<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>1812-9528</journal-id>
<journal-title><![CDATA[Memorias del Instituto de Investigaciones en Ciencias de la Salud]]></journal-title>
<abbrev-journal-title><![CDATA[Mem. Inst. Investig. Cienc. Salud]]></abbrev-journal-title>
<issn>1812-9528</issn>
<publisher>
<publisher-name><![CDATA[Instituto de Investigaciones en Ciencias de la Salud]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S1812-95282018000200038</article-id>
<article-id pub-id-type="doi">10.18004/mem.iics/1812-9528/2018.016(02)38-048</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Gastos catastróficos de salud en los hogares del Paraguay]]></article-title>
<article-title xml:lang="en"><![CDATA[Catastrophic health expenses in households of Paraguay]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Giménez]]></surname>
<given-names><![CDATA[Edgar]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Flores]]></surname>
<given-names><![CDATA[Laura]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Rodríguez]]></surname>
<given-names><![CDATA[José Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ocampos]]></surname>
<given-names><![CDATA[Gladys]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Peralta]]></surname>
<given-names><![CDATA[Néstor]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad Nacional de Concepción Facultad de Medicina ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Investigación para el Desarrollo  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Paraguay</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Dirección General de Estadística, Encuestas y Censos (DGEEC)  ]]></institution>
<addr-line><![CDATA[ ]]></addr-line>
<country>Paraguay</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>08</month>
<year>2018</year>
</pub-date>
<volume>16</volume>
<numero>2</numero>
<fpage>38</fpage>
<lpage>48</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S1812-95282018000200038&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S1812-95282018000200038&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S1812-95282018000200038&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Cada año numerosas familias enfrentan gastos excesivos ante una enfermedad a pesar de que el sistema de salud tiene como uno de sus objetivos la protección financiera de la población de forma equitativa. El objetivo que nos propusimos fue describir la incidencia del gasto catastrófico de salud en los hogares paraguayos. Como material y método analizamos el módulo de salud de la Encuesta Permanente de Hogares de la Dirección General de Estadísticas Encuestas y Censos de Paraguay del 2014. Incluimos como gasto de bolsillo los pagos directos por consultas, medicamentos, estudios de diagnóstico y hospitalizaciones de las personas enfermas o accidentadas. La capacidad de pago la definimos como la suma de todos los ingresos menos los gastos de subsistencia, utilizando una estructura conocida de gastos. Calculamos el gasto catastrófico de salud utilizando distintos umbrales de relación entre el gasto de bolsillo con la capacidad de pago de los hogares (GBS/CPH). Llegamos a los siguientes resultados: En los hogares con al menos un enfermo y que tuvieron gasto de bolsillo para recibir atención la relación GBS/CPH fue en promedio de 9,1%. Entre todos los hogares, las incidencias estimadas de gasto catastrófico fueron 2%, 2,8%, 4,4% y 8,7% utilizando umbrales GBS/GCS ( 40%, 30%, 20% y 10% respectivamente. Como conclusión, la EPH es un instrumento útil, pero con limitaciones, para estimar los gastos catastróficos en el sistema de salud paraguayo. Los resultados indican que es necesario diseñar e implementar mecanismos específicos para evitar este tipo de gastos.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT Every year, many families face excessive expenses in the presence of an illness, despite the fact that the health system has the equitable financial protection of the population as one of its objectives. The objective of this study was to describe the incidence of catastrophic health expenses in Paraguayan households. We analyzed the health module of the Permanent Household Survey (PHS) of the General Directorate of Statistics, Surveys and Census of Paraguay of 2014. We included consultations, medicines, diagnostic studies and hospitalizations of sick or injured people as direct out-of-pocket expenses. The ability to pay is defined as the sum of all incomes minus subsistence expenses, using a known structure of expenses. We calculated the catastrophic health expenses using different thresholds for the relationship between out-of-pocket cost and household payment capacity (OPC/HPC). In households with at least one patient who had out-of-pocket cost to receive care, the OPC/HPC ratio was 9.1% in average. Among all households, the estimated incidences of catastrophic expenses were 2%, 2.8%, 4.4% and 8.7% using 40%, 30%, 20% and 10% OPC/HPC thresholds respectively. The PHS is a useful instrument, but with limitations, to estimate catastrophic expenses in the Paraguayan health system. These results indicate that it is necessary to design and implement specific mechanisms to avoid this type of expenses.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[gasto catastrófico en salud]]></kwd>
<kwd lng="es"><![CDATA[gasto de bolsillo en salud]]></kwd>
<kwd lng="es"><![CDATA[protección financiera]]></kwd>
<kwd lng="es"><![CDATA[Paraguay]]></kwd>
<kwd lng="en"><![CDATA[catastrophic health expenses]]></kwd>
<kwd lng="en"><![CDATA[out-of-pocket health cost]]></kwd>
<kwd lng="en"><![CDATA[financial protection]]></kwd>
<kwd lng="en"><![CDATA[Paraguay]]></kwd>
</kwd-group>
</article-meta>
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