Rabadán Alejandra T, Hernandez Diego, Vazquez Néstor, Torino Rafael, Marcelo Blanco V
Division of Neurosurgery.Institute of Medical Research A.Lanari, University of Buenos Aires (UBA), Buenos Aires, Argentina.
Argentine Association of Neurosurgery (AANC), Buenos Aires, Argentina.
Surg Neurol Int. 2017 Jun 13;8:118. doi: 10.4103/sni.sni_497_16. eCollection 2017.
As far as public health is concerned, brain tumors burden is significant despite their low incidence, because they comprise high direct costs (specific diagnostic resources, high complexity treatments, and rehabilitation) and high-unforeseen costs (labor leave, family, and social issues). Although the Argentine's Health System is supposed to provide healthcare to all the population, it would not guarantee equity of access for brain tumors treatment. In order to analyze this hypothesis we decided to carry out a survey to obtain data on access, availability and resources for tumor management in Argentina.
An online questionnaire with eight dimensions and 29 queries was conducted addressing all professionals involved in tumor management. Two variables were generated: (1) type of medical center according to their financial support, and (2) the geographic region (GeoR). Analysis of association between these variables and the accessibility to different resources was performed with Chi-square and Fisher's exact test. Multivariate analyses through multiple logistic regression models were also tested.
One hundred and fourteen surveys were collected from 56 state-managed centers and 55 private/trade-union managed centers. Responders came from 15 provinces grouped into integrated GeoR. Results and analysis of each dimension were reported.
The data obtained provides information about the accessibility to brain tumors treatment, exposing the unequal distribution of human and technologic resources in Argentina. This problem exceeds the limits of public health to become a bioethical problem. We think these results could be essentially associated to our health system fragmented structure, and the large geographical extension of our country. Finally, we believe that collaboration of professional associations working together with public and private sector authorities responsible for financial resources and logistic should bring a principle of solution.
就公共卫生而言，尽管脑肿瘤发病率较低，但其负担依然沉重，因为其包含高昂的直接成本（特定诊断资源、高度复杂的治疗和康复）以及高额的意外成本（病假、家庭和社会问题）。尽管阿根廷卫生系统本应向全体民众提供医疗服务，但却无法保证脑肿瘤治疗的公平可及性。为了分析这一假设，我们决定开展一项调查，以获取阿根廷肿瘤管理方面的可及性、可用性和资源数据。
针对所有参与肿瘤管理的专业人员开展了一项包含八个维度和29个问题的在线问卷。生成了两个变量：（1）根据资金支持划分的医疗中心类型，以及（2）地理区域（地理区域）。使用卡方检验和费舍尔精确检验对这些变量与不同资源可及性之间的关联进行分析。还通过多个逻辑回归模型进行了多变量分析。
从56个国家管理中心和55个私人/工会管理中心收集了114份调查问卷。受访者来自分为综合地理区域的15个省份。报告了每个维度的结果和分析。
所获得的数据提供了有关脑肿瘤治疗可及性的信息，揭示了阿根廷人力和技术资源分配不均的情况。这个问题超出了公共卫生的范畴，成为了一个生物伦理问题。我们认为这些结果可能主要与我国卫生系统的分散结构以及幅员辽阔有关。最后，我们相信专业协会与负责资金和后勤的公共及私营部门当局共同合作应能带来解决之道。
