A dimensão espacial e o lugar social da loucura: por uma cidade aberta / The spatial dimension and the social place of madness: for an open city

Resumo O processo de Reforma Psiquiátrica Brasileira (RPB) propõe o rompimento com o paradigma manicomial em diversas dimensões. Pensar nos espaços de cuidado e no direito à cidade constituem bandeiras importantes para tal. Dessa forma, construímos um arcabouço teórico-conceitual objetivando discutir e sistematizar a relação da arquitetura dos espaços de cuidado destinados à loucura e à produção de subjetividades e relações. Assim, a partir da arqueogenealogia, organizamos um diálogo entre conceitos e autores que abordem o espaço e a arquitetura como dispositivos de produção de subjetividades e relações, tais como, instituições totais e mortificação do eu (Erving Goffman) e síndrome espaço-comportamental (Mirian de Carvalho), e experiências como as de Maura Lopes Cançado e Lima Barreto. Objetivamos, ainda, discutir e desenhar, pelas lentes de campos diversos de saber, um ideal de cidade que nos ajude a enfrentar o paradigma manicomial e fortalecer o processo de RPB: a cidade aberta, aquela que inclui a diferença. Ao localizarmos a importância da discussão das arquiteturas, dos espaços e da cidade que construímos para o processo de RPB, propomos, como resultado deste artigo, construir e adicionar uma nova dimensão de análise de tal processo às já existentes: a dimensão espacial.

Abstract The Brazilian Psychiatric Reform (BPR) process proposes a break with the asylum paradigm in several dimensions. Thinking about care spaces and the right to the city are important flags for this issue. Bearing that in mind, a theoretical-conceptual framework was constructed, aiming to discuss and systematize the relationship between the architecture of care spaces geared toward madness and the production of subjectivities and relationships. Thus, based on archeo-genealogy, a dialogue was organized between concepts and authors that approach space and architecture as devices for the production of subjectivities and relationships, such as total institutions and self-mortification (Erving Goffman) and space-behavioral syndrome (Mirian de Carvalho), as well as experiences such as those by Maura Lopes Cançado and Lima Barreto. It is also the aim of this study to discuss and draw, through the lens of different fields of knowledge, an ideal city that will aid in facing the asylum paradigm and strengthening the BPR process: the open city, that which includes difference. Locating the importance of discussing the architectures, spaces, and the city built for the BPR process, this article proposes to build and add a new dimension of analysis of such a process to those that already exist: the spatial dimension.

SUS de retalhos Amefricanos: A luz antirracista da ABADFAL / Amefrican patchwork SUS: ABADFAL's anti-racist light

Nesta dissertação discuto em um diálogo de primeira pessoa com meus semelhantes a presença da colonialidade e do racismo nos espaços democráticos do SUS (Sistema Único de Saúde) Discuto o universalismo europeu presente na saúde coletiva e a existência de uma sociedade amefricana no Brasil, apresenta ações coletivas e a valorização do intelectual periférico na produção de políticas públicas e como a ABADFAL se organiza para superar o racismo ainda presente no SUS e na sociedade brasiliana. Concluo que a colonialidade e o racismo ainda estão presentes na produção intelectual, política e gestão do SUS, ainda havendo a manutenção de populações subalternizadas e que uma ação coletiva tem se apresentado como forma de superar tal estrutura.

In this dissertation, I discuss, in a first-person dialogue with my peers, the presence of coloniality and racism in the democratic spaces of the SUS (Unified Health System). collectives and the valorization of the peripheral intellectual in the production of public policies and how ABADFAL organizes itself to overcome the racism still present in the SUS and in the Brazilian society. I conclude that coloniality and racism are still present in the intellectual, political and management production of the SUS, with the maintenance of subordinate populations and that collective action has been presented as a way to overcome this structure.

Study on the inpatient care use since China′s new healthcare reform / 中华医院管理杂志

Objective:To analyze the reform actions on raising the appropriateness of inpatient care use, as well as the current situation, so as to provide suggestions on improving the appropriateness.Methods:Policies and literatures on the appropriateness of inpatient care use released from 2009 to 2021 were collected from such official websites as the State Council and China National Health Commission as well as literature databases from home and abroad, for a text analysis. Based on the data of China Health Statistics Yearbook(2010-2021) and The Sixth National Health Service Survey Report (2018), descriptive methods were adopted to analyze the situation of inpatient care use in China. Results:Since the new healthcare reform, the Chinese government had standardized the hospitalization standards and procedures to minimize inappropriate use of inpatient care, increased financial subsidies for public hospitals to minimize their inappropriate patient attraction merely for economic interests, and reformed the medical insurance payment methods so as to regulate physicians′ behavior. Under the influence of the above policies, the average length of stay decreased from 10.5 days in 2009 to 9.1 days in 2019, with an average annual growth rate of -1.42%. The average waiting time in hospitals decreased from 3.6 days in 2008 to 1.5 days in 2018.From 2012 to 2019, the admission rate increased from 13.2% to 19.0%.Conclusions:Since the new healthcare reform, the average length of stay in China has decreased year by year, but the admission rate has increased year by year. Therefore, it is necessary to further reduce the inappropriate utilization of inpatient care use by speeding up the construction of the close-type medical alliances, improving the reform of payment methods, refining the performance appraisal standards for medical staff and strengthening supervision mechanism.

Formação em gestão para apoio à reforma da atenção primária à saúde em Portugal e países africanos lusófonos / Formation in management for supporting health reforms in Portugal and portuguese-speaking countries / Formación en gestión para apoyo de las reformas sanitarias en Portugal y en los países de lengua oficial portuguesa

Resumo Apresentamos lições que resultaram de atividades de capacitação dos gestores conduzidas em Portugal no contexto da reforma da atenção primária em saúde e nos países africanos de língua oficial portuguesa, em termos do planejamento e da gestão dos serviços hospitalares e de saúde pública. Descrevemos três programas de formação-ação realizados pela Unidade de Saúde Pública Internacional do Instituto de Higiene e Medicina Tropical de Lisboa, com o apoio de parceiros portugueses e internacionais como a Organização Mundial da Saúde e o Instituto de Medicina Social da Universidade do Estado do Rio de Janeiro. Os programas foram desenvolvidos na base da identificação das necessidades de competências dos participantes e focaram a resolução de problemas concretos com o objetivo de ajudar os gestores a enfrentar as dificuldades inerentes aos processos de reforma. Apesar do seu valor intrínseco, por si só não se mostram suficientes, uma vez que são sempre necessários outros mecanismos, como o acompanhamento continuado dos gestores, sistemas de incentivos coerentes com os objetivos das reformas, ferramentas e recursos (financiamento, sistemas de informação, pessoal qualificado suficiente) adequados para implementar as mudanças. Além disso, a sustentabilidade das intervenções de fortalecimento das capacidades carece de apoio continuado dos decisores políticos.

Abstract We present lessons that have resulted from formation activities of managers conducted in Portugal in the context of primary health care reform and in the Portuguese-speaking African countries, regarding planning and management of hospital services. and public health. We describe three action-formation programs conducted by the International Public Health Unit of the Institute of Hygiene and Tropical Medicine-Lisbon, with the support of Portuguese and international partners such as the World Health Organization, and the Institute of Social Medicine of Universidade do Estado do Rio de Janeiro. The programs were developed on the basis of identifying participants' skills needs and focused on solving concrete problems in order to help managers address the difficulties inherent in reform processes. Despite their intrinsic value, they are not sufficient by themselves, as other mechanisms such as the continued monitoring of managers, incentive systems consistent with the objectives of reforms, tools and resources (funding, information systems, qualified staff) are always needed and sufficient to implement the changes. In addition, the sustainability of capacity-building interventions needs continued support from policy makers.

Resumen En ese artículo presentamos lecciones que resultaran de actividades de capacitación de los gestores conducidas en Portugal en el contexto de la reforma de la atención primaria en Salud y en los países africanos de lengua oficial portuguesa a nivel de planeamiento y de la gestión de los servicios hospitalarios y de salud pública. El artículo describe tres programas de formación-acción realizados por la Unidad de Salud Pública Internacional del Instituto de Higiene y Medicina Tropical, con el apoyo de socios portugueses e internacionales como la Organización Mundial de Salud, y el Instituto de Medicina Social, Universidad del Estado del Rio de Janeiro. Los programas se desarrollaron sobre la base de la identificación de las necesidades de competencias de los participantes y enfocaran en la resolución de problemas concretos con el objetivo de ayudar los gestores a enfrentar las dificultades inherentes a los procesos de reformas. A pesar de su valor intrínseco, no son suficientes por sí solas, ya que siempre son necesarios otros mecanismos, como el monitoreo continuo de los gestores, sistemas de incentivos coherentes con los objetivos de las reformas, herramientas y recursos (financiación, sistemas de información, personal cualificado suficiente) adecuados para implementar los cambios. Además, la sostenibilidad de las intervenciones de fortalecimiento de las capacidades carece de apoyo continuado de los responsables políticos.

Preventive healthcare-seeking behavior among poor older adults in Mexico: the impact of Seguro Popular, 2000-2012 / Comportamiento en cuidado preventivo de salud entre adultos pobres mayores en México: impacto del Seguro Popular, 2000-2012

Abstract: Objective: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. Materials and methods: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). Results: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. Conclusions: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.

Resumen: Objetivo: Determinar el efecto del Seguro Popular (SP) en la utilización de la atención preventiva entre beneficiarios de SP de bajos ingresos y ancianos sin seguro en México. Material y métodos: Estimación de pseudopanel de variables instrumentales de efectos fijos (FE-IV) en tres rondas de la Encuesta Nacional de Salud y Nutrición de México (2000, 2006 y 2012). Resultados: El SP no tiene un efecto significativo en el uso de los servicios preventivos, incluida la detección de diabetes, hipertensión, cáncer de mama y cáncer de cuello uterino en adultos de 50 años o más. Conclusiones: Aún existen desigualdades en el acceso a la asistencia médica en México. El gobierno mexicano debe seguir trabajando para extender la cobertura del seguro de salud a la población más vulnerable. Se necesitan esfuerzos adicionales para aumentar la cobertura de atención médica y apoyar la atención preventiva para reducir las disparidades persistentes.

Mágica ou magia? Colegiados gestores no Sistema Único de Saúde e mudanças nos modos de cuidar / ¿Mágica o magia? Colegiados gestores en el Sistema Brasileño de Salud y cambios en los modos de cuidar / Magic or enchantment? Management committees in the Brazilian National Health System and changes in healthcare modes

Em uma pesquisa sobre a produção do cuidado nas redes de saúde, avaliou-se o papel dos colegiados de gestão em uma experiência de mudança no governo da saúde. Com metodologia qualitativa de abordagem cartográfica, observou-se que a ativação dos colegiados pela gestão visava uma dupla tarefa: por um lado, a democracia institucional, e por outro, a criação de governabilidade para a mudança proposta. No entanto, predominavam nesses colegiados pautas restritas aos agires técnicos ou profissionais, além de uma certa tensão junto com vários atores da rede. Por outro lado, também houve encontros nos quais se vivenciou novos pactos intra e entre-equipes, mediante relações simétricas e de coautoria: um analisador aqui denominado magia a-significante. Conclui-se como possível que os colegiados gestores configurem-se como cenários para uma mudança, e para tanto propõe-se o seu engravidamento com ferramentas de educação permanente em Saúde.

En una investigación sobre la producción del cuidado en las redes de salud se evaluó el papel de los colegiados de gestión en una experiencia de cambio en el gobierno de la salud. Con metodología de abordaje cartográfico, se observó que la activación de los colegiados por la gestión tenía como objetivo una tarea doble: por un lado, la democracia institucional y, por el otro, crear gobernabilidad para el cambio propuesto. Sin embargo, predominaban en ellos las mismas pautas restringidas a las actuaciones técnicas o profesionales, además de una cierta tensión en relación a varios de los actores de la red. Por otro lado, también hubo encuentros en los cuales se experimentaron nuevos pactos intra y entre equipos, mediante relaciones simétricas y de coautor: Un analizador aquí denominado magia a-significante. Se concluye como posible que los colegiados gestores se configuren como escenarios para un cambio y para ello se propone que ellos contengan herramientas de Educación permanente en salud.

In a qualitative research about healthcare production in the health networks, the role of management committees in an experience of change in the government of health was evaluated. Using a cartographic approach, we found that the activation of the committees by the government aimed at a double task: to promote institutional democracy and to create governability for the proposed change. Nevertheless, the committees' agendas were predominantly restricted to technical or professional matters, and there was some tension involving several of the network actors. On the other hand, there were encounters in which intra- and inter-team pacts were experienced, through symmetrical and co-authorial relationships: an analyzer that we called "a-significant enchantment". We conclude that the management committees can configure themselves as scenarios for a change, and to that end, we propose to make them pregnant with Permanent Health Education tools.

Thoughts on the Construction of Humanistic Care System in Public Hospitals in Anhui Province / 中国医学伦理学

Humanistic care centered on the interests and needs of patients, is an important means to maintain the doctor-patient relationship and to build a harmonious society. However, there are still some problems in the major public hospitals, such as inadequate communication and coordination, complicated and time-consuming medical procedures, and so on. Based on this, this paper discussed the problems existing in public hospitals in Anhui Province, and put forward some measures, such as strengthening doctor-patient communication, caring for doctor-patient personnel, and constructing hospital culture, so as to perfect the humanistic care system.

Practical strategies for healthcare integration / 中华医院管理杂志

Integration is an inevitable trend for healthcare development. In order to bring support to the promotion of healthcare integration and the deepening of healthcare reform in China, we put forward the core strategies of healthcare integration from the point of technological service and non-technological service. We also clarified auxiliary strategies of healthcare integration from such aspects as organizational construction, resource integration, training, management adjustment, payment reform and information system building.

Analysis of social and policy factors affecting doctor-patient relationship / 中华医院管理杂志

This paper described the market reform′s influence and the healthcare reform on medical behaviors of both doctors and patients.It is held that the healthcare reform should ensure the public welfare nature of public hospitals and focus on medical quality and patient′s health,so as to promote the harmonious development of the doctor-patient relationship from the policy and practice aspect.

Colorectal Surgery Training in the Hong Kong Special Administrative Region and China

Until 1st July 1997, Hong Kong was under the governance of the British Government; therefore, the British system of education was followed. After internship, 7 years of general surgical training is required to obtain registration and fellowship qualifications of the College of Surgeon of Hong Kong and Edinburg. After having become a specialist in general surgery, the surgeon could choose to specialize in colorectal surgery with an additional 3 to 5 years of specialist training in an accredited centre and 6 months of overseas training with subsidies. On the contrary, China has more than 600 medical schools, and students can enroll in different programs to become a medical practitioner. Despite a great discrepancy exists in the quality of teaching and supervision but there are comprehensive regulations governing the accreditation of hospitals, credentialing of operations, medical records, etc. to ensure medical and patient safety. Vast amounts of resources are being invested to strengthen the quality and to advance the technology used in patient care, not only by supporting basic and clinical research but also by providing extra resources to “import” experts and help develop services with clinical excellence. To accomplish this, the aim of the “three fames project” with a 5-year funding of 3 million United States dollar is to invite overseas experts to help build medical teams in specific areas. Due to its huge population (more than 1.3 billion people), China is a country full of potential for development in clinical research, collaboration, knowledge exchange, and the provision of premier medical services.

Ethical Dilemmas and Countermeasures of China's Primary Medical System under the Background of New Healthcare Reform / 中国医学伦理学

Since the implementation of the new healthcare reform,it has achieved some success.However,many problems still exist in the process of primary medical reform,and there are many ethical dilemmas.The un-balanced allocation of medical resources reflects the relationship between government and market,the difficult pro-motion of " three medicine" reflects the sectoral conflicts of interest,the difficult implementation of the grading di-agnosis and treatment system reflects the different demands of stakeholders in health care system.As a result,the whole function of China's medical and health system has not been fully played.Based on the ethical perspective,this paper put forward that taking the scientific definition of government and market responsibility as a framework,it should construct an investment system of health resource allocation taking equity as a value orientation; taking ethi-cal responsibility as the framework,it should promote the cooperation consensus of the linkage reform of medical treatment,medical insurance and medical departments; and taking ethical community as the constraint,it should balance the interests of all parties and promote the implementation of the policy of grading treatment system.

A Reforma dos Cuidados de Saúde Primários em Portugal: portuguesa, moderna e inovadora / Primary Health Care Reform in Portugal: Portuguese, modern and innovative

Resumo A reforma de 2005 dos cuidados de saúde primários (CSP) portugueses foi uma das mais bem-sucedidas feitas nos serviços públicos do país. O acontecimento mais relevante foi a constituição das Unidades de Saúde Familiar (USF): equipes multidisciplinares voluntárias e auto-organizadas, que prestam cuidados médicos e de enfermagem personalizados a um conjunto de pessoas. Num segundo momento reorganizaram-se as restantes dimensões dos CSP com a criação dos Agrupamentos de Centros de Saúde (ACeS). Apostou-se na governação clínica procurando-se obter ganhos em saúde pela melhoria da qualidade e da participação e responsabilização de todos. Este artigo tem por objetivo caracterizar a reforma de 2005 dos CSP Portugueses com a análise das suas dimensões sistêmica e local. Trata-se de um estudo de caso de uma reforma na área dos CSP de um sistema de saúde com análise documental e descrição de uma de suas unidades. Esta reforma foi portuguesa, moderna e inovadora. Portuguesa ao não quebrar completamente com o passado, moderna porque se aliou à tecnologia e ao trabalho em rede, e inovadora porque ultrapassou o modelo hierarquizado tradicional. Cumpriu o objetivo de uma reforma: conseguiu melhorias com maior satisfação de todos e ganhos em saúde.

Abstract The 2005 Portuguese primary health care (CSP) reform was one of the most successful reforms of the country's public services. The most relevant event was the establishment of Family Health Units (USF): voluntary and self-organized multidisciplinary teams that provide customized medical and nursing care to a group of people. Then, the remaining realms of CSP were reorganized with the establishment of Health Center Clusters (ACeS). Clinical governance was implemented aiming at achieving health gains by improving quality and participation and accountability of all. This paper aims to characterize the 2005 reform of Portuguese CSP with an analysis of its systemic and local realms. This is a case study of a CSP reform of a health system with documentary analysis and description of one of its facilities. This reform was Portuguese, modern and innovative. Portuguese by not breaking completely with the past, modern because it has adhered to technology and networking, and innovative because it broke with the traditional hierarchized model. It fulfilled the goal of a reform: it achieved improvements with greater satisfaction of all and health gains.

Research on the medical service pricing policy in China′s ongoing healthcare reform / 中华医院管理杂志

Objective To analyze the medical service pricing policy of 30 provinces and autonomous regions in China and recommend on problems and challenges, for reference of medical service pricing reform in the future.Methods Literature review and policy analysis were used for summary and performance appraisal of medical service pricing of China.Results Most of the areas surveyed followed the step-by-step approach to gradually adjust pricing, while a few areas completed it in a one-time adjustment manner.2015 witnessed most areas, up to 20 (66.67%), in price adjustment;their price adjustments focused on price reduction of large-scale medical equipment inspection fees and some medical tests.On the other hand, prices of diagnosis, nursing care, and treatment which are labor-intensive were increased.Conclusions Specifications of medical services are improving, yet there exist great gaps in the convergence of medical insurance.It is advisable to expedite the convergence of the new version specifications, to achieve value regression and dynamic price adjustment of medical services.

Analyzing the Historical Development and Transition of the Korean Health Care System

OBJECTIVES: Many economically advanced countries have attempted to minimize public expenditures and pursue privatization based on the principles of neo-liberalism. However, Korea has moved contrary to this global trend. This study examines why and how the Korean health care system was formed, developed, and transformed into an integrated, single-insurer, National Health Insurance (NHI) system. METHODS: We describe the transition in the Korean health care system using an analytical framework that incorporates such critical variables as government economic development strategies and the relationships among social forces, state autonomy, and state power. This study focuses on how the relationships among social forces can change as a nation’s economic development or governing strategy changes in response to changes in international circumstances such as globalization. RESULTS: The corporatist Social Health Insurance (SHI) system (multiple insurers) introduced in 1977 was transformed into the single-insurer NHI in July 2000. These changes were influenced externally by globalization and internally by political democratization, keeping Korea’s private-dominant health care provision system unchanged over several decades. CONCLUSION: Major changes such as integration reform occurred, when high levels of state autonomy were ensured. The state’s power (its policy capability), based on health care infrastructures, acts to limit the direction of any change in the health care system because it is very difficult to build the infrastructure for a health care system in a short timeframe.

Behavioral logic of community health service institutions in the background of the new healthcare reform based on the grounded theory / 中国卫生政策研究

Community health service institutions are the basic tentacles of medical services which directly indicates their relation to the quality and experience of health service.This paper focuses on the behavioral logic of community health service institutions under the background of new medical reform, and looks forward to a perspective on the grassroots practice caused by the reform of medical system through the behavioral analysis of the community health service institutions.The behavioral logic features of the community health service institutions were constructed based on the interview data Nanjing City using the grounded theory.It was found that the realization of public welfare orientation of the aforesaid institutions needs to be completed under the internal and external coordination.The degree of coordination among the interests, orientation, incentives and resource elements will determine the behavior orientation and basic operational practices in the community health service institutions.This study will provide a reference value for the cognition and optimization of healthcare reform policies.

"Analysis on the management system and operation mechanism of Sanming's healthcare reform towards ""Tripartite-sector reform""" / 中华医院管理杂志

Centering on the reform practice in Sanming featuring a synergistic reform in public health services,medical insurance and medicine production-circulation (Tripartite-sector reform below),this paper focused on the top-level design of the management system in such a reform and its synergistic operation mechanism.The authors probed into the main reasons for its grounding-breaking success and challenges,to pave way for their discussions on the reproducibility and sustainability of the reform.

Study of the Establishment of Modern Hospital Management System Guided by Constitution / 中国医院管理

The establishment of modern hospital management system is the core of the reform of public hospitals.For hospitals,it is necessary to create a constitution and take this as the guide to build a scientific,efficient and systematic management system.Taking Peking Union Medical College Hospital as an example,the paper discusses the basic path,key points and basic principles to establish a modern hospital management system,to provide reference and enlightenment for the construction of modern hospital management system in China.

Further reform of the healthcare system in Zhejiang province：explorations and insights / 中华医院管理杂志

The paper covered the initial success of Zhejiang province in furthering its development of a basic healthcare system in alignment of social and economic growth. Such progress has been achieved by adhering to the principles of coordinated arrangement,highlighting key points and step-by-step progress. Also presented are the methods and experiences of the province in its reform and perspectives for furthering the ongoing reform.

Rethinking on the Doctor-patient-Relationship / 中国医学伦理学

Starting on the research findings from a study on cancer patients decision making,the author tried to further analyze the Doctor-Patient-Relationship in China from the historical perspective.Having the disease re-moved or treat the patient responsibly,represents different meaning and implication on how a society regards the medicine as profession,and how define the role of physicians.Considerations on these issues are hoped to facilitate the improvement of doctor-patient relationship in China.

Professional psychological quality education in the training of clinical medicine postgraduates / 中华医学教育探索杂志

In the context of the combination of education for clinical medicine graduates and standardized training of resident doctors,the professional psychological quality of clinical medical postgraduates is confronted with a test.The professional psychological quality education is not only related to the professional development of medical graduate studlents,but also to the realization of the goal of training talents in medical colleges,even to the people's life and health.Medical institutions and relevant teaching hospitals can,through strengthening the psychological education system,promote the occupation education,carry out rich and colorful educational activities,strengthen employment guidance,and improve the security policy to improve the medical personnel quality,and promote the comprehensive reform of the medical and health education.