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Desigualdades no uso e acesso aos serviços de saúde entre a população idosa do município de São Paulo ; Inequalities in use and access to health care services among the elderly population in São Paulo.

Louvison, Marilia Cristina Prado
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Dissertação de Mestrado Formato: application/pdf
Publicado em 16/08/2006 PT
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95.72%
Objetivos: Este estudo é parte do Projeto Saúde, Bem-estar e Envelhecimento (SABE), com o objetivo de identificar as desigualdades no acesso e uso de serviços de saúde entre idosos no município de São Paulo, Brasil. Métodos: Em 2000, foram entrevistados, 2143 indivíduos com 60 anos ou mais, utilizando-se o questionário padronizado do SABE. A amostra foi obtida em dois estágios, utilizando-se setores censitários com reposição, probabilidade proporcional à população e complementação da amostra de pessoas de 75 anos. Os dados finais foram ponderados, de forma a serem expandidos. Foi mensurado o uso de serviços hospitalares (internações) e ambulatoriais (consultas médicas) nos últimos quatro meses e o não uso de serviços de saúde (mesmo precisando), relacionando-os com fatores de capacidade, necessidade e predisposição (renda total, escolaridade, seguro saúde, morbidade referida, auto-percepção, sexo e idade). Resultados: A proporção dos entrevistados que referiu ter utilizado algum serviço de saúde, nos últimos quatro meses, foi de 4,7 por cento com relação à internação hospitalar e 64, 4 por cento com referência ao atendimento ambulatorial. Dos atendimentos ambulatoriais, 24,7 por cento ocorreu em hospital público e 24...

Desigualdades no acesso aos serviços de saúde : o caso dos cuidados primários; Inequalities in access to health services: the case of primary care

Martins, Soraia Maria da Rocha Ferreira
Fonte: Universidade do Minho Publicador: Universidade do Minho
Tipo: Dissertação de Mestrado
Publicado em //2014 POR
Relevância na Pesquisa
85.72%
Dissertação de mestrado em Economia Social; O trabalho apresentado tem como objetivo o estudo das desigualdades no acesso aos cuidados de saúde, em particular aos cuidados de saúde primários. Estes representam o primeiro contacto dos utentes com os serviços de saúde. Apesar da evolução significativa da esperança de vida da população portuguesa e da diminuição da taxa de mortalidade ao longo dos últimos anos, as dificuldades em aceder a determinados cuidados de saúde em Portugalainda persistem. Neste sentido realizamos uma análise teórica sobre o conceito de cuidados primários e acesso aos serviços de saúde. Foram também alvo de análise as dimensões do acesso, mencionadas pelos diversos autores e diferentes estudos já publicados. Para a concretização do estudo empírico, foi utilizado um conjunto de variáveis quantitativas recolhidas pela Administração Central do Sistema de Saúde, sendo que o principal objetivo desta investigação consistiu em perceber se as variáveis em análise permitem, ou não, concluir sobre a existência de desigualdades no acesso aos cuidados primários. Para tal, socorremo-nos de um conjunto de “testes/procedimentos estatísticos”. A análise realizada pemite-nos concluir que existem desigualdades no acesso aos cuidados de saúde primários ao nível regional...

Support networks and people with physical disabilities: social inclusion and access to health services

Holanda,Cristina Marques de Almeida; Andrade,Fabienne Louise Juvêncio Paes de; Bezerra,Maria Aparecida; Nascimento,João Paulo da Silva; Neves,Robson da Fonseca; Alves,Simone Bezerra; Ribeiro,Kátia Suely Queiroz Silva
Fonte: ABRASCO - Associação Brasileira de Saúde Coletiva Publicador: ABRASCO - Associação Brasileira de Saúde Coletiva
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2015 EN
Relevância na Pesquisa
95.63%
This study seeks to identify the formation of social support networks of people with physical disabilities, and how these networks can help facilitate access to health services and promote social inclusion. It is a cross-sectional study, with data collected via a form applied to physically disabled persons over eighteen years of age registered with the Family Health Teams of the municipal district of João Pessoa in the state of Paraíba. It was observed that the support networks of these individuals predominantly consist of family members (parents, siblings, children, spouses) and people outside the family (friends and neighbors). However, 50% of the interviewees declared that they could not count on any support from outside the family. It was observed that the support network contributes to access to the services and participation in social groups. However, reduced social inclusion was detected, due to locomotion difficulties, this being the main barrier to social interaction. Among those individuals who began to interact in society, the part played by social support was fundamental.

The Political Economy of Health Services Provision and Access in Brazil

Mushfiq Mobarak, Ahmed; Rajkumar, Andrew Sunil; Cropper, Maureen
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
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75.74%
The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains access to health services when he, or she seeks it. The authors find that an increase in income inequality, an increase in the percentage of the population that votes, and an increase in the percentage of votes going to left-leaning candidates are each associated with higher levels of public health services. The per capita provision of doctors, nurses, and clinics is also greater in counties with a popular local leader, and in counties where the county mayor and state governor are politically aligned. Administrative decentralization of health services to the county decreases provision levels, and reduces access to services by the uninsured, unless it is accompanied by good local governance.

Equity, Access to Health Care Services and Expenditures on Health in Nicaragua

Angel-Urdinola, Diego; Cortez, Rafael; Tanabe, Kimie
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
95.76%
Nicaragua has embarked on an ambitious health sector program, which has contributed to significant progress in the health sector over the past decade. Health indicators show gradual but steady improvements: access to basic services such as clean water and sanitation facilities has improved, as have other related performance indicators such as life expectancy, infant/child mortality, immunization rates, and child nutrition among others. Despite these achievements, there are still large inequities in access and quality of health services across socioeconomic groups and regions. Poor individuals living in rural areas (especially in the Central and Atlantic regions), the indigenous population, and individuals living in households engaged in agriculture have average access to health care services and preventive care. The lack of risk mitigation mechanisms such as insurance and social security is causing users in Nicaragua to spend, out-of-pocket, a significant share of their income on health care, especially to buy medications and other non-consultation items such as medical tests. Long distances...

Overcoming Barriers to Health Service Access and Influencing the Demand Side Through Purchasing

Ensor, Tim; Cooper, Stephanie
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
Relevância na Pesquisa
75.74%
This paper investigates the role of demand-side barriers in impeding access to the use of health services. Demand-side barriers are defined as determinants of use of health care that are not dependent on service delivery or price or direct price of those services. They include distance, education, opportunity cost, and cultural and social barriers. There is some evidence that these barriers are at least as important in determining access to services as the quality, volume, and price of services delivered by health care providers. The paper is divided into two sections. In the first section literature on demand barriers to accessing services is reviewed. Since the literature on these barriers is so substantial, the review is restricted to an illustrative survey of the main barriers in low-, middle-, and high-income countries. The second section surveys studies that report and evaluate methods for overcoming these barriers. The literature here is substantially less voluminous even when gray and unpublished sources are included in the survey. Many of the studies relate to access to obstetrical and family planning care. In most cases evaluation is not rigorous...

Universal Health Coverage and the Challenge of Informal Employment : Lessons from Developing Countries

Bitran, Ricardo
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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75.75%
The aim of the report is to review existing approaches and available policy options to improve access to health care services and financial protection against health shocks for informal-sector workers (ISWs). Along with their families, ISWs represent the majority of the population in many developing countries. The report reviews the definition and measurement of the informal sector and the literature on efforts toward its health insurance coverage. It also examines several country cases based on published and unpublished reports and on structured interviews of expert informants. Developing country efforts to expand health coverage are characterized by a common enrollment and financing pattern, starting with formal-sector workers and following with government-subsidized enrollment of the poor. Thus, ISWs are typically left behind and have been referred to as "the missing middle." They find themselves financially unprotected against health shocks and with limited access to quality and timely health care. ISWs are generally reluctant to enroll in insurance schemes...

The effects of access to health care on infant mortality in Indonesia

Frankenberg, Elizabeth
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, the Australian national University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, the Australian national University
Tipo: Artigo de Revista Científica Formato: 68993 bytes; application/pdf
EN_AU
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This paper examines the impact of access to health facilities and personnel on infant and child mortality in Indonesia. Demographic and Health Survey data are combined with village-level censuses of infrastructure collected by the Central Bureau of Statistics. Because the village-level data are available from two points in time, it is possible to analyse the effects on mortality risks within the village of changes in access to health care. Factors about villages that might affect both access to health care and mortality risks are held constant. Adding a maternity clinic to a village decreases the odds of infant mortality by almost 15 per cent, in comparison to the risk before the clinic was added. An additional doctor reduces the odds by about 1.7 per cent.; yes

Access to health-care in Canadian immigrants: a longitudinal study of the National Population Health Survey

Setia, M.S.; Quesnel-Vallee, A.; Abrahamowicz, M.; Tousignant, P.; Lynch, J.
Fonte: Blackwell Publishing Publicador: Blackwell Publishing
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
95.72%
Immigrants often lose their health advantage as they start adapting to the ways of the new society. Having access to care when it is needed is one way that individuals can maintain their health. We assessed the healthcare access in Canadian immigrants and the socioeconomic factors associated with access over a 12-year period. We compared two measures of healthcare access (having a regular doctor and reporting an unmet healthcare need in the past 12 months) among immigrants and Canadian-born men and women, aged more than 18 years. We applied a logistic random effects model to evaluate these outcomes separately, in 3081 males and 4187 females from the National Population Health Survey (1994-2006). Adjusting for all covariates, immigrant men and women (white and non-white) had similar odds of having a regular doctor than the Canadian-born individuals (white immigrants: males OR: 1.32, 95% C.I.: 0.89-1.94, females OR: 1.14, 95% C.I.: 0.78-1.66; non-white immigrants: males OR: 1.28, 95% C.I.: 0.73-2.23, females OR: 1.23, 95% C.I.: 0.64-2.36). Interestingly, non-white immigrant women had significantly fewer unmet health needs (OR: 0.32, 95% C.I.: 0.17-0.59). Among immigrants, time since immigration was associated with having access to a regular doctor (OR per year: 1.02...

Arab Republic of Egypt - Inequality of Opportunity in Access to Basic Services among Egyptian Children

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Policy Note; Economic & Sector Work
ENGLISH; EN_US
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Egypt's children and youth, representing more than one-third of the country´s population and its future, face several significant challenges, as shown by higher child poverty rates and unequal access to basic services. The objective of this report is three-fold: (i) to analyze the extent of inequality of opportunity among Egyptian children; (ii) to inform government policy on how success in life is influenced by factors predetermined at birth; and (iii) to identify policies and interventions that may contribute to improving equality of opportunity. The underlying premise is that ensuring equality of opportunity entails leveling the playing field in such a way that every child, regardless of the circumstances of his/her birth, will have an equal chance to succeed in life. This report analyzes the extent of provision of equal access to basic opportunities to all children (including healthcare, education, clean water and sanitation), and identifies the main circumstances that affect it and therefore determine human development outcomes. The analysis in this report builds on the concepts and ideas developed in the World Development Report (WDR). The findings are aimed at supporting debates and discussions...

Private Voluntary Health Insurance : Consumer Protection and Prudential Regulation

Brunner, Greg; Gottret, Pablo; Hansl, Birgit; Kalavakonda, Vijayasekar; Nagpal, Somil; Tapay, Nicole
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research
EN_US
Relevância na Pesquisa
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Health care expenditures can be financed through a mix of public resources and private spending. Private spending is a much larger share of total health spending in low- and middle-income countries than in higher income countries. Moreover, a significant percentage of private spending in those countries is out-of-pocket direct payments for health care services by individuals. Out of pocket expenditures account for more than 60 percent of the total health care spending in low-income countries and 40 percent of total health care spending in middle-income countries. A growing number of low- and middle-income governments are considering private health insurance as a way of both reducing the risk that individuals will have a catastrophic financial burden and achieving other public health care goals. Among these goals are reducing the financial burden on overstretched public health financing, achieving more equitable access to health care, and improving quality and efficiency in the delivery of health care services. An important component of a successful private health insurance market, however, is its legal framework. As discussed in detail later in this book, countries regulate insurance companies to counter systemic market failures that lead to an inefficient and inequitable market. In particular...

Turkey : Reforming the Health Sector for Improved Access and Efficiency, Volume 1. Main Report; Turkey - Health Sector Study

World Bank
Fonte: Washington, DC Publicador: Washington, DC
Tipo: Economic & Sector Work :: Other Health Study; Economic & Sector Work
ENGLISH; EN_US
Relevância na Pesquisa
75.73%
Fundamental and systemic changes would have to be brought about in the ways that health care is financed, delivered, organized, and managed in Turkey in order to meet the ultimate objective of improving the health status of people, and not only meet but surpass the health-related Millennium Development Goals. This would require significant improvements in resource mobilization, allocation and utilization, enhanced efficiency in production and delivery of health services, including primary and hospital care, and greater emphasis on clinical quality and patient access to health services. Against this backdrop, the World Bank and the Government of Turkey agreed to undertake an intensive review of all aspects of the health sector, and the present report is produced from this effort. One objective of an evaluation at this juncture is to lay the foundation for developing a medium-term health sector strategy and a prioritized action plan aimed at improving access to health services, enhancing equity in utilization...

Explicit Health Guarantees for Chileans : The AUGE Benefits Package

Bitran, Ricardo
Fonte: World Bank, Washington DC Publicador: World Bank, Washington DC
Tipo: Publications & Research :: Working Paper; Publications & Research
EN_US
Relevância na Pesquisa
75.74%
This paper focuses on recent and significant health reform implemented in 2005, known as Universal Access with explicit guarantees (Acceso Universal con Garantias Explicitas - AUGE or GES), which mandated SHI insurers to adopt a broad benefits package defined via explicit legal guarantees for all beneficiaries. This innovative reform is a policy reaction to that which previously existed in Chile and which is widespread in many developing countries, whereby the health rights of citizens remain largely undefined or implicit. Limited public resources imply in those countries that access to health care is rationed through queues, patient deflection, legal or under-the-table user fees, and low-quality care. This paper describes the AUGE reform, its implementation, and the functioning of AUGE for the poor and for non-poor citizens. This paper is organized as: section two provides a brief historic overview of health coverage in Chile's SHI system. Section three describes the SHI system in existence today. Section four describes the services offered and mechanisms in place to cover the poor under SHI, while section five spells out the benefits of SHI. Section six introduces the AUGE health reform of 2005, which sought to broaden and make explicit the rights of all SHI beneficiaries. Section seven offers information about the flows and magnitudes of health financing in SHI. Section eight focuses on the system used by Fonasa to target the poor. Section nine explains how Fonasa manages AUGE. Section ten comments on the information environment of AUGE. Section eleven addresses the equity and fiscal implications of expanding the AUGE benefits. Finally...

Improving Access to Health Care Services through the Expansion of Coverage Program : The Case of Guatemala

Lao Pena, Christine
Fonte: World Bank, Washington DC Publicador: World Bank, Washington DC
Tipo: Publications & Research :: Working Paper
EN_US
Relevância na Pesquisa
95.76%
Since the signing of the 1996 Peace Accords, Guatemala has made efforts to establish economic and political stability, and to improve its social indicators. The country's Constitution states that access to health care is a basic right of all Guatemalans. In practice, however, it has been challenging for the Government of Guatemala to guarantee this right using public facilities. As a result, it has been trying to improve access to health services using both Ministry of Public Health and Social Assistance (MOH) facilities and staff, and alternative health service providers, particularly nongovernmental organizations (NGOs). This case study reviews the experience implementing the Expansion of Coverage Program (Programa de Extension de Cobertura, PEC) that was established by the Government of Guatemala in 1997 to improve coverage of health and nutrition services to poor, rural, and largely indigenous areas by contracting NGOs. It describes its origins; its package of services; contracting, financing, monitoring, and supervision mechanisms; and its contributions to improving access and strengthening primary health care services in Guatemala. It also discusses opportunities and challenges that need to be addressed to continue to improve health services coverage in the country.

Jamaica’s Effort in Improving Universal Access within Fiscal Constraints

Chao, Shiyan
Fonte: World Bank, Washington DC Publicador: World Bank, Washington DC
Tipo: Publications & Research :: Working Paper; Publications & Research
EN_US
Relevância na Pesquisa
75.77%
Jamaica's primary health care system was a model for the Caribbean region in the 1990s. Because of it, Jamaicans enjoy relatively better health status than people in other countries of similar income level in the Caribbean region. However, Jamaica's health system is being severely challenged by persistent and reemerging infectious diseases and by the rapid increase in noncommunicable diseases (NCDs) and injuries. At the same time, the country has suffered from low economic growth and carries a high debt burden, which leaves limited fiscal space for improving health care. The Government of Jamaica has been trying to sustain the gain in health outcomes and improve access to health care for its population in an environment of constrained resources during the last decade. With the establishment of the Jamaica National Health Fund (NHF) in 2003 and the abolition of user fees at public facilities in 2008, the Government of Jamaica has taken steps toward achieving universal coverage. This study reviews the achievements and challenges in expanding universal access in Jamaica and assesses the impact of the NHF's drug-subsidy programs and the abolition of user fees on universal access, and discusses policy options for achieving universal coverage.

Right of access to health information

Dytz,Jane Lynn Garrison
Fonte: Associação Brasileira de Enfermagem Publicador: Associação Brasileira de Enfermagem
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2004 EN
Relevância na Pesquisa
95.67%
The access to health information is one of the rights of the user of the public health care system, but it is little respected in health services. This study investigates the problem from the perspective of the female clientele. A qualitative study was carried out with a sample of seventeen low-income mothers, which reside in the outskirts of the Federal District. The mothers are frequent users of the health care services, but their adherence to prescribed conducts depends on social and economic factors and how they perceive the various alternatives at their hand. Access to health information is hampered by the mother's low level of instruction, use of folklore medicine, faulty communication and lack of receptive/nurturing environment, indifference to social rights on the part of health providers.

Disability as a determinant of access to health care services in Colombia

Pinilla Roncancio, Monica Viviana
Fonte: Facultad de Economía Publicador: Facultad de Economía
Tipo: info:eu-repo/semantics/masterThesis; info:eu-repo/semantics/acceptedVersion Formato: application/pdf
Publicado em 01/04/2012 SPA
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75.77%
The relationship between disability and poverty has been described in different contexts. Nevertheless, the basic characteristics of this relationship have not yet been fully established. The social exclusion and discrimination against people with disabilities increase the risk of poverty and reduce the access to basic opportunities such as health and education. This study examines the impact of a health limitation and poverty in the access to health care services in Colombia. Data from the Colombian National Health Survey (2007) was used in the analysis. Variables related with health condition and socio economic characteristics were first generated. Then interactions between health limitations and the lower levels of the asset index were created. This variable gave information related to the relationship between disability and poverty. A probabilistic model was estimated to examine the impact of a health condition and the relation between poverty and disability on the access to health care. The results suggest that living with a physical limitation increases by 10% the probability of access to health care services in Colombia. However, people with a disability and in the lowest quartile of the asset index have a 5% less probability of access to health care services. We conclude that people who live with a physical...

A human rights-based approach to poverty reduction: the role of the right of access to medicine as an element of the right of access to health care

Strauss,Z; Horsten,D
Fonte: PER: Potchefstroomse Elektroniese Regsblad Publicador: PER: Potchefstroomse Elektroniese Regsblad
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2013 EN
Relevância na Pesquisa
95.77%
The prevention and treatment of infectious diseases remain among the greatest challenges faced by today's developing countries. The World Health Organisation estimates that about one-third of the world's population lacks access to essential medicine, a fact which, according to the United Nations, directly contradicts the fundamental principle of health as a human right. According to the World Summit for Social Development, poor health and illness are factors that contribute to poverty, while the adverse effects of illness ensure that the poor become poorer. A lack of access to health care, amongst other rights, (including access to medicines as an element thereof) aggravates poverty. The most important provision in international law relating to the right to health is article 12 of the United Nations International Covenant on Economic, Social and Cultural Rights. Article 12(1) of this Covenant provides a broad formulation of the right to health in international law, while article 12(2) prescribes a non-exhaustive list of steps to be taken in pursuit of the highest attainable standard of health. Article 12(2), in particular, illustrates the role that adequate access to medication plays in the right of access to health care. The United Nations Committee on Economic...

Equity of access to health care for older adults in four major Latin American cities

Wallace,Steven P.; Gutiérrez,Verónica F.
Fonte: Organización Panamericana de la Salud Publicador: Organización Panamericana de la Salud
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2005 EN
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OBJECTIVES: To identify if older adults have equitable access to health services in four major Latin American cities and to determine if the inequities that are found follow the patterns of economic inequality in each of the four nations studied. METHODS: Data from persons age 60 and over in the cities of São Paulo, Brazil (n = 2 143); Santiago, Chile (n = 1 301); Mexico City, Mexico (n = 1 247); and Montevideo, Uruguay (n = 1 450) were collected through a collaboration led by the Pan American Health Organization. For our study, three process indicators of access (availability, accessibility, and acceptability) and one indicator of actual health services use (visit to a medical doctor in the past 12 months) were analyzed by wealth quintiles, health insurance type, education, health status, and demographic characteristics. RESULTS: Each of the four cities had a different level of access to care, and those levels of access were only weakly related to per capita national wealth. Given the relatively high level of wealth inequality in Brazil and the lower level in Uruguay, older persons in São Paulo had better-than-expected equity in access to care, while older persons in Montevideo had less equity than expected. Inequity in Mexico City was driven primarily by low levels of health insurance coverage. In Santiago...

Making the right to health a reality for Brazil's indigenous peoples: innovation, decentralization and equity

Coelho,Vera; Shankland,Alex
Fonte: Medical Education Cooperation with Cuba Publicador: Medical Education Cooperation with Cuba
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2011 EN
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85.65%
This article provides an overview of governance arrangements and changes in the Brazilian public health system since 1988, when the "Citizen's Constitution" declared health to be a universal right. Since then, population coverage has grown substantially and health indicators have improved. Despite these achievements, inequities in access remain an important barrier to universal coverage, in particular for marginalized groups such as indigenous peoples. This article discusses the innovation cycle that produced the gains and recent efforts to guarantee more equitable access to health services for the indigenous population in a continent-sized country historically plagued by great inequalities.