Las brechas de género en las áreas de trabajo del sistema de salud argentino / Gender gaps in the work areas of the Argentine health system

Studies with a gender perspective focus on the way in which women and men relate to each other in different spheres, reflecting the distribution of power between them. This type of work division conditions the working life of women, who tend to dedicate fewer hours to paid work than men, affecting their labor income, as well as other non-monetary compensations. The objective of this study was to characterize the men and women employed in the health sector of Bahía Blanca, from a gender perspective. For this, the Permanent Household Survey of the Instituto Nacional de Estadística y Censos (INDEC, as per its initials in Spanish) was analyzed using a quantitative methodology. The main results indicate that, although the sector is composed of a majority of women, this proportion being even greater than in the rest of the country, with more education and work experience than their male counterparts, women face conditions of horizontal and vertical labor segregation. At the same time, differences are observed in the contracting conditions. The study of work from a gender perspective will contribute to the design of policies that propose gender equity, that is, the absence of systematic and unfair differences in the working conditions and opportunities between women and men. In particular, this information can be very useful for developing strategies that tend to improve the situation of women when health care management is decentralized to lower levels of government.

Los estudios con perspectiva de género se centran en la forma en que se relacionan mujeres y varones en distintos ámbitos, reflejando la distribución de poder entre ambos. La división del trabajo según el género condiciona las trayectorias laborales de las mujeres, quienes suelen destinar menos horas que los varones al trabajo remunerado, lo que repercute en su ingreso laboral, así como en otras compensaciones no monetarias. El objetivo de este trabajo fue caracterizar a las personas ocupadas del sector de salud del partido de Bahía Blanca, Argentina, desde una perspectiva de género. Para ello se analizó la Encuesta Permanente de Hogares del Instituto Nacional de Estadística y Censos (INDEC), utilizando una metodología cuantitativa. Los principales resultados señalan que, aun cuando el sector este compuesto por una mayoría de mujeres, incluso mayor que en el resto del país, con mayor educación y experiencia laboral que sus compañeros varones, estas enfrentan condiciones de segregación laboral horizontal y vertical, a la vez que se observan diferencias en las condiciones de contratación. El trabajo desde una mirada de género contribuirá al diseño de políticas que se propongan la equidad de género, es decir la ausencia de diferencias sistemáticas e injustas en las condiciones y las oportunidades de trabajo entre mujeres y varones. En particular, esta información puede resultar de gran utilidad para diseñar estrategias que tiendan a mejorar la situación de las mujeres cuando la gestión de la atención de salud se encuentra descentralizada a los niveles inferiores de gobierno.

Posicionamento Atitudinal, Percepção de Vulnerabilidade e Preocupação em contrair a COVID-19 / Attitudinal Positioning, Perception of Vulnerability and Concern on getting COVID-19 / Posicionamiento Actitudinal, percepción de vulnerabilidad y preocupación por contraer la COVID-19

Este programa de pesquisa objetivou testar um conjunto de hipóteses de modo a evidenciar como Posicionamentos Atitudinais e Políticos, Atitudes em face das Doenças, Traços de Personalidade e a Religiosidade de brasileiros relacionam-se com sua Percepção de Vulnerabilidade e Preocupação em contrair a COVID-19. Para tanto, realizaram-se dois estudos. No primeiro, identificou-se o Posicionamento Atitudinal de internautas em 2.000 comentários sobre um pronunciamento do Presidente do Brasil acerca do novo coronavírus e da COVID-19. Já o estudo 2 resultou na proposição de um modelo explicativo com bons índices de ajustes [x² = 67,72; g = 24; x²/gl = 2,6; CFI = 0,94; TLI = 0,9; RMSEA = 0,06 (IC90%: 0,04-0,08)], demonstrando que Posicionamentos Políticos, Atitudes em face das Doenças e Consienciosidade predizem a Percepção de Vulnerabilidade e a Preocupação em contrair a COVID-19. Em suma, tais achados podem subsidiar estudos futuros e modelos interventivos na dinâmica social para contenção da atual pandemia

This research program aimed to test a set of hypotheses in order to show how Attitudinal and Political Positions, Attitudes towards Diseases, Personality Traits and the religiosity of Brazilians are related to their perception of vulnerability and concern in contracting COVID-19. To do this, two studies were carried out. In the first, the Attitude Positioning of internet users was identified in 2.000 comments on a statement made by the President of Brazil about the new coronavirus and COVID-19. Study 2, on the other hand, resulted in the proposition of an explanatory model with good adjustment rates [x² = 67.72; g = 24; x²/gl = 2.6; CFI = 0.94; TLI = 0.9; RMSEA = 0.06 (CI90%: 0.04-0.08)], demonstrating that Political Positions, Attitudes towards Diseases and Conscientiousness predict the perception of vulnerability and the concern to get COVID-19. In short, such findings may support future studies and interventional models in social dynamics to contain the current pandemic

Esta investigación buscó probar un conjunto de hipótesis sobre cómo las posiciones actitudinales y políticas, las actitudes hacia las enfermedades, los rasgos de personalidad y la religiosidad de los brasileños están relacionadas con su percepción de vulnerabilidad y preocupación en contraer la COVID-19. Para esto, se realizaron dos estudios. En el primero, se identificó el posicionamiento actitudinal de los usuarios de Internet en 2.000 comentarios en una declaración del presidente de Brasil sobre el nuevo coronavirus y la COVID-19. El estudio 2, resultó en un modelo explicativo con buenas tasas de ajuste [x² = 67,72; g = 24; x²/gl = 2,6; CFI = 0,94; TLI = 0,9; RMSEA = 0,06], demostrando que las Posiciones políticas, las actitudes hacia las enfermedades y la conciencia predicen la percepción de vulnerabilidad y la preocupación en contraer la COVID-19. En resumen, tales hallazgos pueden respaldar futuros estudios y modelos de intervención en la dinámica social para contener esta pandemia

Contratualização de resultados: fragilidades na transparência e baixa accountability das organizações sociais / Contractualización de resultados: fragilidades en la transparencia y baja accountability de las organizaciones sociales / Results-based contracs: weaknesses in transparency and low accountability

Resumo Esta pesquisa analisou a transparência e a responsabilização na contratualização de resultados entre o Governo do Estado de São Paulo e as organizações sociais (OS) de cultura, com base nos julgamentos do Tribunal de Contas do Estado de São Paulo (TCE-SP). Adotou-se a perspectiva instrumental da transparência, para analisar os inputs e os outputs do processo de contratualização. Os resultados apontam fragilidades da transparência, especialmente nos aspectos de mensurabilidade e tempestividade da informação, afetando negativamente a responsabilização da OS e do governo estadual diante da população. Indica-se, também, a necessidade do governo aprimorar os mecanismos de controle interno na análise dos contratos.

Resumen Este trabajo analizó la transparencia y la responsabilización en la contractualización de resultados entre el gobierno del estado de São Paulo y las organizaciones sociales de cultura con base en los pareceres del Tribunal de Cuentas del Estado. Se adoptó la perspectiva instrumental de la transparencia, para analizar los inputs y outputs del proceso de contractualización. Los resultados señalan fragilidades en la transparencia, especialmente en los aspectos de mensurabilidad y de tesmpestividad de la información, lo que afecta negativamente la responsabilización de la organización social y del gobierno del estado en relación a la población. Se señala, también, la necesidad de que el gobierno mejore los mecanismos de control interno en el análisis de los contratos

Abstract This work analyzed the transparency and accountability in results-based contracts signed between the state government of São Paulo and legal private entities "Social Organizations" operating in the area of culture, examining the opinions of the State Court of Auditors. The instrumental perspective of transparency was adopted to analyze the inputs and outputs of the contracting process. The findings point to weaknesses in transparency, especially in the aspects of measurability and timeliness of information, negatively affecting the accountability of the Social Organization and the state government. the research points out the need for the government to improve the mechanisms of internal control in the analysis of results-based contracts.

Expanding healthcare coverage: An experience from Rashtriya Swasthya Bima Yojna

Background & objective: Given that Ayushman Bharat Yojna was launched in 2018 in India, analysis of Rashtriya Swasthya Bima Yojna (RSBY) become relevant. The objective of this study was to examine the scheme design and the incentive structure under RSBY. Methods: The study was conducted in the districts of Patiala and Yamunanagar in the States of Punjab and Haryana, respectively (2011-2013). The mixed method study involved review of key documents; 20 in-depth interviews of key stakeholders; 399 exit interviews of RSBY and non-RSBY beneficiaries in Patiala and 353 in Yamunanagar from 12 selected RSBY empanelled hospitals; and analysis of secondary databases from State nodal agencies and district medical officers. Results: Insurance companies had considerable implementation responsibilities which led to conflict of interest in enrolment and empanelment. Enrolment was 15 per cent in Patiala and 42 per cent in Yamunanagar. Empanelment of health facilities was 17 (15%) in Patiala and 37 (30%) in Yamunanagar. Private-empanelled facilities were geographically clustered in the urban parts of the sub-districts. Monitoring was weak and led to breach of contracts. RSBY beneficiaries incurred out-of-pocket (OOP) expenditures (?5748); however, it was lower than that for non-RSBY (?10667). The scheme had in-built incentives for Centre, State, insurance companies and health providers (both public and private). There were no incentives for health staff for additional RSBY activities. Interpretation & conclusions: RSBY has in-built incentives for all stakeholders. Some of the gaps identified in the scheme design pertained to poor enrolment practices, distribution of roles and responsibilities, fixed package rates, weak monitoring and supervision, and incurring OOP expenditure.

A direct comparison of the performance of public-private partnerships with that of traditional contracting / Una comparación directa del desempeño de una CPP con el modelo tradicional de contratación pública / Uma comparação direta do desempenho de uma PPP com o modelo tradicional de contratação pública

Abstract This paper assesses the city of Belo Horizonte's experience building school infrastructure through public-private partnerships (PPPs). Between 2009 and 2015, Belo Horizonte built very similar schools using both PPPs and traditional public contracting (TPC). As the choice of mode of contracting was unrelated to our outcomes of interest, the experience constitutes a quasi-experiment that allows for a simple and direct comparison of PPPs to TPC. We examine construction- and operation-phase outcomes measured using administrative data and a survey of school administrators. We find that schools constructed under the PPP contracting model outperformed those built using TPCs in most outcomes.

Resumen Este artículo evalúa la experiencia del municipio de Belo Horizonte en la construcción y operación de infraestructura escolar a través de una Colaboración Público-Privada (CPP). Entre 2009 y 2015, Belo Horizonte construyó escuelas similares usando tanto CPPs como el modelo tradicional de contratación pública (MTCP). Dado que la elección del modelo de contratación no tenía relación causal con los resultados evaluados, se puede afirmar que esa experiencia constituye un cuasi experimento que permite la comparación simple y directa de las CPPs con el MTCP. Evaluamos los principales resultados en las etapas de construcción y operación usando datos administrativos sumistrados por la alcaldía y con cuestionario aplicado a los directores de las escuelas. El artículo muestra que las escuelas construidas en el modelo de CPP tuvieron un desempeño mejor que las que usaron el MTCP.

Resumo Este artigo avalia a experiência do município de Belo Horizonte na construção e operação de infraestrutura escolar por meio de Parcerias Público-Privadas (PPPs). Entre 2009 e 2015, Belo Horizonte construiu escolas similares usando tanto PPPs como o modelo tradicional de contratação pública (MTCP). Dado que a escolha do modelo de contratação não tinha relação causal direta com os resultados avaliados, pode-se afirmar que essa experiência constitui um quasi experimento que permite a comparação simples e direta das PPPs com o MTCP. Avaliamos os principais resultados nas fases de construção e operação usando dados administrativos fornecidos pela prefeitura e com questionário aplicado aos diretores das escolas. O artigo mostra que as escolas construídas no modelo de PPP tiveram um desempenho melhor do que as que usaram o MTCP.

An evaluation study on family doctors′ income level and policy incentive effect in Changning / 中华医院管理杂志

Objective To evaluate the motivation effect of family doctors′ contracting service and health insurance compensation mechanism from the perspective of income change and income satisfaction of family doctors .Methods The situation about salary compensation plan reform and the change of income level and structure were learnt from interviews on the management personnel and questionnaire surveys of family doctors in 2013 and 2016 .The data were subject to descriptive statistics .Results The proportion of family doctors earning between 8000 and 10000 yuan in 2016 rose to 67.16％ (90/134 ) from 18.18％ (26/143 ) in 2013.11.72％ (15/128 ) of family doctors′contracting service fee amounted to over 50％ of their income. The number of family doctors who were dissatisfied with their income has fallen by 28.52％ .There were still 51.90％ (68/131)of the family doctors who were not satisfied with their income and 24.64％ (34/138)of them held the incentives of performance appraisal as a failure .Conclusions The income of family doctors has been greatly increased in the last three years.Contracting service fee plays a key role in motivating these doctors , but three risks also need to be prevented in the process of further reform .

Análise de desempenho de indicadores de contratualização em cuidados de saúde primários no período de 2009-2015 em Lisboa e Vale do Tejo, Portugal / Analysis of the performance of contractualization primary health care indicators in the period 2009-2015 in Lisbon and Tagus Valley

Resumo As reformas iniciadas em 1996 pretendiam que as Administrações Regionais de Saúde (ARS) viessem a ter um papel relevante no processo de transformação de um sistema de saúde de modelo integrado num outro de modelo contratual. O instrumento essencial desta transformação viria a ser a Agência de Contratualização, instituída em cada uma das ARS. O seu papel na nova cultura de contratualização era de proceder a negociação de orçamentos prospectivos com as instituições prestadoras de cuidados de saúde, onde se incluíam os Cuidados de Saúde Primários. Este artigo realiza uma análise longitudinal da evolução de um conjunto de 9 indicadores de contratualização de cuidados de saúde primários, em três Agrupamentos de Centros de Saúde (ACeS), da Administração Regional de Saúde de Lisboa e Vale do Tejo (ARSLVT). Verificamos que a fixação de metas, em sede de contratualização externa e a sua monitorização e acompanhamento são decisivos para que os profissionais de saúde definam trajetórias e objetivos de desempenho. Reconhecemos ainda, a necessidade de se reverem os indicadores de base, fazendo-os evoluir para indicadores de resultado.

Abstract Reforms started in 1996 intended that Regional Health Administrations (ARS) should play a relevant role in the process of transforming an integrated model towards a contractual health care model. The essential tool of this transformation would be the Contractualization Agency, established in each ARS. Its role in the new contractualization culture was to negotiate prospective budgets with health care institutions, which included Primary Health Care (PHC). This paper is a longitudinal analysis of the development of a set of nine PHC contractualization indicators in three Health Center Clusters (ACeS) of the Regional Health Administration of Lisbon and Tagus Valley (ARSLVT). We have noticed that the setting of goals, in terms of external contractualization and its monitoring and follow-up are decisive and help health professionals to define trajectories and performance goals. We also recognize the need to revise baseline indicators by developing them into outcome indicators.

Discussions on Commercial Insurance Agencies Undertaking Claiming Services for Basic Medical Insurances / 中国卫生经济

It started with the legitimacy of commercial insurance agencies undertaking claiming services for basic medical insurances.Experiences and warnings from the international world in this area were examined and causes behind it were scrutinized,under a context of the contracting-out of public services.The domestic picture was also drew and arguments were given.A three-step strategy was suggested for China's contracting-out of claiming services for basic medical insurances.

A Certificação de Entidades de Assistência Social na área da saúde: alterações normativas 2008-2016 / The Social Assistance Entities Certification in healthcare: legislative changes 2008-2016 / La Certificación de Entidades de Asistencia Social en Salud: cambios normativos 2008- 2016

A contratualização de estabelecimentos de saúde pelos gestores públicos é uma realidade em todo território nacional para complementar a rede pública na efetivação do direito constitucional à saúde. O presente artigo teve como escopo realizar levantamento das alterações legislativas ocorridas entre o período de 2008 a 2016 para concessão e renovação do Certificado de Entidades Beneficentes de Assistência Social na área da saúde-CEBAS-SAÚDE. O estudo tem natureza descritiva e analítica, a partir da pesquisa normativa. Dos nove atos normativos que tratam sobre o assunto, verificou-se modificações significativas quanto aos legitimados para obtenção do CEBAS-SAÚDE, à competência para certificar as entidades postulantes, ao prazo de validade e do pedido de renovação e as alternativas para não prestação de 60 % dos serviços de saúde ao Sistema Único de Saúde-SUS. Conclui-se que houve alterações favoráveis às entidades beneficentes da área da saúde, mas isso não significa necessariamente incremento à rede pública de saúde.

The hiring of healthcare companies by public managers is a reality throughout the country to complement the public health system net in the realization of the constitutional right to health. This article was scoped to carry out a survey of legislative changes between the period 2008 to 2016 for concession and renewal of the Social Welfare Charitable Entities Certificate in Health-CEBAS-SAÚDE. The study has descriptive and analytical nature, from the legislative research. From 9 legal acts that deal with the subject, there has been significant changes as to legitimized to obtain the CEBAS-SAÚDE, the competence to certify candidates entities, the expiration date and the renewal application and the alternatives for not providing 60 % of health services to the SUS Health System. It follows an amendment favorable to the charitable health organizations, but that does not necessarily mean increasing and improvement the public health system and must to be analysed and discussed.

La contratación de los servicios de salud por los administradores públicos es una realidad en todo el país para complementar el público en el ejercicio del derecho constitucional a la salud. Este artículo fue con ámbito para llevar a cabo un estudio de los cambios legislativos entre el período de 2008 a 2016 para la concesión y renovación del Certificado de Entidades de Bienestar Social en salud-CEBAS-SALUD. El estudio es la naturaleza descriptiva y analítica, de la investigación normativa. A partir de nueve actos normativos que tienen que ver con el tema, ha habido cambios significativos en cuanto a legitimado para obtener el CEBAS-SALUD, la competencia para certificar candidatos entidades, la fecha de vencimiento y la solicitud de renovación y las alternativas para no proporcionar 60 % de los servicios de salud a la Salud-Sistema SUS. De ello se desprende una modificación favorable para las organizaciones de salud de caridad, pero eso no significa necesariamente un incremento el aumento de la salud pública.

Novos modelos de gestão do trabalho no setor público de saúde e o trabalho do agente comunitário de saúde / New work management models in the public health sector andthe work of the community health agent / Nuevos modelos de gestión deltrabajo en el sector público de salud y eltrabajo del agente comunitario de salud

Este artigo discute a parceria do Estado com organizações sociais para a gestão do trabalho em saúde no setor público, com ênfase no trabalho do agente comunitário de saúde. Trata-se de um estudo de caso realizado no município do Rio de Janeiro numa conjuntura de expansão da cobertura da Estratégia Saúde da Família. O tema é analisado num contexto mais amplo de reforma do Estado brasileiro, partindo-se do entendimento de que o movimento reformista da administração pública, conhecido como gerencialismo, guarda estreita relação nas suas ações e valores com a reestruturação produtiva iniciada nos anos 1970. Os resultados mostram que o modelo de gestão do trabalho implantado opera sob a lógica da produtividade, influenciando o modelo de atenção à saúde prestado à população e a organização do trabalho do agente comunitário de saúde. A análise também destaca a temporalidade e a externalidade dos vínculos de trabalho como fatores que podem comprometer os avanços da democratização, equidade e cidadania no campo da saúde e do trabalho conquistados na Constituição brasileira de 1988.

This article discusses the partnership between the State and social organizations for the management of health work in the public sector, with emphasis on the work of the community health agent. This is a case study carried out in the municipality of Rio de Janeiro, Brazil, in an environment of expansions in the coverage of the Family Health Strategy. The topic is analyzed in a context of a broader reform of the Brazilian State, starting from the understanding that the public administration reform movement, known as managerialism, is closely related in their actions and values with the productive restructuring that got underway in the 1970s. The results show that the work management model that was deployed operates under the logic of productivity, influencing the model of the health care provided to the population and the organization of the work done by the community health agent. The analysis also highlights the temporality and externality of the work ties as factors that can compromise the progress of democratization, equity, and citizenship in the field of health and work ensured by the Brazilian Constitution of 1988.

Este artículo discute la asociación del Estado con organizaciones sociales para la gestión del trabajo en salud en el sector público, con énfasis en el trabajo del agente comunitario de salud. Se trata de un estudio de caso realizado en el municipio de Río de Janeiro, Brasil, en una coyuntura de expansión de la cobertura de la Estrategia Salud Familiar. El tema se analiza en un contexto más amplio de reforma del Estado brasileño, partiendo de la base de que el movimiento reformista de la administración pública, conocido como gerencialismo, guarda estrecha relación en sus acciones y valores con la restructuración productiva iniciada en los años 70. Los resultados muestran que el modelo de gestión del trabajo implantado opera bajo la lógica de la productividad, influyendo sobre el modelo de atención de la salud prestado a la población y la organización del trabajo del agente comunitario de salud. El análisis también destaca la temporalidad y la externalidad de los vínculos de trabajo como factores que pueden comprometer los avances de la democratización, equidad y ciudadanía en el campo de la salud y del trabajo conquistados en la Constitución brasileña de 1988.

Study on the application of EPC in management of hospital energy saving / 中国医学装备

Objective: Through the analysis of the current situation of energy consumption and the energy management problems that hospital faced, elaborat the high demands of energy management in hospital effective logistics management, the saving mechanism of Energy Performance Contracting (EPC) is proposed. Methods: The process of introducing EPC to China and related concepts are described, and the main mode and implementation processes as well. Results: To explore the feasibility of the integration in energy-saving reformation and the mode of energy runing management what is the core to EPC, tell people what need to pay attention to in the implementation process, and provide scientific methods for energy management of efficiency operation and sustainable development in hospital. Conclusion:At last, pointing out that saving mechanism of EPC is suitable for hospitals and will bring significant saving benefit.

Universal Health Care in India: Panacea for Whom.

This paper examines the current notion of universal health care (UHC) in key legal and policy documents and argues that the recommendations for UHC in these entail further abdication of the State’s responsibility in health care with the emphasis shifting from public provisioning of services to merely ensuring universal access to services. Acts of commission (recommendations for public private partnership [PPPs], defi nition and provision of an essential health package to vulnerable populations to ensure universal access to care) and omission (silence maintained on tertiary care) will eventually strengthen the private and corporate sector at the cost of the public health care services and access to care for the marginalized. Thus, the current UHC strategy uses equity as a tool for promoting the private sector in medical care rather than health for all.

Effect of responsibility contracting system on clinical teaching / 现代临床护理

Objective To investigate the effect of responsibility contracting system in clinical teaching.Methods One hundred and eighty eights probationers from August 2009 to July 2010 as controls were trained by functional nursing teaching. Another 192 probationers from August 2009 to July 2010 were assigned as the experiment group,and given clinical teaching by way of the Responsibility Contracting System.The teaching effects in the two groups were compared.Results The probationers in the experiment group had significant improvements in the ability to perform health education,manipulation of nursing skills,ability in observation skills,and nursing documents writing,compared to the control group(P<0?01).Conclusions The teaching mode of responsibility contracting system is effective in strengthening the responsibility of probationer nurses,attaching great importance to the implementation of basic nursing,improving students’ability in implementation of health education and performance of skill manipulation and nursing,and eventually improving the level and quality of nursing teaching?

A contratualização nos Hospitais de Ensino no Sistema Único de Saúde brasileiro / The contracting of teaching hospitals in the Brazilian Unified Health System

São discutidas as possibilidades e os limites da contratualização para a melhoria do desempenho, o incremento da prestação de contas, o aprimoramento da gestão, a melhoria da assistência e a maior inserção dos hospitais de ensino na rede de serviços no âmbito do Programa de Reestruturação dos Hospitais de Ensino no Sistema Único de Saúde/SUS. Quatro hospitais contratados e suas secretarias contratantes são entrevistados. Segundo os dirigentes de hospitais, é frágil a associação entre contratualização e a presença de mecanismos de inserção na rede, de práticas e estruturas de qualificação assistencial e gerencial nos hospitais. Hospitais mais estruturados assistencial e gerencialmente apresentaram uma contratualização mais estruturada com a secretaria. Houve um aumento de produção da média complexidade ambulatorial e uma diminuição dos procedimentos de atenção básica em todos os hospitais. Sugere-se o desenvolvimento gerencial contínuo do hospital e da secretaria, a revisão do plano operativo, orçamento, mecanismos de monitoramento e sistema de incentivos, pactuação com as equipes, dentre outros.

This study identifies the potential and limitations of contracting to improve health care management, accountability and quality, and expand the participation of teaching hospitals in the health service network in the context of the Restructuring Program of Teaching Hospitals in the Brazilian Unified Health System. It is a case study of four teaching hospitals and their contracting State Health Departments. According to the hospital managers, the association is weak between contracting and the presence of mechanisms for hospital insertion into the health service network with practices and structures for managerial and healthcare qualification in the hospital. More structured hospitals in managerial and healthcare terms were more structured between contracting and the State Health Department. There was an increase in production of medium complexity outpatient care and a decrease in primary healthcare procedures. The proposal is for ongoing managerial development of the hospital and of the State Health Department, review of the operational plan, budgeting, monitoring mechanisms and an incentive system, bonding in the teams, among others.

On the legal attributes of self-payment agreement regarding medical expenses / 中华医院管理杂志

In the macrocosmic perspective,the development trend of the rights and obligations of doctors and patients is regarded as changes in the healthcare mode.In the microcosmic perspective,it is regarded as a clarification and emphasis of the informed consent of the patients as required by laws and regulations.However,medical workers tend to neglect their obligation of informing the patients of the medical expenses to be paid out of their own pocket.In this consideration,informing the patients in writing of their self-payment in medical expenses is obligatory and important,i.e,the self-payment agreement is highly important in clinical work.This paper analyzed the legal at-tributes of self-payment agreement in the aspects of both the informed consent and the signing of the medical service contract,with discussions of the tining of signature,in the hope of inspiring and helping medical workers in their clinical practice.

Contratualização na saúde: proposta de um contrato único para os programas no Estado de Minas Gerais / Contracting in health: proposal of contrato único for programs in the State of Minas Gerais

O processo de contratualização na gestão pública nasce da perspectiva de que o Estado, por meio de instrumentos contratuais, repassa às entidades não-estatais a execução de determinados serviços. No entanto, o Estado permanece como responsável pelas políticas públicas, exercendo o papel de financiador, indutor e regulador, para que os serviços sejam prestados adequadamente,com qualidade e eficiência. Visando prestar assistência à população, a Secretaria de Estado de Saúde de Minas Gerais (SES/MG) caracteriza-se como grande compradora de serviços e ações de saúde, fazendo uso de uma variedade excessiva de instrumentos contratuais, sem padronização, para a formalização dessas transações. Nesse contexto, viu-se a necessidade de reformular os contratos dos programas estaduais, como adotar instrumento jurídico único que centralize a formalização do conteúdo. O objetivo deste trabalho foi apresentar o Contrato Único como uma proposta de inovação e qualidade na gestão pública, visando desenvolver no Sistema Único de Saúde em Minas Gerais (SUS/MG) a cultura de resultados. Essa mudança da lógica contratual torna o processo mais objetivo, organizado e transparente, propiciando uma gestão mais eficiente e que efetiva uma relação de parceria. O modelo proposto contribuirá para o aprimoramento da gestão dos contratos assistenciais no Estado de Minas Gerais, além de viabilizar a existência de um processo de acompanhamento e avaliação, até então não-efetivo nos processos de contratação da SES/MG.

The contracting process in public management derives from the perspective that the State, bycontractual arrangements, passes to non-state entities the implementation of certain services. However, the State remains responsible for the public policies, playing the role of financier, regulator and inductor, so the services are rendered with proper quality and efficiency. Aiming to assistthe population, the Secretaria de Estado de Saúde of Minas Gerais (SES/MG) is characterized as a large buyer of health services and actions, using a variety of contractual arrangements, withoutstandardization, for the transactional formalization. In this context, it is necessary to restructure thecontracts of the State programs, with the adoption of a single legal instrument, which centralizes the formalization of the content. The aim of this paper was to present Contrato Único as a proposal for innovation and quality in public administration, in order to develop results-oriented culture inthe National Health System of Minas Gerais (SUS/MG). This change in contractual logic makes the process more objective, organized and transparent, and provides a more efficient management which effects a partnership. The proposed model will contribute to the improvement of assistance contract management in Minas Gerais and will provide the existence of a monitoring and evaluationprocess which is not effective yet in SES/MG hiring procedures.

Relaciones contractuales entre las instituciones prestadoras y aseguradoras de servicios de salud del municipio de Medellín, Colombia, 2005-2006 / Contractual relationships between Health Insurance Companies and hospitals, Medellín, Colombia, 2005-2006

Objetivo: caracterizar las relaciones entre las instituciones prestadoras y las aseguradoras alrededor de los procesos de contratación. Metodología: se realizó un estudio cualitativo, en el cual se entrevistaron 29 funcionarios de diferentes instituciones aseguradoras y prestadoras de servicios de salud de la ciudad de Medellín. Para las entrevistas se utilizó una guía de entrevista semiestructurada. El análisis de la información se realizó siguiendo los criterios de codificación y categorización propuestos por Huberman y Miles, y de él surgieron dos categorías analíticas y una interpretativa. Resultados: los hallazgos muestran que las Instituciones Prestadoras de Servicios han realizado transformaciones administrativas para mejorar y mantenerse en el mercado; se visualiza una posición dominante de las aseguradoras, expresada en la imposición de tarifas y condiciones para la contratación de servicios de salud, así mismo hay factores políticos que condicionan los procesos contractuales. Conclusiones: hay un desequilibrio de poder entre los actores, que se expresa en la contratación, en la cual las aseguradoras dominan el proceso, en detrimento de los otros actores como las instituciones prestadoras de servicios y los usuarios.

Objective: to characterize the relationships between Insurance Companies and hospitals within the contracting out process. Methodology: an exploratory study was conducted, involving twenty-nine officials from several health institutions located in Medellín city. The recollection of the information was made through semiestructural interviews based on a guide. The analysis of information was made following the coding criteria proposed by Huberman and Miles. It was developed in three steps, through which descriptive, analytic and interpretative categories emerged. Results: findings suggest that hospitals have carried out administrative transformations in order to improve and maintain within a market environment. The health insurance companies achieve a dominant position between the actors of the health system, which is expressed through out the contracting out process, with imposition of tariffs and conditions to the contracts. Conclusions: there is unbalance in power of actors, within which, the health insurers dominate the contracting out process, which generate conflicts between actors.

Possibilidades e limites da contratualização para o aprimoramento da gestão e da assistência em hospitais: o caso dos Hospitais de Ensino no Sistema Único de Saúde brasileiro / Possibilities and limits of contracting for the improvement of management and assistance in hospitals: the case of Teaching Hospitals Health System in Brazil

O objetivo geral do estudo foi identificar possibilidades e limites da contratualização para a melhoria do desempenho, o incremento da prestação de contas, o aprimoramento da gestão, a melhoria da assistência e a maior inserção dos hospitais de ensino na rede de serviços de saúde, no âmbito do Programa de Reestruturação dos Hospitais de Ensino do Ministério da Educação no Sistema Único de Saúde/SUS, fornecendo ainda contribuições para o aperfeiçoamento dos processos de contratualização dos hospitais de ensino no país, assim como para outras práticas de contratualização de serviços de saúde. Como objetivos específicos enumeraram-se: (1) identificar mecanismos indutores de inserção do hospital na rede e sua relação com a contratualização; (2) identificar a presença de estruturas e práticas qualificadoras da assistência e da gestão no hospital e sua relação com a contratualização; (3) identificar alterações na produção de atividades e de alguns indicadores de desempenho no hospital e sua relação com a contratualização; (4) caracterizar o processo de contratualização entre secretarias e hospitais considerando as recomendações do Programa de Reestruturação dos Hospitais de Ensino do Ministério da Educação no Sistema Único de Saúde/SUS; e (5) identificar os aspectos facilitadores, as dificuldades, os benefícios e finalmente sistematizar as proposições de ajustes à contratualização. Caracterizou-se como um estudo de caso de quatro hospitais de ensino e respectivas secretarias contratantes, pré-identificados como experiências de contratualização maisou menos estruturadas...

The overall objective of the study was to identify possibilities and limitationsof the contracting to improve performance, increase accountability, improve management, improve care and expand the insertion of teaching hospitals in the network of health services within the Teaching Hospitals Restructuring Program of the Ministry of Education in the Single Health System / SUS (Sistema Único de Saúde), providing contributions to the improvement of contracting procedures of teaching hospitals in the country, as well as other contracting practices of health services. The specific objectives are enumerated: (1) identify mechanisms that induce the insertion of the hospital in the network and its relationship with contracting, (2)identify the presence of structures and practices that qualify care and management in the hospital and its relationship with contracting, (3) identify changes in the production of activities and of some indicators of hospital performance and itsrelationship with the contracting, (4) characterize the process of contracting between departments and hospitals considering the recommendations of the Teaching Hospitals Restructuring Program of the Ministry of Education in the Single Health System / SUS, and (5) identify the facilitator aspects, the difficulties, the benefits, and finally to systematize the proposals for adjustments to contracting. It was characterized as a case study of four teaching hospitals and their respective contracting departments, pre-identified as more or less structured experiences of contracting. Eleven leaders of hospitals and secretariat as well as aleader of the Ministry of Health were interviewed...

Endoperoxides and Thromboxane A2 in Porcine Coronary Arteries with Regenerated Endothelium

BACKGROUND: Endothelin-1 is a potent vasoconstrictor substance that causes slow and longlasting contractions of isolated blood vessels. In the aorta of the spontaneously hypertensive rat, endothelin-1 stimulates the release of a cyclooxygenase-dependent, endothelium-derived contracting factor(EDCF), presumably thromboxane A2. There have not been any studies about the response of porcine coronary arteries with regenerated endothelium to endothelin-1. METHODS: The present study was designed to determine the role of EDCF in the response to endothelin-1 in arteries with regenerated endothelium. Rings of porcine coronary arteries, with and without endothelium of previously deendothelialized left anterior descending coronary artery and native left circumflex coronary arteries, were suspended in conventional organ chambers for the measurement of isometric force. RESULTS: In quiescent rings of the previously deendothelialized left anterior descending coronary artery treatd with the nitric oxide synthase inhibitor nitro-Larginine, endothelin-1 caused contractions which were larger in the rings with edothelium than in those without endothelium. Under the same experimental conditions, in the left circumflex coronary artery, the contractions to edothelin-1 were significantly greater by the removal of the endothelium. In rings with endothelium of the previously deendothelialized left anterior descending coronary artery, indomethactin(inhibitor of cyclooxygenase) and ridogrel(thromboxane A2 receptor antagonist, and inhibitor of thromboxane synthase) shifted the concentration-response curve to endothelin-1 to the right and to a comparable extent. Dazoxiben(inhibitor of thromboxane syndthase) and BQ-123(selective antagonist of endothelin-A receptor subtype) inhibited, to the same extent as indomethacin and ridogrel, the response to higher concentrations of endothelin-1. The endothelium-dependent component of the response to lower concentrations of endothelin-1 was inhibited by indomethacin and ridogrel, but not by dazoxiben and BQ-123. In rings without endothelium of both previously deendothelialized left anterior descending and native left circumflex coronary arteries, indomethacin and ridogrel did not affect the contractions to endothelin-1. CONCLUSION: These findings suggest that in regenerated endothelium, high concentrations of endothelin-1 stimulate the release of thromboxane A2 through activation of edothelin-A receptors. Endoperoxides generated by activation of endothelial cyclooxygenase may be the endothelium-derived contracting factor(s) released in regenerated endothelium by lower concentrations of the peptide.

Pharmacodynamic study on Chanfuan Oral Solution / 中成药

AIM: To study the pharmacodynamic effect of Chanfuan Oral Solution. METHODS: Acute blood stagnation caused by adrenaline, ankle swelling, ear edema and writhing caused by acetic acid were taken for experiment models. RESULTS: Chanfuan Oral Solution could significantly reduce blood viscosity. Results also showed that it had inhibitory effect on rat's ankle swelling, ear edema and reduction in ratio of writhing of mice. CONCLUSION: These results suggest Chanfuan Oral Solution is an effective drug for reducing blood viscosity, anti inflammation and analgesia.