emergency room at the University of São Paulo General Hospital: a tertiary hospital providing primary and secondary level care. Clinics. 2007;62(3):301-8. OBJECTIVE:To assess the need for emergency care in a tertiary hospital, in the Ophthalmology Emergency Room of the University of the São Paulo Medical School General Hospital. MATERIALS AND METHODS:A cross-sectional analytic study of the treatment complexity level was carried out in a readily available sample, n = 574, of patients seen at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital, during a typical week. RESULTS: Of the 574 treated patients, 69.0% of the cases were diagnosed as requiring a simple treatment for their problem. The most frequent diagnoses were related to ocular inflammation and infection (55.0%), mainly including conjunctivitis (29.4%) and eyelid inflammations (10.5%). Next in frequency were ocular trauma (19.2%), particularly foreign bodies on the cornea (7.5%) and blunt trauma (5.2%). Refractive errors (3.1%) was the most prevalent diagnosis in the "other ocular modifications" category. CONCLUSION: Most of the cases (69.0%) treated at the Ophthalmology Emergency Room of the University of São Paulo Medical School General Hospital could have been diagnosed and treated in primary or secondary care units. Also, the fact that return visits to check recovery are seen in the ER demonstrates the lack of referral services. The fact that patients come to a tertiary hospital with rather simple cases shows the poor structure of the Brazilian Public Healthcare System, which overloads the tertiary care facilities, where costs for human resources, materials, and other items are higher.

According to this study, there is no lack of Ophthalmologists in the country, but a distribution imbalance which leads to professional shortage in particular places. A higher concentration of ophthalmologists/inhabitants was noticed in States which the economic growth is higher, expressed by the GDP per capita.

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PURPOSETo evaluate the governmental costs of patients undergoing phacoemulsification and extracapsular cataract extraction at a public hospital in a developing country.METHODSA prospective study was conduced with 205 patients. The subjects were randomized for cataract surgery using either phacoemulsification or extracapsular cataract extraction techniques.RESULTSOf the 205 patients, 101 patients were submitted to phacoemulsificationand 104 patients were submitted to extracapsular cataract extraction. Brazilian Health Care System expenditures for the surgery and the postoperative period were US$ 95.49 more in the phacoemulsification group than in the extracapsular cataract extractiongroup. If we take into account Social Security expenditures, then we estimate that the average difference for the total direct cost for the government for the surgery and the postoperative period for both procedures was US$ 50.91 or approximately half of the initial difference in cost for the phacoemulsification surgery. The total cost of cataract surgery for the government (excluding social security) was estimated at US$ 258.79 for extracapsular cataract extraction and US$ 309.70 for phacoemulsification per patient. Focusing only on working patients, the total cost was US$ 342.21 for phacoemulsification and US$ 587.71 for extracapsular cataract extraction, a difference of US$ 245.50. This difference can be considered monetarily and socially justifiable when the benefits of the surgical technique are evaluated.CONCLUSIONUnder the conditions of this study, we observed that phacoemulsification was an efficient procedure with regard to the impact on public health care system, when all costs are assessed comprehensively, mainly for subjects with regular jobs.