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Eficácia e gestão da política de atenção básica de saúde nos municípios brasileiros; Effectiveness of policy and management of basic health care in municipalities

Peixoto, Sandro Garcia Duarte
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 28/11/2008 PT
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76.1%
Este trabalho tem como objetivo investigar dois aspectos complementares da política de atenção básica em saúde: auferir sua eficácia, em termos de impacto sobre indicadores de saúde populacionais, e avaliar a qualidade de sua gestão. A referida política se consolidou nos últimos anos como base estruturante do Sistema Único de Saúde. Com execução de responsabilidade dos municípios, sua relevância deriva basicamente de três aspectos, a saber: a política de atenção básica articula um conjunto de atividades voltadas ao cuidado preventivo, o que, em tese, reduz a demanda por serviços terapêuticos; capilariza o sistema de assistência à saúde pelo país; e instrumentaliza a organização dos modelos municipais de saúde. No que se refere à análise de eficácia, a abordagem empregada foi a econometria de painel de dados, com base na amostra dos municípios da Região Sudeste entre 1999 e 2003. Com base na evolução da cobertura populacional do Programa Saúde da Família e do Programa de Agentes Comunitários de Saúde, constatou-se que a política de atenção básica reduz de forma significativa a mortalidade infantil e a subnotificação de óbitos. Porém, não gera redução das internações hospitalares. Os aspectos concernentes à gestão do programa...

Mobilizando coletivos e construindo competências culturais no cuidado à saude : estudo antropológico da política brasileira de atenção primária à saúde; Mobilizing collectives and building cultural competences in health care: anthropological study of the Brazilian primary health care policy

Targa, Leonardo Vieira
Fonte: Universidade Federal do Rio Grande do Sul Publicador: Universidade Federal do Rio Grande do Sul
Tipo: Dissertação Formato: application/pdf
POR
Relevância na Pesquisa
86%
Este trabalho estuda a política nacional de Atenção Primária à Saúde (APS) a partir da proposta de realizar uma outra antropologia das políticas públicas, que se aproxime do princípio de simetria. Inicialmente, alguns aspectos da APS e de como esta é constituída como modelo científico para os sistemas de saúde mundiais são revisados, bem como sua configuração atual no Sistema Único de Saúde, através da Estratégia Saúde da Família (ESF) e do Programa de Agentes Comunitários. Analisa-se também a forma como conceitos de família e de comunidade estão presentes nestas políticas. A partir do estudo das redes de atuantes, no sentido de Latour, sugere-se que as diferenças criadas entre a ESF e outros modelos, que dividem o cuidado da saúde em terapias especializadas clínicas e cirúrgicas de um lado e o planejamento epidemiológico-sanitarista de outro, podem ser entendidos como uma postura diferente em relação ao acordo modernista. Para isso utilizam-se três aspectos principais observados em campo: a) a prática de cuidado mais individualizado de saúde, ou clínica; b) o trabalho com territórios e as identidades relacionadas com o processo de territorialização; c) a prática da atenção domiciliar. Ao mapear estas redes híbridas mobilizadas pelas equipes de saúde da família...

Health Care Policy Issues as a Result of the Genetic Revolution: Implications for Public Health

Ojha, Rohit P.; Thertulien, Raymond
Fonte: © American Journal of Public Health 2005 Publicador: © American Journal of Public Health 2005
Tipo: Artigo de Revista Científica
Publicado em /03/2005 EN
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85.88%
The genetic revolution has spawned 4 distinct issues of universal importance to health care policy and society: genetic privacy, regulation and standardization of genetic tests, gene patenting, and education.

Poverty in the Midst of Plenty: Unmet Needs and Distribution of Health Care Resources in South Korea

Heo, Jongho; Oh, Juwhan; Kim, Jukyung; Lee, Manwoo; Lee, Jin-seok; Kwon, Soonman; Subramanian, S.V. Venkata; Kawachi, Ichiro
Fonte: Public Library of Science Publicador: Public Library of Science
Tipo: Artigo de Revista Científica
EN_US
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75.92%
Background: The unmet needs for health care have been used as an alternative measurement to monitor equity in health services. We sought to examine contextual influences on unmet needs for health care whereas precedent studies have been focused on individual characteristics on them. Methods and Findings: The current study conducted multilevel logistic regression analysis to assess the effects of individual- and contextual-level predictors in meeting individual health care needs in South Korea. We sampled 7,200 individuals over the age of 19 in the Fourth Korea National Health and Nutrition Examination Survey in 2009. Included in the regression model were individual predictors such as demographic variables, socio-economic status, and self-rated health; the density of beds and physicians in public and private sectors within different regions were used as contextual-level predictors. This study showed the inverse association between unmet needs and regional resources in private sectors after controlling for the effects of individual-level predictors. Conclusion: Our findings suggest that increasing regional resources in private sectors might produce inefficiency in the health care system and inequity in access to health services, particularly where the competition in private health care sectors was highly stimulated under the fee-for-service reimbursement scheme. Policies for the reallocation of health care resources and for reduction of individual health care costs are needed in Korea.

Health policy in Bogota (2004-2008): an analysis of the experience with primary health care; Social Medicine

Vega Romero, Roman Rafael
Fonte: Pontifícia Universidade Javeriana Publicador: Pontifícia Universidade Javeriana
Formato: 126-144
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3-2; This study summarizes the health policy and the Primary Health Care strategies developed by the Bogota municipal government from 2004-2008. The experiences and outcomes during this time period indicate that, despite the market-oriented health policy that exists in Colombia, it was beneficial to implement health policies and strategies at the local level so as to guarantee the right to health and equitable access to health care. National level restrictions, however, impose constraints on the potential implementation of such policies and strategies. This suggests that in order to achieve effective and sustainable changes at the local level, it is necessary to promote substantial reforms within national health care policy.

Risk Pooling in Health Care Financing : The Implications for Health System Performance

Smith, Peter C.; Witter, Sopie N.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
EN_US
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75.94%
Pooling is the health system function whereby collected health revenues are transferred to purchasing organizations. Pooling ensures that the risk related to financing health interventions is borne by all the members of the pool and not by each contributor individually. Its main purpose is to share the financial risk associated with health interventions for which there is uncertain need. The arguments in favor of risk pooling in health care embody equity and efficiency considerations. The equity arguments reflect the view that society does not consider it to be fair that individuals should assume all the risk associated with their health care expenditure needs. The efficiency arguments arise because pooling can lead to major improvements in population health, can increase productivity, and reduces uncertainty associated with health care expenditure. The report considers four classes of risk pooling: no risk pool, under which all expenditure liability lies with the individual; unitary risk pool, under which all expenditure liability is transferred to a single national pool; fragmented risk pools...

Density versus Quality in Health Care Provision : Using Household Data to Make Budgetary Choices in Ethiopia

Collier, Paul; Dercon, Stefan; Mackinnon, John
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Artigo de Revista Científica
EN_US
Relevância na Pesquisa
76.08%
Usage of health facilities in Ethiopia is among the lowest in the world; raising usage rates is probably critical for improving health outcomes. The government has diagnosed the principal problem as the lack of primary health facilities and is devoting a large share of the health budget to building more facilities. But household data suggest that usage of health facilities is sensitive not just to the distance to the nearest facility but also to the quality of health care provided. If the quality of weak facilities were raised to that currently provided by the majority of facilities in Ethiopia, usage would rise significantly. National data suggest that given the current density and quality of service provision, additional expenditure on improving the quality of service delivery will be more cost-effective than increasing the density of service provision. The budget allocation rule presented in the article can help local policymakers make decisions about how to allocate funds between improving the quality of care and decreasing the distance to the nearest health care facility.

Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa

Wilkinson, David; Gouws, Eleanor; Sach, Marlene; Abdool Karim, Salim S.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica
Publicado em //2001 EN
Relevância na Pesquisa
76.06%
User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 years and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001) for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant. The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.; David Wilkinson...

Protection in Good and Bad Times? The Turkish Green Card Health Program; Policy Research Working Paper ; no. 6178

Aran, Meltem A.; Hentschel, Jesko S.
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH; EN_US
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76.11%
This paper evaluates the equity and financial protection implications of the expansion of the Green Card (Yesil Kart) non-contributory health insurance program in Turkey during the growth years from 2003 to 2008. It also considers the program's protective impact during the economic crisis in 2009. The authors find that the rapid expansion of the program between 2003 and 2008 was highly progressive. It led to significant gains in coverage of the poor but offered limited financial protection as out-of-pocket expenditures even before the introduction of the program had been limited. Using a specialized welfare monitoring survey, fielded in 2009, the authors estimate the impact of the program on household level health care utilization during the first phase of the economic slowdown in Turkey. Using three different estimation techniques, they find that the Green Card program had a significantly positive impact on protecting health care utilization during the crisis.

Measuring Equity in Health Care Financing : Reflections on (and Alternatives to) the World Health Organization's Fairness of Financing Index

Wagstaff, Adam
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper
EN_US
Relevância na Pesquisa
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In its latest World Health Report, The World Health Organization (WHO) argues that a key dimension of a health system's performance is the fairness of its financing system. The report discusses how policymakers can improve this aspect of performance, proposes an index of fairness, discusses how it should be put into operation, and presents a league table of countries, ranked by fairness with which their health services are financed. The author shows that the WHO index cannot discriminate between health financing systems that are regressive, and those that are progressive - and cannot discriminate between horizontal inequity, and progressiveness, or regressiveness. The index cannot tell policymakers whether it deviates from 1 (complete fairness) because households with similar incomes spend different amounts on health care (horizontal inequity), or because households with different incomes spend different proportions of their income on health care (vertical inequity, given the WHO's interpretation of the ability-to-pay principle) - although the two have different policy implications. With the WHO's index, progressiveness, and regressiveness are both treated as unfair. This makes no sense, because policymakers who may be strongly averse to regressive payments (which worsen income distribution) may in the name of fairness be quite receptive to progressive payments (requiring that the better-off...

The Impact of Price Subsidies on Child Health Care Use : Evaluation of the Indonesian Healthcard

Somanathan, Aparnaa
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
ENGLISH
Relevância na Pesquisa
76.08%
Financial barriers to seeking care are frequently cited as one of the main causes of underutilization of child health care services. This paper estimates the impact of Indonesia's healthcard on health care use by children. Evaluation of the healthcard effect is complicated by the fact that card allocation was non-random. The analysis uses propensity score matching to control for systematic differences between treatment and control groups. A second potential source of bias is related to contemporaneous, exogenous influences on health care use unrelated to the healthcard itself. Using panel data collected prior to and after the introduction of the healthcard, a difference-in-differences estimator is constructed to eliminate the effects of exogenous changes over time. The author finds that although health care use declined for all children during the crisis years of 1997-2000, use of public sector outpatient services declined much less for children with healthcards. The protective effect of the healthcard on public sector use was concentrated among children aged 0-5 years. The healthcard had no significant impact on use of private sector services. The results highlight the need to provide adequate protection against the financial burden of health care costs...

Health Care in Sri Lanka : What Can the Private Health Sector Offer?

Govindaraj, Ramesh; Navaratne, Kumari; Cavagnero, Eleonora; Seshadri, Shreelata Rao
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
ENGLISH; EN_US
Relevância na Pesquisa
76.09%
This review represents an attempt to bridge the significant knowledge gaps on the private health sector in Sri Lanka, and foster a dialogue on opportunities for collaboration between the government and the private sector. It accomplishes this through a systematic collection and analysis of primary and secondary data on the provision, financing, and regulation of health care services. On health service delivery, the review finds that the private sector: includes a range of providers; focuses primarily on curative and outpatient services rather than preventive services; is heavily dependent on the public sector for its supply of human resources; and is concentrated in urban areas. The quality of health care services in Sri Lanka in both the private and public sectors, while better than in most developing countries, still lags behind those in more advanced countries. There is also little systematic dialogue and collaboration between the public and private sectors. On financing, the review finds that private health expenditure is more than half of total health expenditure...

Building on Values: Report of the Commission on the Future of Health Care in Canada [Reports]

Commission on the Future of Health Care in Canada; Romanow, Roy
Fonte: Saskatoon: Commission on the Future of Health Care in Canada Publicador: Saskatoon: Commission on the Future of Health Care in Canada
EN
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105.84%
In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. The mandate of the Commission was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system's quality and sustainability.; Paper copy - CA1 Z1 2001F0 Stauffer Library - Documents

Building on Values: Report of the Commission on the Future of Health Care in Canada [Discussion Papers]

Commission on the Future of Health Care in Canada; Romanow, Roy
Fonte: Saskatoon: Commission on the Future of Health Care in Canada Publicador: Saskatoon: Commission on the Future of Health Care in Canada
EN
Relevância na Pesquisa
105.84%
In April 2001, the Prime Minister established the Commission on the Future of Health Care in Canada. The mandate of the Commission was to review medicare, engage Canadians in a national dialogue on its future, and make recommendations to enhance the system's quality and sustainability.; Paper copy - CA1 Z1 2001F0 Stauffer Library - Documents

The role of public policy in health care promotion: a comparative perspective

Asensio, Maria
Fonte: Direção Geral da Qualificação dos Trabalhadores em Funções Públicas Publicador: Direção Geral da Qualificação dos Trabalhadores em Funções Públicas
Tipo: Conferência ou Objeto de Conferência
ENG
Relevância na Pesquisa
76.04%
Comunicação apresentada na 17th International conference on Health Promotio Hospitals and Health Services em Hersonissis, Crete, Grécia de 6-8 de maio de 2009; This paper analyse the role of public policy in health care promotion in a comparative perspective. Public health has become a sensible issue, which takes up a prominent position in public and political debate. National health systems throughout the world face a common set of core challenges related to demography, epidemiology, developments in science and technology, medical demand and rising public expectations. These pressures are producing common challenges in the objectives and activities of health care in several key areas, including health promotion and the prevention of health problems. At the same time, it is also necessary to recognize the role of the political, legal and governmental processes, as well as the clinical and professional variables, in shaping different societal responses to health care promotion challenges. The approach this paper takes is to look at the documentary record for evidence of changes in the ideas and in the identity of actors that may be moving health care policy towards health promotion. This analysis is not definitive, as that would require detailed quantitative and qualitative empirical data about how health promotion is operating within the member states. However...

Analysing health care systems performance: the story behind the statistics

Healy, Judith
Fonte: Public Health Association of Australia Publicador: Public Health Association of Australia
Tipo: Artigo de Revista Científica
Relevância na Pesquisa
85.93%
This commentary paper argues that the Asia-Pacific region would benefit from a home-grown version of the European Observatory on Health Care Systems to inform health sector policy: an Asia-Pacific Observatory. The countries in this diverse region, ranging

Considerações sobre o Programa de Saúde da Família e a promoção de maior eqüidade na política de saúde; Considerations about the Family Health Program and the promotion of greater equity in health care policy

Sisson, Maristela Chitto
Fonte: Universidade de São Paulo. Faculdade de Saúde Pública Publicador: Universidade de São Paulo. Faculdade de Saúde Pública
Tipo: info:eu-repo/semantics/article; info:eu-repo/semantics/publishedVersion; Formato: application/pdf
Publicado em 01/12/2007 POR
Relevância na Pesquisa
76%
Na Constituição Brasileira, a eqüidade em saúde é tomada como igualdade, garantida pela gratuidade no acesso aos serviços de saúde, o que pressupõe não só uma divisão quantitativa de recursos, mas sua orientação à redução das desigualdades sociais, por meio do modelo assistencial. Nesse sentido, estratégias como o Programa de Saúde da Família têm sido consideradas como implementadoras do acesso ao sistema de saúde. Este estudo tem como objetivo desenvolver uma reflexão sobre eqüidade e modelo assistencial PSF, através de revisão baseada em autores que discutem o tema. A visão sobre o Programa de Saúde da Família vem mudando com o passar do tempo, desde crítica a seu caráter focalizado até sua consideração como ação afirmativa. Estudos mostram que mudanças no financiamento e no planejamento do sistema aproximaram os municípios e envolveram novos atores no processo, trazendo maior acesso à atenção básica - embora sem influenciar os outros níveis do sistema. Para que o Programa de Saúde da Família assuma caráter de estratégia de inclusão de segmentos populacionais que não têm acesso aos serviços de saúde, deverá realizar-se por meio de sua incorporação a uma política maior, que garanta suporte social...

Inequalities in health care use and expenditures: empirical data from eight developing countries and countries in transition

Makinen,M; Waters,H; Rauch,M; Almagambetova,N; Bitran,R; Gilson,L; McIntyre,D; Pannarunothai,S; Prieto,A.L; Ubilla,G; Ram,S
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 EN
Relevância na Pesquisa
75.99%
This paper summarizes eight country studies of inequality in the health sector. The analyses use household data to examine the distribution of service use and health expenditures. Each study divides the population into "income" quintiles, estimated using consumption expenditures. The studies measure inequality in the use of and spending on health services. Richer groups are found to have a higher probability of obtaining care when sick, to be more likely to be seen by a doctor, and to have a higher probability of receiving medicines when they are ill, than the poorer groups. The richer also spend more in absolute terms on care. In several instances there are unexpected findings. There is no consistent pattern in the use of private providers. Richer households do not devote a consistently higher percentage of their consumption expenditures to health care. The analyses indicate that intuition concerning inequalities could result in misguided decisions. It would thus be worthwhile to measure inequality to inform policy-making. Additional research could be performed using a common methodology for the collection of data and applying more sophisticated analytical techniques. These analyses could be used to measure the impact of health policy changes on inequality

Effect of removing user fees on attendance for curative and preventive primary health care services in rural South Africa

Wilkinson,David; Gouws,Eleanor; Sach,Marlene; Karim,Salim S. Abdool
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2001 EN
Relevância na Pesquisa
76.06%
User fees are used to recover costs and discourage unnecessary attendance at primary care clinics in many developing countries. In South Africa, user fees for children aged under 6 years and pregnant women were removed in 1994, and in 1997 all user fees at all primary health care clinics were abolished. The intention of these policy changes was to improve access to health services for previously disadvantaged communities. We investigated the impact of these changes on clinic attendance patterns in Hlabisa health district. Average quarterly new registrations and total attendances for preventive services (antenatal care, immunization, growth monitoring) and curative services (treatment of ailments) at a mobile primary health care unit were studied from 1992 to 1998. Regression analysis was undertaken to assess whether trends were statistically significant. There was a sustained increase in new registrations (P = 0.0001) and total attendances (P = 0.0001) for curative services, and a fall in new registrations (P = 0.01) and total attendances for immunization and growth monitoring (P = 0.0002) over the study period. The upturn in demand for curative services started at the time of the first policy change. The decreases in antenatal registrations (P = 0.07) and attendances (P = 0.09) were not statistically significant. The number of new registrations for immunization and growth monitoring increased following the first policy change but declined thereafter. We found no evidence that the second policy change influenced underlying trends. The removal of user fees improved access to curative services but this may have happened at the expense of some preventive services. Governments should remain vigilant about the effects of new health policies in order to ensure that objectives are being met.

China's public health-care system: facing the challenges

Liu,Yuanli
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/07/2004 EN
Relevância na Pesquisa
75.99%
The severe acute respiratory syndrome (SARS) crisis in China revealed not only the failures of the Chinese health-care system but also some fundamental structural deficiencies. A decentralized and fragmented health system, such as the one found in China, is not well-suited to making a rapid and coordinated response to public health emergencies. The commercial orientation of the health sector on the supply-side and lack of health insurance coverage on the demand-side further exacerbate the problems of the under-provision of public services, such as health surveillance and preventive care. For the past 25 years, the Chinese Government has kept economic development at the top of the policy agenda at the expense of public health, especially in terms of access to health care for the 800 million people living in rural areas. A significant increase in government investment in the public health infrastructure, though long overdue, is not sufficient to solve the problems of the health-care system. China needs to reorganize its public health system by strengthening both the vertical and horizontal connections between its various public health organizations. China's recent policy of establishing a matching-fund financed rural health insurance system presents an exciting opportunity to improve people's access to health care.