Departamento de Ortopedia y Traumatología, Universidad de Chile, Santiago, Chile.
Departamento de Epidemiología y Estudios en Salud, Universidad de Los Andes, Santiago, Chile.
Medwave. 2023 Jan 16;22(1):e2668. doi: 10.5867/medwave.2023.01.2668.
Introduction: Knee osteoarthritis affects the quality of life, with knee arthroplasty being a cost-effective treatment for the severe stage of this disease. Access to knee arthroplasty is a health indicator of the Organisation for Economic Co-operation and Development. The objectives of this study are to determine the incidence of knee arthroplasty between 2004 and 2021 in beneficiaries of the National Health Fund in Chile, the proportion of patients who underwent surgery in the private system, and to estimate the patient's out-of-pocket expenditure for surgery. Methods: Cross-sectional study. We used the Department of Statistics and Health Information database. Patients discharged from a Chilean health center who underwent knee arthroplasty surgery between 2004 and 2021 were investigated. We analyzed the proportion of patients by their National Health Fund category and whether their surgery was performed in public or private network facilities. Results: Of the 31 526 knee arthroplasty procedures, 21 248 (67.38%) were performed on National Health Fund patients and 16 238 in public institutions (51.49%). Patients from the National Health Fund showed a systematic increase in knee arthroplasty volume until 2019 but decreased in 2020 and 2021 by 68% and 51%. Of the total number of patients in the public system operated on for knee arthroplasty, 856 (9%) belonged to group A1, 12 806 (60%) to group B, 2044 (10%) to group C, and 4421 (21%) to group D. The expenditure incurred by these patients was estimated to vary between 24.4% and 27.2%. The historical proportions of access to this surgery in private institutions are 7% in group A, 13% in group B, 24% in group C, and 52% in group D. Conclusion: Fifty percent of knee arthroplasty surgeries are performed in public institutions, and two-thirds are performed on patients of the National Health Fund. Forty-six percent of the C and D groups were operated in the private system. The pandemic has increased the access gap, leading to a substantial increase in the proportion of patients from the National Health Fund of the B, C, and D groups who have migrated to the private system to access this surgery.
膝骨关节炎会降低生活质量，膝关节置换术是治疗该病重度阶段的一种具有成本效益的方法。获得膝关节置换术是经济合作与发展组织的一项卫生指标。本研究的目的是确定 2004 年至 2021 年期间智利国家卫生基金受益人膝关节置换术的发病率、在私人系统中接受手术的患者比例，并估算患者手术的自付支出。方法：这是一项横断面研究。我们使用了卫生部的统计和卫生信息数据库。调查了在 2004 年至 2021 年期间在智利卫生中心接受膝关节置换术的患者。我们根据国家卫生基金类别分析了患者的比例，以及他们的手术是在公共网络设施还是私人网络设施中进行的。结果：在 31526 例膝关节置换术中，21248 例（67.38%）在国家卫生基金患者中进行，其中 16238 例在公共机构中进行（51.49%）。国家卫生基金患者的膝关节置换术数量呈系统增加，直到 2019 年，但在 2020 年和 2021 年分别下降了 68%和 51%。在接受膝关节置换术的公共系统患者总数中，A1 组有 856 例（9%），B 组有 12806 例（60%），C 组有 2044 例（10%），D 组有 4421 例（21%）。这些患者的支出估计在 24.4%至 27.2%之间。历史上，私人机构中获得这种手术的比例分别为 A 组 7%，B 组 13%，C 组 24%，D 组 52%。结论：50%的膝关节置换术在公立医院进行，三分之二的手术是为国家卫生基金的患者进行的。C 组和 D 组中有 46%的患者在私立系统中进行了手术。大流行增加了获得手术的差距，导致 B、C 和 D 组中来自国家卫生基金的患者大量转移到私人系统以获得这种手术。
