novas receitas é fundamental para melhorar a equidade. É necessário melhorar a arrecadação de recursos fiscais. Para tanto, é necessário desenvolver uma agenda de pesquisa e ação que compreenda a análise do espaço fiscal inserido nos processos de transformação e reforma dos sistemas de saúde, incluindo os aspectos técnicos ainda não abordados e estudos sobre a eficiência social do espaço fiscal para grandes objetivos de desenvolvimento, como os Objetivos de Desenvolvimento Sustentável 2030. Nos países da Região das Américas é essencial ter uma gestão eficiente para fazer mais e melhor com mais recursos, mesmo durante ciclos econômicos adversos. Isso deve ser evidente em todos os níveis, incluindo a solidariedade para alcançar melhores resultados de saúde, a compra estratégica de bens e serviços de saúde e o fortalecimento dos sistemas de planejamento orçamentário.

Revista Panamericana de Salud Pública, 2018

[RESUMEN]. Objetivo. Analizar las fuentes de espacio fiscal para el sector salud en Honduras en u... more [RESUMEN]. Objetivo. Analizar las fuentes de espacio fiscal para el sector salud en Honduras en un contexto de reforma del sector, con el compromiso de alcanzar una meta de gasto público en salud de 6% del producto interno bruto (PIB).
Métodos. Se realizó un análisis de la condición básica y las fuentes de espacio fiscal en base a una revisión bibliográfica y datos secundarios. Se estimó el tamaño de las fuentes con datos oficiales, estadísticas internacionales y estudios previos. De manera complementaria al estudio, se realizó un análisis de la factibilidad política y se aplicó una encuesta en línea a actores clave.
Resultados. Las estimaciones de la condición básica de crecimiento económico muestran que es necesario identificar otras fuentes para poder generar nuevos recursos. La reciente reforma tributaria limita la factibilidad política de generar nuevos impuestos, a excepción de los impuestos al pecado cuya recaudación se podría asignar exclusivamente a salud. La reforma de protección social abre el camino para explorar medidas que liberen recursos con mejoras en la eficiencia del sector. Una limitante en el caso del gasto público proveniente de la seguridad social es el techo de la base contributiva, independiente de una aceleración en la formalización laboral.
Conclusiones. Honduras puede avanzar en lograr la meta de un gasto público en salud de 6% del PIB que respalde los planes de reforma sectorial, pero sus opciones se ven limitadas por la reciente reforma tributaria. La reforma de protección social en salud debe considerar los recursos adicionales que tendrá disponibles para no poner en riesgo su implementación.

[ABSTRACT]. Objective. To analyze sources of fiscal space for the health sector in Honduras, in the context of sectoral reform, with a commitment to achieving the target of public expenditure on health equivalent to 6% of gross domestic product (GDP).
Methods. An analysis of baseline conditions and sources of fiscal space was conducted on the basis of a literature review and secondary data. The size of each source was estimated from official data, international statistics, and previous studies. In parallel to this study, political feasibility was analyzed and an online survey was administered to key actors.
Results. Estimates of baseline conditions for economic growth show that other sources must be identified in order to generate new resources. The recent tax reform limits the political feasibility of creating new taxes, except for “sin taxes”, that could be used exclusively to fund health. Social protection reform paves the way to explore measures that could make resources available by improving efficiency in the sector. One limitation on public expenditure based on social security contributions is the ceiling on taxable income, notwithstanding acceleration in the formalization of the labor market.
Conclusions. Honduras can advance towards achieving the target of public expenditure on health equivalent to 6% of GDP with the support of plans for sectoral reform, but its options are limited by the recent tax reform. The reform of social protection in health should consider additional available resources so as not to jeopardize implementation of the reform.

[RESUMO]. Objetivo. Analisar as fontes de espaço fiscal para saúde em Honduras no context da reforma do setor, com o compromisso de alcançar uma meta de gasto público em saúde de 6% do produto interno bruto (PIB).
Métodos. Foi realizada uma análise da situação básica e das fontes de espaço fiscal com base em uma revisão da literatura e dados secundários. Foi estimado o tamaño das fontes com dados oficiais, estatísticas internacionais e estudos prévios. Para complementar o estudo, foi realizada uma análise da viabilidade política e uma pesquisa online com os principais interessados diretos.
Resultados. As estimativas da situação básica de crescimento econômico indicam que é necessário identificar novas fontes para geração de recursos. A reforma tributária recente restringe a viabilidade política de criar impostos, exceto impostos pecuniários cuja arrecadação poderia ser alocada exclusivamente à saúde. A reforma da previdência social abre caminho para examinar medidas para liberar recursos com a melhoria da eficiência do setor. Uma limitante no caso do gasto público proveniente da previdência social é o teto da base contributiva, independente de uma aceleração na formalização das relações de trabalho.
Conclusões. Honduras pode procurar alcançar uma meta de gasto público em saúde de 6% do PIB que respalde os planos de reforma setorial, mas as opções são limitadas pela recente reforma tributária. A reforma da previdência social em saúde deve considerar os recursos adicionais que terá à disposição para não comprometer a própria implementação.

OECD Journal on Budgeting, 2018

Revista Panamericana de Salud Pública, 2018

The Lancet, 2012

This is the second in a Series of two papers about equity in child survival, health, and nutrition

Revista Panamericana de Salud Pública, 2019

PloS one, 2017

Salud Pública de México, 2016

Health policy and planning, 2015

Revista Panamericana de Salud Pública, 2012

IDB Publications, 2010

World Scientific Handbook of Global Health Economics and Public Policy, 2016

Revista Panamericana de Salud Pública, 2018

OECD Journal on Budgeting, 2018