Assessment of public hospital drug supply financing through the public-private partnership: pharmacists' perspectives

In Nigeria, drug financing by the public has been challenged by financial constraints through public fund due to a limited fund available to the government to meet all its demands. The objectives of this study were to determine the variability of the hospital patient prices of same drugs under the PublicPrivate Partnership (PPP) and in Private Retail Community Pharmacy (PRCP), and to investigate the perceived efficiency and effectiveness of the PPP by comparing it with the Drug Revolving Fund (DRF) model in drug supply financing. This study was conducted in Nigeria utilizing a mixed method. Mann-Whitney U test analysis was used to compare the median drug price of the two facilities. The majority (76.19%) of the drugs were sold at a cheaper rate in the hospital than what was obtained in the PRCP with no significance difference (p > 0.05). Dominant responses from the focused group discussions supported the PPP model. This study shows that the median patient price of the basket of matched pairs of same drugs in the hospital under the PPP and in the PRCP was identical. Overall, the participants were of the opinion that the PPP model was more efficient and effective than DRFin the financing drug supply

Sistema de salud de Cuba / The health system of Cuba

En este trabajo se describen las condiciones de salud de Cuba y el sistema cubano de salud, incluyendo su estructura y cobertura, sus fuentes de financiamiento, su gasto en salud, los recursos físicos, materiales y humanos de los que dispone, y las actividades de rectoría e investigación que desarrolla. También se discute la importancia de sus instituciones de investigación y se describe el papel de los usuarios de los servicios en la operación y evaluación del sistema, así como las actividades que en este sentido desarrollan la Federación de Mujeres Cubanas y los Comités de Defensa de la Revolución. La parte final de este trabajo se dedica a discutir las innovaciones más recientes dentro de las que destacan las redes de cardiología, la Misión Milagro y la Batalla de Ideas.

This paper describes the health conditions in Cuba and the general characteristics of the Cuban health system, including its structure and coverage, its financial sources, its health expenditure, its physical, material and human resources, and its stewardship functions. It also discusses the increasing importance of its research institutions and the role played by its users in the operation and evaluation of the system. Salient among the social actors involved in the health sector are the Cuban Women Federation and the Committees for the Defense of the Revolution. The paper concludes with the discussion of the most recent innovations implemented in the Cuban health system, including the cardiology networks, the Miracle Mission (Misión Milagro) and the Battle of Ideas (Batalla de Ideas).

Financiamiento público de la investigación en salud en cinco países de América Latina / Public financing of health research in five Latin American countries

OBJETIVOS: Describir los subsistemas públicos de los Sistemas Nacionales de Investigación en Salud (SNIS) en cinco países de América Latina (Argentina, Bolivia, Chile, Paraguay y Uruguay), con énfasis en los tipos de arreglos institucionales que se observan en cada país para promover, desarrollar y sostener sus SNIS, así como en los mecanismos explícitos o implícitos de priorización de proyectos de investigación en salud. MÉTODOS: Se identificó a los organismos responsables de manejar los recursos públicos destinados a financiar proyectos de investigación en salud en los cinco países estudiados. Luego se analizaron los tipos de proyectos que fueron financiados -utilizando una matriz por área y objeto de estudio-, ciertas características de los investigadores principales y los montos asignados entre 2002 y 2006. RESULTADOS: Solamente los países con mayores recursos o con redes de investigadores más desarrolladas poseen estructuras formales de asignación de fondos, con convocatorias periódicas y reglas estables, y ninguno cuenta con mecanismos explícitos e integrales de priorización para la investigación en salud. A su vez, las prioridades de investigación en salud presentan diferencias importantes entre países. En este sentido, es notorio que ciertos problemas, como "nutrición y medio ambiente" o "violencia y accidentes", reciban escasa atención en la mayoría de los países, al igual que varios temas de salud pública en algunos otros. Contrariamente, la investigación referida a "ciencias básicas" absorbe hasta un tercio de los recursos totales para investigación. CONCLUSIONES: Surgen numerosos interrogantes acerca de la capacidad de estos países para adaptar y generar nuevos conocimientos, y de la casi inexistente investigación sobre condicionantes sociales, económicos y culturales o sobre servicios y sistemas de salud, de alto impacto en grupos con acceso limitado al cuidado de la salud. Es necesario establecer explícitamente las prioridades en la agenda de investigación en salud, en consenso con las partes interesadas, así como incorporar mecanismos de monitoreo y seguimiento por temas y áreas de estudio del financiamiento de la investigación en este campo.

OBJECTIVES: Describe the public subsystems of the national health research systems (SNIS) in five Latin American countries (Argentina, Bolivia, Chile, Paraguay, and Uruguay), emphasizing the types of institutional arrangements in place in each country to promote, develop, and sustain their SNIS, as well as explicit or implicit mechanisms for prioritizing health research projects. METHODS: The bodies responsible for managing the public resources allocated to finance health research projects in the five countries studied were identified. The types of projects financed were then analyzed-using a matrix constructed by area and object of study-, certain characteristics of the principal investigators, and the sums allocated between 2002 and 2006. RESULTS: Only the countries with greater resources or better developed networks of investigators have formal structures for allocating funds with regular calls for proposals and fixed rules. None of them has explicit comprehensive mechanisms for prioritizing health research. Moreover, the health research priorities in the countries vary widely. In this regard, it is significant that problems such as "nutrition and the environment" or "violence and accidents" receive little attention in most countries. The same holds true for a number of public health issues in some countries. In contrast, the research in the "hard sciences" absorbs up to one-third of the total resources for research. CONCLUSIONS: Many questions arise about the ability of these countries to adapt and generate new knowledge, as well as the nearly nonexistent research on social, economic, and cultural determinants, or on health services and systems that have a high impact on groups with limited access to health care. Explicit priorities should be set with stakeholders for the health research agenda, and mechanisms should be adopted for monitoring and following up health research financing by subject and area of study.

El financiamiento público de la investigación en salud en Chile / Public financing of health research in Chile

Background: In Chile, researchers can apply to public research funds through specific research projects and must compete with other professionals of other disciplines. Aim: To perform a critical assessment of the allocation of public funds for health research in Chile by a public institution called CONICYT. Material and Methods: A database was constructed with health projects financed by CONICYT, between 2002 and 2006. Projects were classified (according to their titles) in three methodological categories and nine topics. Age, gender and region where the main researcher is based, were also recorded. Results: 768 research projects were analyzed. Biomedical, clinical and public health research projects accounted for 66, 24 and 10 percent of allocated funds, respectively. Main researchers were female in 31 percent of projects, their mean age was 52 years and 76 percent worked in the Metropolitan region. Conclusions: These results show that some objectives of the National Research System lead by CONICYT, such as using research as a tool for regional development and allocating funds for conditions with a large burden, are not been met.

Transfronteirização e financiamento dos serviços de saúde: umareflexão a partir de Foz do Iguaçu-PR / Partnership between cities of different countries and health care funding: a reflection based on Foz do Iguaçu city

A fronteira é uma área fragilizada; o trânsito livre de pessoas na região faz com que ela seja altamente vigiada, tanto para a segurança quanto o contrabando e tráfico. Essa facilidade de acesso no transito entre os países, traz um número de pessoas que fazem um trajeto longo, muitas vezes com risco de vida eminente, em busca de assistência médica, inexistente no seu país de origem. O pagamento dessa fatura é de responsabilidade do país que realizou o atendimento, assim como a estatística. Os gestores estaduais e municipais tentam contornar essa situação da melhor maneira possível, sem causar perdas financeiras no seu orçamento. A partir da experiência internacional de parcerias entre cidades de fronteira (transfronteirização),esta dissertação tem como eixo principal analisar o caso do município de Foz do Iguaçu, onde a problemática da política brasileira de saúde nas fronteiras se revela em sua potência máxima. O trabalho apresenta a situação do financiamento da saúde na fronteira oeste do Estado do Paraná, propondo um termo de cooperação na assistência e no financiamento.

The frontier is a fragile area. Free traffic of people in this frontier region makes it highly monitored as to safety and as to restrain smuggling and drugs trafficking. Facility of access within coutries, brings in a great number of people who travel a long way, many times, facing great eminent death hazard, in search of medical care that does not exist in their home country. When they are assisted, payment is due to the country responsible for health care Managers try to overcome this situation and avoid financial losses. Inspired by Europeanexperience of partnerships between neighbor towns of different countries, this thesis analyzes the situation in Foz do Iguaçu city, where the problem of Brazilian health politics in the frontier is revealed at its maximum. The work presents the health financing situation in the West frontier of Parana State, proposing a cooperation term for health care and health financing, which would allow treatment for this population by Brazilian health system, providing adequate financial and other increased resources to the municipalities.

O modelo de intervenção do Ministério da Saúde brasileiro nos anos 90 / The Brazilian Ministry of Health policy model in the 1990s

O artigo analisa o modelo de atuação do Ministério da Saúde de 1990 a 2002, a partir de uma pesquisa que compreendeu: realização de entrevistas com atores envolvidos com a política nacional de saúde, análise documental, orçamentária e de bancos de dados oficiais. Observou-se que o Ministério da Saúde passou por mudanças expressivas, influenciadas tanto pela agenda da reforma sanitária quanto pela agenda liberal de reforma do Estado, hegemônica nos anos 90 e, moldadas por dois movimentos: a unificação nacional do comando sobre a política e a descentralização político-administrativa. Houve uma retração da prestação federal direta de serviços e mudanças no financiamento e na regulação. No final do período, configura-se um modelo caracterizado por forte indução federal sobre Estados e municípios e pela adoção de estratégias de regulação de mercados. A baixa integração com outras políticas, a fragilidade de planejamento em longo prazo e as lacunas no financiamento expressam a ausência de um projeto positivo para o Ministério da Saúde e favorecem distorções no modelo de intervenção federal que prejudicam o enfrentamento dos problemas estruturais do sistema de saúde brasileiro.

This paper analyzes the policy model of the Brazilian Ministry of Health from 1990 to 2002. The methodology included interviews with key actors in the national health policy, document review, and analysis of the Federal budget and official databases. The Brazilian Ministry of Health underwent major changes under the influence of the health reform agenda and the liberal State reform agenda prevailing in the 1990s, shaped by two movements: institutional unification of national policy control and political/administrative decentralization. The Federal role was diminished in terms of direct services provision, and there were changes in financing and regulation. The model in the late 1990s featured strong Federal induction of States and municipalities and the adoption of market regulation strategies. There is no record of a long-term planning effort, which favors distortions in the Federal intervention model and hinders solutions to structural problems in the Brazilian health system.

Assessment of scientific programs: a necessary procedure for Brazilian scientific policy - the Young Investigator Program of the State of São Paulo Research Foundation

Programs of Science and Technology research have grown significantly in Brazil over the last decades. Until the 1980s the so-called undirected programs, without specific goals and requiring only scientific merit, prevailed. The few programs with defined goals in this period were never objectively assessed. The same situation occurred in developed countries. In the early 1990s, the assessment of programs supported by public funding became mandatory in US and some European countries. In Brazil, program assessment has so far not been implemented yet. The Fundação de Amparo à Pesquisa no Estado de São Paulo (FAPESP) (Brazilian funding agency) Young Investigator (YI) Program is in its eleventh year, with approximately eight hundred projects awarded. Although it is free-demand based as concerns areas of knowledge, it has specific goals : (1) conceding grants to YI in view of the balance between funding, merit and real needs so as to enable satisfactory working conditions in the short term, (2) providing priority for institutions with a less extensive background in research, (3) granting a special fellowship to YI with no employment connection and (4) introduction of new research fronts in centers with a sound research background. This assessment provided evidence for the achievement of first three goals. The fourth one is still pending on additional data requiring survey assessment. Actions in this direction are recommended.

Programas de Ciência e Tecnologia cresceram significativamente no Brasil nas últimas décadas. Até a década de 80 os assim chamados programas não dirigidos, sem metas específicas e requerendo apenas mérito científico prevaleciam. Os poucos programas com metas definidas neste período não foram jamais objetivamente avaliados. A mesma situação ocorria nos países desenvolvidos. No início da década de 90, a avaliação de programas dependentes de recursos públicos tornou-se mandatória nos Estados Unidos e em alguns países europeus. No Brasil a avaliação de programas não foi até agora implementada. O programa de Jovem Pesquisador (JP) da FAPESP está em seu décimo primeiro ano, com a concessão de aproximadamente 800 projetos. Embora não seja dirigido em termos de áreas específicas de conhecimento, ele tem metas específicas: (1) conceder auxílios a JP tendo em vista um balanço entre fundos, mérito e reais necessidades para permitir condições satisfatórias de trabalho dentro de um curto período, (2) conceder prioridade à instituições menos consolidadas em pesquisa, (3) conceder bolsa especial a JP sem vínculo empregatício à instituição e (4) introduzir novas frentes de pesquisa em centros cientificamente bem consolidados. A presente avaliação forneceu evidências de que as três primeiras metas foram alcançadas.A quarta está ainda pendente de dados adicionais que requerem avaliação por enquete. São sugeridas ações nesta direção.

Deceased-donor kidney transplantation in Iran: trends, barriers and opportunities.

Having enjoyed considerable success in kidney transplantation in recent years, Iran has been named the most active country in the Middle East Society for Organ Transplantation region in providing equitable quick, and intermediary-free access to affordable kidney transplantation for everyone regardless of gender and economic circumstances. We are, however, of the opinion that the Iranian model can benefit further from improving deceased-donor kidney transplantation, especially after a fatwa (Islamic edict) in the early 1980s lifted many religious and legal barriers. Deceased-donor kidney transplantation in Iran should be bolstered by establishing a transplantation model, increasing government funds, and encouraging participation of the general public in the Iranian Network for Transplant Organ Procurement. We recommend that an intensive media campaign be launched to heighten public awareness and more transplantation centres be involved in cadaveric transplantation with streamlined systems of cadaveric donations registration so as to facilitate the process of finding and relating the donors with potential recipients.

Renúncia de arrecadação fiscal: subsídios para discussão e formulação de uma política pública / Tax expenditures on health care: contributions toward a public policy agenda

Este trabalho pretende investigar diversos aspectos relacionados aos incentivos governamentais que permitem o abatimento de parte dos gastos das famílias e empresas com assistência à saúde no imposto de renda. Como tais incentivos são deduzidos da renda tributável das pessoas físicas e do lucro tributável das pessoas jurídicas, a arrecadação fiscal do Estado é forçosamente reduzida. Segundo estimativa da Secretaria da Receita Federal, o valor desta renúncia, considerando as despesas com planos de saúde e os desembolsos diretos com assistência médico-hospitalar, girou em torno de R$ 2,8 bilhões em 2005. Em um quadro de subfinanciamento crônico do SUS, esta problemática será discutida à luz da eqüidade do financiamento e dos conflitos de interesse evidenciados no setor saúde.

The work discusses the tax incentives with private medical expenses to families and workers in Brazil. The estimate presented by the Federal Fiscal Authority is R$ 2,8 billions in 2005. Initially, a review of concepts about the matter is performed that stressed the lack of consensus in the academic community, about the meaning of tax expenditures. It discussed, also, the relations between this fiscal policy and demand to private health insurance. After, the article presents the results of a documental research concerning political positions of relevant Brazilian social actors found in the 2000's. The discussion pointed to problems of equity and conflicts of interests that are involved with the changes in the rules that discipline these incentives.

Uma análise da progressividade do financiamento do Sistema Unico de Saúde (SUS) / Analysis of the progressivity of Brazilian Unified National Health System (SUS) financing

Este artigo analisa o grau de progressividade dos tributos que financiam o Sistema Unico de Saúde (SUS). Nele são identificados os principais tributos que financiam o SUS e, com base nos microdados da Pesquisa de Orçamentos Familiares 2002-2003, é inferida a distribuição do ônus do pagamento dos tributos diretos e indiretos que financiam o SUS e analisado o grau de progressividade dos mesmos. Foi, ainda, calculado o índice de Kakwani do financiamento do SUS, que sintetiza o grau de progressividade de um sistema tributário. Os dados mostraram que o índice de Kakwani do financiamento público é de ­0,008 e que, portanto, o financiamento do SUS corresponde a um sistema quase proporcional, que onera proporcionalmente à renda. Em uma sociedade com o grau de desigualdade da brasileira, que exibe um índice de Gini de 0,57, ter um financiamento do SUS proporcional é fortemente questionável sob a ótica da justiça social: ao contrário, seria desejável construir bases de financiamento do SUS francamente progressivas, de forma a contra-restar a fortíssima concentração de renda da nossa sociedade.

Una buena Idea que perdura / A Good lasting Idea

El presente artículo da cuenta de la existencia de entidades públicas manejadas con criterio gerencial y que aparte de la rentabilidad económica también piensan en cumplir con uno de los fines principales del Estado, cual es garantizar a la comunidad las condiciones básicas para su bienestar. Aunque nuestra cotidianidad está plagada de ejemplos negativos quiebras, malos manejos, fraudes y otra clase de actitudes poco sanas dentro de la administración pública, también hay casos como el que se expone en estas páginas que dan cuenta de instituciones que no sólo sobreviven sino que crecen y expanden sus servicios. Éste es el caso del Instituto para el Desarrollo de Antioquia, que ha prevalecido durante cuarenta y un años, haciendo frente a la realidad del país, enfrentado desafíos desde su creación misma, sin ser ajena a los ataques de intereses particulares, y que aún así continúa prestando un invaluable apoyo a las administraciones locales y a las regiones del Departamento y el País. Este escrito destaca un positivo ejemplo de lo que hoy parece una utopía, trabajar pensando en el desarrollo de la comunidad, sin permanecer bajo condiciones precarias o afrontando un alto déficit fiscal. En tiempos en los que el pensamiento Neoliberal descarga cualquier tipo de intervención del Estado, nos encontramos con una empresa a través de la cual se puede pensar que la administración pública puede verdadera y decididamente ayudar a la solución de las necesidades básicas de la ciudadanía.

A Comparison of Smoking Control Strategies in Korea and the United States / 간호학회지

The purpose of this study was to compare smoking control strategies between Korea and the United States. Korea and other developing countries may learn from the experience of the United States in dealing with the growing epidemic of cigarettes. In particular, smoking control objectives, structures, laws and regulations, funds, programs and activities, research, and surveillance systems were compared. The comparison was conducted at the federal, states/provincial, and county levels of the two countries. The data were collected through various governmental websites, contact with people directly, and a literature review. Based on the comparison, seven recommendations for smoking control strategies were made primarily for Korea.

Organization of the Saudi health system

Using existing data, we reviewed the organizational structure of the Saudi Arabian health system: its demography and history, principal health indicators, organization and management, type and distribution of facilities, financial base, and the impact on it of the Haj. We noted duplication of services, inadequate coordination between some health industry sectors, and the need for a more extensive and rational health centre network with improved information systems and data collection. We also noted scope for a greater role for the private health sector and increased cooperation between it and the public sector to improve health service delivery and population health

Health for all in the Libyan Arab Jamahiriya

The Libyan Arab Jamahiriya is committed to the goal of health for all through primary health care. This review outlines the evolution of health services, and looks at the achievements, analyses current challenges and predicts future prospects for health for all in the country

La cooperación externa en el sector salud en 1994 y perspectivas para 1995 / External cooperation on the health sector

Documento que resume los principales logros alcanzados con le apoyo de los proyectos de cooperación externa durante el año 1994, los que se clasifican de acuerdo a la procedencia de los fondos: Bilaterales, Multilaterales, Financieros y Líneas de Crédito. Los avances financieros en la ejecución de los proyectos se plasman en tablas que expresan montos programados y los porcentajes de ejecución alcanzados de acuerdo a los informes recibidos por los Organidmos de Cooperación. También se hace énfasis sobre las alternativas de cooperación externa para 1995.