Comparison of PhilHealth case rate and actual charge of hospitalization for common in-patient surgical procedures from 2017-2019 in a level 3 Hospital

Objective@#To compare PhilHealth case rate versus actual charge of hospitalization of common general surgery procedures in a Level 3 government hospital from 2017-2019.@*Methods@#The five most common procedures were determined and records were reviewed. Hospital bills and professional fees (PF) were compared to the PhilHealth rates using t-test. The range of perceived acceptable PF was determined by an online survey.@*Results@#The most common procedures were open appendectomy, open cholecystectomy, initial repair of inguinal hernia, total thyroidectomy and modified radical mastectomy. The study included 1934 charts. For service cases, the hospital bill for appendectomy was significantly lower than the PhilHealth institutional fee, while the rest were significantly higher. For private cases, hospital bills for open cholecystectomy and modified radical mastectomy were significantly higher, while that of open appendectomy was lower. The average PF of private patients in all procedures were significantly higher than the PhilHealth rate, also reflected on the survey.@*Conclusion@#The significant discrepancies between the actual charges and the PhilHealth case rates showed that the PhilHealth rates were insufficient for the five most common general surgery procedures in a Level 3 government hospital.

Overview of global healthcare policies for patients with chronic kidney disease: an integrative literature review

ABSTRACT Introduction Chronic kidney disease is a progressive and irreversible loss of kidney function and considerably affects the lives of patients and their families. Its high incidence necessitates efficient public policies for prevention and treatment. However, policies for chronic kidney disease education and awareness are scarce. Objective To evaluate global public policies for the prevention and treatment of chronic kidney disease adopted in various regions, aiming to comprehend the differences between various models. Methods This integrative review followed PRISMA recommendations and included papers published between 2016 and 2021 across several databases. Results The 44 selected articles were categorized into three themes: structural and financial aspects of the organization of renal healthcare, access to renal healthcare or management of chronic kidney disease, and coping strategies for chronic kidney disease or kidney health. Critical analysis of the papers revealed global neglect of kidney disease in political agendas. Considerable policy variations exist between different countries and regions of the same country. Our research highlighted that free and universal health coverage, especially for the most vulnerable patients, is crucial for accessing treatment owing to the prohibitively high treatment costs. Conclusion Social, economic, and ethnic inequalities strongly correlate with disease occurrence, primarily affecting minority groups who lack health support, especially for the prevention and treatment of chronic kidney disease.

Incidents in the context of pre-hospital care by ambulances: contributions to patient safety / Incidentes en el contexto de la atención prehospitalaria por ambulancias: contribuciones a la seguridad del paciente / Incidentes no contexto da assistência pré-hospitalar por ambulâncias: contribuições para a segurança do paciente

ABSTRACT Objectives: to analyze the occurrence of incidents in the context of mobile terrestrial pre-hospital care. Methods: a descriptive research was carried out through the observation of 239 treatments performed by 22 healthcare professionals at the Mobile Emergency Care Service, located in Baixada Fluminense, Rio de Janeiro, Brazil. Fisher's exact test and chi-square test were used for data analysis. Results: the total time dedicated to patient care was 439.5 hours, during which 2386 security incidents were observed. The most notable ones were related to written communication (235), patient identification through bracelets (238), and safety in medication preparation (81). Conclusions: the need to promote and implement initiatives aimed at patient safety is evident, with special focus on international safety goals within the scope of mobile pre-hospital care services.

RESUMEN Objetivos: analizar la ocurrencia de incidentes en el contexto de la atención prehospitalaria móvil terrestre. Métodos: se realizó una investigación descriptiva a través de la observación de 239 atenciones realizadas por 22 profesionales de la salud en el Servicio de Atención Móvil de Urgencia, ubicado en la Baixada Fluminense, Río de Janeiro, Brasil. Para el análisis de los datos, se emplearon la prueba exacta de Fisher y la prueba de chi-cuadrado. Resultados: el tiempo total dedicado a la atención al paciente fue de 439,5 horas, durante las cuales se observaron 2386 incidentes de seguridad. Los más destacados fueron relacionados con la comunicación escrita (235), la identificación del paciente a través de pulseras (238) y la seguridad en la preparación de medicamentos (81). Conclusiones: se evidencia la necesidad de promover e implementar iniciativas que apunten a la seguridad del paciente, con un enfoque especial en las metas internacionales de seguridad, en el ámbito de los servicios de atención prehospitalaria móvil.

RESUMO Objetivos: analisar a ocorrência de incidentes no contexto do atendimento pré-hospitalar móvel terrestre. Métodos: realizou-se uma pesquisa descritiva através da observação de 239 atendimentos efetuados por 22 profissionais de saúde no Serviço de Atendimento Móvel de Urgência (SAMU), situado na Baixada Fluminense, Rio de Janeiro, Brasil. Para a análise dos dados, empregaram-se o teste exato de Fisher e o teste qui-quadrado. Resultados: o tempo total dedicado ao atendimento ao paciente foi de 439,5 horas, durante o qual se observaram 2386 incidentes de segurança. Os mais notáveis foram relativos à comunicação escrita (235), identificação do paciente através de pulseiras (238) e à segurança na preparação de medicamentos (81). Conclusões: evidencia-se a necessidade de promover e implementar iniciativas que visem a segurança do paciente, com foco especial nas metas internacionais de segurança, no âmbito dos serviços de atendimento pré-hospitalar móvel.

Percurso formativo e necessidades de aprendizagem de trabalhadores de um serviço de atendimento móvel de urgência / Training path and learning needs of workers of a mobile emergency care service

INTRODUÇÃO: No Brasil, a formação de recursos humanos para o Sistema Único de Saúde (SUS) tem avançado na última década com a disseminação da Política Nacional de Educação Permanente em Saúde (PNEPS). Neste contexto, está inserido o Serviço de Atendimento Móvel de Urgência (SAMU), tendo em vista que a qualificação de suas ações depende de uma equipe que aprimora suas competências técnicas baseada nas evidências da literatura e consciente de suas responsabilidades ético-sociais. Um dos desafios da gestão do SAMU é a implantação de um processo de trabalho que possa integrar no seu cotidiano atividades de educação, que favoreçam as mudanças da prática profissional que se fizerem necessárias frente aos problemas identificados. Atividades que deverão ser construídas por meio do diálogo democrático entre os profissionais, gestores e usuários a partir de problemas identificados, bem como de necessidades de aprendizagem da equipe. OBJETIVO: Analisar o percurso formativo de trabalhadores de um Serviço de Atendimento Móvel de Urgência e suas percepções sobre as necessidades de aprendizagem para qualificação do seu processo de trabalho na unidade. MÉTODO: Trata-se de uma pesquisa descritiva de caráter qualitativo realizada com trabalhadores de saúde do Serviço de Atendimento Móvel de Urgência de um município do interior do Estado de São Paulo à luz da Política Nacional de Educação Permanente em Saúde e o referencial teórico-metodológico de Paulo Freire; a coleta de dados foi realizada a partir de encontros dialógicos on-line com 20 trabalhadores do local pesquisado (4 técnicos de enfermagem, 4 enfermeiros, 4 médicos, 3 técnicos auxiliares de regulação médica [TARM] e 3 condutores), que foram transcritos e analisados segundo a temática dos conteúdos identificados. RESULTADOS: Participaram deste estudo: seis (37,5%) técnicos em enfermagem, quatro (80%) enfermeiros, quatro (21,05%) médicos, três (13,04%) condutores e três (13,63%) TARM. No mapa temático construído as principais categorias dos assuntos trazidos pelos participantes foram as seguintes: a formação dos trabalhadores e a necessidade do conhecimento teórico-prático no Atendimento Pré-Hospitalar (APH); a necessidade de atualização do conhecimento teórico-prático e a compreensão da Educação Permanente em Saúde no APH; a internet enquanto ferramenta na busca de informações atualizadas e a necessidade do diálogo na construção coletiva do conhecimento; a necessidade de atualização do conhecimento técnico-científico na pandemia e a conscientização sobre a importância das normas regulamentadoras; a percepção do processo de trabalho e a necessidade de compreensão do trabalho de equipe. CONSIDERAÇÕES FINAIS: Os profissionais do SAMU enfrentam grandes dificuldades com os processos formativos. Apesar da heterogeneidade da formação inicial e os cursos que foram desenvolvidos, as iniciativas foram interrompidas ou suprimidas e, atualmente, ocorrem de forma assistemática e pontual. Constata-se também que há a necessidade de aprimorar as estratégias de aprendizado para essa população e que os Núcleos de Educação Permanente, fundamentados pelos círculos de cultura, podem contribuir para favorecer tal prática. Além disso, a pandemia da COVID-19 dificultou ainda mais o trabalho desses profissionais

BACKGROUND: In Brazil, the training of human resources for the Unified Health System (SUS) has advanced, in the last decade, with the dissemination of the National Policy for Permanent Education in Health (PNEPS). The Mobile Emergency Care Service (SAMU) is inserted in this context, considering that the qualification of its actions depends on a team that improves its technical competencies based on the evidence of the literature and awareness of its ethical-social responsibilities. One of the challenges of SAMU management is the implementation of a work process that could integrate into their daily lives educational activities, which could favor the changes in professional practice that are necessary to face the problems identified. These activities should be built from the democratic dialogue between professionals, managers and users based on identified problems, as well as on the learning needs of the team. OBJECTIVE: To analyze the training path of workers of a mobile emergency care service and their perceptions about the learning needs for qualification of their work process in the unit. METHOD: This is a descriptive research study of qualitative nature carried out with health workers of mobile emergency care service of a municipality in the Northeast region of the state of São Paulo in the light of the National Policy of Permanent Education in Health and the theoretical-methodological framework of Paulo Freire; data collection was performed through online meetings with 20 workers from the researched site (4 nursing technicians, 4 nurses, 4 physicians, 3 auxiliary technicians of medical regulation [TARM], and 3 drivers), meetings were transcribed and analyzed according to the theme. RESULTS: In the research context, according to professional categories, participated in this study: six (37.5%) nursing technicians, four (80%) nurses, four (21.05%) physicians, three (13.04%) drivers, and three (13.63%) TARMs. As a result, a thematic map was obtained containing the main categories of the themes brought by participants; training of workers and the need for theoretical and practical knowledge in Pre-Hospital Care (PHC); need to update theoretical and practical knowledge and understanding of Permanent Education in Health in PHC; internet as a tool in the search for updated information and the need for dialogue in the collective construction of knowledge; need to update technical-scientific knowledge in the pandemic and raise awareness of the importance of regulatory standards; perception of the work process and the need to understand teamwork. CONCLUSION: Through this research, it is possible to observe that SAMU professionals face great difficulties with the educational processes, it also points out that, despite the heterogeneity of initial training and the courses that were developed, the initiatives were interrupted or suppressed, and they currently occur in an unsystematic and punctual way. It is also noticed that there is a need to improve the forms of learning strategies for this population, and that the Permanent Education Centers based on cultural circles contribute to favor this practice. In addition, the COVID-19 pandemic has made the work of these professionals even more difficult

Evaluación de disponibilidad y preparación de servicios de salud en el primer nivel de atención de cinco regiones sanitarias del Paraguay durante el 2022

Paraguay definió como prioridad lograr acceso y cobertura universal basado en Atención Primaria de Salud, incorporando a las Unidades de Salud de la Familia (USF) en las comunidades. El objetivo del estudio fue proporcionar métricas para gestionar mejoras en la red asistencial nacional analizando el grado de preparación del primer nivel de atención para proveer servicios de salud integrales. El diseño fue no experimental, cuantitativo, transversal, descriptivo con componente analítico. Incluyó a 216 establecimientos de las Regiones Sanitarias de Concepción, Amambay, Caaguazú, Canindeyú e Itapúa que representaban el 88% del total de USF de estas regiones. Se adaptó el método de evaluación SARA de la OMS con 82 indicadores trazadores, aplicando un cuestionario en línea dirigido a profesionales de salud en julio de 2022. El índice de preparación se midió de 0 a 1 y resultó que el 66,2% de las USF eran rurales y 33,8% urbanas. La mediana de preparación general fue 0,655 mientras que la mediana de la capacidad de diagnóstico fue 0,500, de disponibilidad de medicamentos esenciales 0,625, de infraestructura 0,650, de capacidad para prevenir infecciones 0,667 y de disponibilidad de equipamiento básico 0,833. Sólo el 13,89% tuvo una preparación suficiente, 75,0% intermedia y 11,11% baja. Hubo menor desempeño en las áreas rurales y el 31,02% carecía de personal completo según la norma. Se concluyó que las USF presentaron limitaciones para proveer servicios de salud integrales a las comunidades y que se requiere mejorar el desempeño con base en evaluaciones y ajustes periódicos.

Paraguay defined as a priority to achieve universal access and coverage based on Primary Health Care, incorporating the Family Health Units (FHU) in the communities. The objective of the study was to provide metrics to manage improvements in the national healthcare network by analyzing the degree of preparation of the first level of care to provide comprehensive health services. The design was non-experimental, quantitative, cross-sectional, descriptive with an analytical component. It included 216 establishments from the Sanitary Regions of Concepción, Amambay, Caaguazú, Canindeyú and Itapúa that represented 88% of the total FHU of these regions. The WHO SARA evaluation method was adapted with 82 tracer indicators, applying an online questionnaire addressed to health professionals in July 2022. The preparedness index was measured from 0 to 1 and it turned out that 66.2% of the FHU were rural and 33.8% urban. The overall readiness median was 0.655 while the median diagnostic power was 0.500, the availability of essential medicines 0.625, the infrastructure 0.650, the capacity of preventing infections 0.667 and the availability of basic equipment 0.833. Only 13.89% had sufficient preparation, 75.0% intermediate and 11.11% low. There was lower performance in rural areas and 31.02% lacked full staff according to the standard. It was concluded that the FHU presented limitations to provide comprehensive health services to the communities and that it is necessary to improve performance based on periodic evaluations and adjustments.

Estudios mamográficos en un centro metropolitano de referencia en imágenes mamarias: Chile 2008-2018 ¿Vamos por el camino correcto? / Analysis of mammograms performed in a public imaging center in Santiago, Metropolitan Region Chile 2008-2018

BACKGROUND: Mammograms are one of the most effective preventive means for the early detection of breast cancer. OBJECTIVE: To describe the features of patients and results of mammograms performed at a public breast imaging service of the Santiago Metropolitan Area. MATERIAL AND METHODS: We reviewed the reports of mammograms performed on 174,017 women and 18 men, between 2008 and 2018 in an Imaging Center. The BI-RADS classification was used in the reports. RESULTS: Forty-six percent of mammograms (75,781) were reported as BI-RADS 2. The high proportion of BI-RADS 4 reports (674 reports) was seen in patients aged 40 to 49 years, corresponding to 30% of reports in this age range. Among patients aged 50 to 59 years, there were 779 BI-RADS 4 reports (35%). BI-RADS 5 reports were more common among patients aged 50 to 59 years (50 reports, 30%) and among patients aged 70 years or older (83 reports, 28%). CONCLUSIONS: The presence of a significant number of women between 40 and 49 years of age with a BI-RADS 4 mammography result stands out; being an opportunity to develop new clinical research and public health strategies within the framework of the Universal Health Care policy for breast cancer in Chile.

Continuidade do cuidado a partir do hospital: interdisciplinaridade e dispositivos para integralidade na rede de atenção à saúde / Continuity of care from the hospital: interdisciplinarity and devices for integrality in health care networks

RESUMO O objetivo deste estudo foi analisar a produção científica sobre a continuidade do cuidado e a integralidade da atenção, identificando dispositivos utilizados para essa construção a partir do hospital. A presente investigação é uma revisão integrativa realizada nos meses de junho e julho de 2021. Assim, para a seleção dos artigos, utilizou-se das bases de dados PubMed/Medline, Lilacs, BDENF e Lis. Foram analisados 36 artigos. Da análise, emergiram três categorias: Cuidado em saúde e integralidade dentro do hospital; O enlace e as conexões na continuidade do cuidado; Redes de atenção à saúde no Sistema Único de Saúde e a continuidade do cuidado. A análise permitiu identificar estratégias/ferramentas sobre a organização do trabalho na dimensão micropolítica da produção do cuidado em saúde. Os principais dispositivos encontrados foram: alta segura, corridas de leitos, gestão da clínica, discussão de casos, linhas de cuidado, enfermeira de enlace, complexos reguladores, educação permanente e multidisciplinaridade. Concluiu-se que, embora alguns estudos se refiram a uma prática na rede de atenção à saúde ainda fragmentada, os dispositivos mencionados constituem-se em avanços em direção a um modelo de atenção baseado em linhas de cuidado dentro do hospital e para fora, buscando articulação com a rede de atenção à saúde.

ABSTRACT The aim of this study is to analyze the scientific production on the continuity and comprehensiveness of care, identifying devices used for this construction starting from the hospital. This research is an integrative review carried out in June and July 2021. Thus, PubMed/Medline, Lilacs, BDENF, and Lis databases were used for the selection of articles. Thirty-six articles were analyzed. Three categories emerged from the analysis: Health care and comprehensiveness within the hospital; The linkage and connections in the continuity of care; Health care networks in the Unified Health System and continuity of care. The analysis allowed identifying strategies/tools on the organization of work in the micropolitical dimension of health care production. The main devices found were: safe discharge, bed races, clinic management, case discussion, care lines, liaison nurses, regulatory complexes, continuing education, and multidisciplinarity. It was concluded that, although some studies are related to a practice in the still fragmented health care network, the mentioned devices constitute advances towards a model of care based on lines of care within and outside the hospital seeking articulation with the health care network.

A call for an evidence-informed criteria selection to guide equitable health investments in the era of Universal Health Care: Policy analysis

Background@#The passage of the Universal Health Care (UHC) Act in the Philippines in early 2019 intensified the need to ensure equitable health investments by the government. Exploring the different criteria and indicators that are used to determine areas that are most in need of health services can help local and national health authorities determine priorities for health investments given finite resources. @*Methods@#A systematic review of literature on determinants of health equity and other indicators was conducted as pre-work to generate discussion points to the roundtable discussion participated by all major key stakeholders. Shared insights and expertise were thematically analyzed to produce a policy paper with consensus policy recommendations. @*Results@#Based on the review of the literature and the discussion, indicators (mainly physical inaccessibility and socioeconomic factors) for identifying Geographically Isolated and Disadvantaged Areas (GIDA) in DOH Administrative Order 185, s. 2004 is used to prioritize municipalities for health investments. Review of other policies and guidelines to determine the level of health needs and prioritizing investments yielded to four laddered domains: geographic, population characteristics (e.g., social and cultural determinants of access), health system (e.g., health service delivery), and health status. These domains may provide a more equitable set of metrics for health investment. The Local Investment Plan for Health (LIPH) is the current process used for health-related investments at the local level and may be revised to be more responsive to the requirements set by the UHC Act 2018. Hot spotting to concentrate health services by communities may be a more rapid approach to investment planning for health. Bed capacity as a specific metric in the UHC Act 2018 highlights the need for a review of the Hospital Licensure Act 2004. @*Conclusion and Recommendations@#To aid in determining priorities for health investments, a comprehensive integrated analysis of resources, determinants, and indicators should be done to determine the need and the gaps in the available resources. Innovative strategies can also be best implemented such as mathematical models or formulas. Lastly, current strategies in the development, monitoring, and evaluation of investment planning for health at different levels should be strengthened, expanded, and harmonized with other existing development plans.

Perceptions of Spanish nurses on economic crisis and the impacts on health care system / Percepciones de enfermeras españolas acerca de la crisis económica y sus impactos en el sistema sanitario / Percepções de enfermeiras espanholas sobre a crise econômica e os impactos no sistema de saúde

ABSTRACT Objective: to analyze the perceptions of Spanish nurses regarding the country's economic crisis situation, and its impacts on nursing work, health system and population's health. Methods: qualitative approach, with data collection using an internet-based questionnaire and individual in-depth interviews. Data were analyzed according to Thematic-Categorical Content Analysis, supported by Historical and Dialectical Materialism perspective. Results: the categories produced discuss themes as: cutbacks in health care and the consequences of workforce non-replacement and work overload; salary impact; care model changes; negative impacts on population health. The impact on population health and work was discussed, especially regarding vulnerable groups, as well as in assistance model reconfiguration, reinforcing the biomedical and assistance perspective.

RESUMEN Objetivo: analizar las percepciones de las enfermeras españolas en cuanto a la coyuntura de crisis económica vivenciada por el país y sus impactos en el trabajo, en el sistema de salud y en la salud de la población. Métodos: enfoque cualitativo, con recolección de datos por medio de un cuestionario publicado en Internet y a partir de entrevistas individuales en profundidad. Los datos fueron analizados con base en el Análisis de Contenido Temático-Categorial, con suporte teórico del Materialismo Histórico y Dialético. Resultados: las categorías discuten temas como: los cortes financieros y sus impactos de no-reposición de la fuerza de trabajo, sobrecarga de trabajo, impacto salarial y en las plazas de trabajo; énfasis en un modelo asistencial biomedico; impactos negativos en la salud de la población. Se discutieron los impactos en el trabajo y la salud de la población, sobre todo en los grupos vulnerables, así como en la reconfiguración del modelo asistencial, reforzando la perspectiva biomédica y asistencial. Consideraciones finales: la perspectiva de la enfermería española apunta hacia el agravamiento de las políticas liberales y su expresión en la salud, y para el papel de la enfermería en los sistemas universales de salud.

RESUMO Objetivo: analisar as perceções de enfermeiras espanholas quanto à conjuntura de crise econômica e seus impactos no trabalho, no sistema de saúde e na saúde da população. Método: abordagem qualitativa; coleta de dados por questionário publicado na internet e em entrevistas individuais. Análise com base na Análise de Conteúdo Temático-Categorial, apoiada pela perspectiva teórica do materialismo histórico-dialético. Resultados: as categorias produzidas abordam temas como: cortes financeiros e seus impactos de não reposição da força de trabalho, sobrecarga de trabalho, impacto salarial e na oferta de emprego; ênfase em um modelo de saúde biomédico; impactos negativos na saúde da população. Discussão: destacam-se impactos no trabalho e na saúde, sobretudo nos grupos vulneráveis, assim como sobre o modelo assistencial reforçando a perspectiva biomédica. Considerações finais: as percepções da enfermagem espanhola apontam para o acirramento das políticas liberais e sua expressão na saúde e para o papel da enfermagem nos sistemas de saúde.

Formación y perfeccionamiento de recursos humanos en el sistema de salud cubano para cobertura sanitaria universal / Formation and improvement of human resources in the Cuban health care system aimed at universal health coverage

Las acciones desarrolladas para la formación y perfeccionamiento de los recursos humanos parten del control del Ministerio de Salud Pública que establece una interrelación de trabajo entre las universidades, los servicios de salud y la comunidad, que posibilita mayor integración docente, asistencial, investigativa y gerencial entre los diferentes actores del proceso docente-atencional-investigativo. El presente artículo pretende propiciar el intercambio entre profesionales sobre la experiencia cubana, la importancia de la integración y de que el sistema de salud forme sus propios recursos humanos para garantizar cobertura sanitaria universal sin descuidar la solidaridad y cooperación internacional entre los pueblos. Se hace un análisis teórico de los modelos prestador de servicios y educativo en ciencias de la salud con argumentos basados en indicadores sanitarios y en resultados de investigaciones. Se crearon espacios comunes de acción, a partir del diálogo, la concertación y la negociación entre todos los actores, lo que tuvo como fin la consolidación del proceso de producción social de salud. Entre las estrategias principales destaca la atención primaria de salud, la formación y superación de todos los profesionales, técnicos y demás trabajadores, sobre la base de la identificación de las necesidades de aprendizaje; así como la organización de un sistema de control integral que se desarrolla a través de inspecciones y supervisiones, y se basa en evaluaciones externas, donde la universidad médica juega un papel decisivo. También para Cuba, la solidaridad y cooperación internacional en servicios de salud y docencia médica entre los pueblos es un deber(AU)

The actions in the formation and improvement of the human resources stem from the regulation of the Ministry of Public Health that establishes work interrelations among the university, the health services and the community leading to greater teaching, assistance, research and management integration among the various actors involved in the teaching-assistance-research process. This article was aimed at encouraging exchanges of opinions among health professionals about the Cuban experience, the importance of integration and the formation of human resources by the health care system in order to assure universal health coverage without neglecting international solidarity and cooperation with other peoples. A historical analysis was made of the service provision and educational models in health sciences by using arguments based on health indicators and research outcomes. Common spaces for action were created on the basis of the dialogue, the agreement and the negotiation among all the actors, all of which was aimed at consolidating the process of social production of health. Some of the main strategies are primary health care, formation and upgrading of health professionals and technicians and other groups of workers on account of their learning requirements as well as the organization of a comprehensive control system through supervisions and inspections and third-party evaluations where the medical university plays a decisive role. For Cuba, solidarity and international cooperation in health services and medical education among the nations is a must(AU)

The application of social impact bonds to universal health-care initiatives in South-East Asia.

Social impact bonds (SIBs) have the potential to improve the efficiency of government health-care spending in South-East Asia. In a SIB, governments sign a pay-for-performance contract with one or several providers of health-care services, and the providers borrow up-front capital from investors. Governments outside South-East Asia have started to experiment with SIBs in criminal justice, homelessness and health care. Governments of South-East Asia can advance the goal of universal health care by using SIBs to improve the efficiency of healthcare service providers and by motivating providers to expand coverage. This paper describes SIBs and their potential application to health-care initiatives in the Region.

Review and Recommendations on Employee Medical Insurance System under Universal Health Care Perspective / 中国卫生经济

Through viewing the employee medical insurance system, problems were found as below: ( 1) The content of system did not match the name of “urban workers” and “basic medical insurance”. (2) In financing system, some business units and participated people had heavy burden; personal accounts shunt exceed 60% of the total health insurance fund and constituted a reverse subsidy;retirees did not assume the obligation of payment while they could obtain unjust enrichment through the personal accounts of the possible. (3) System inefficient and risky fund cost overruns. (4) Insurance coverage is low within the system. Recommendations: (1) To build a unified national basic medical insurance based on merger residents and new rural cooperative medical insurance. (2) Abolish workers’ medical insurance system, put urban workers into the universal basic medical insurance. ( 3) Introduce “medical expenses surtax”, establish supplementary medical aid fund or direct universal basic medical insurance fund. ( 4) To develop commercial health insurance and build a comprehensive health care system.

Universal Health Care: The Changing International Discourse.

Nearly 34 years ago, in 1978 in the face of a looming crisis in the health of the world’s populations and rising health inequality, 134 countries came together to sign the historic Alma Ata Declaration where the idea of primary health care as the chosen path to “Health for All” was formulated. However even before the declaration and more so since, countries have diverse interpretations of Universalism, each setting it in the context of its own health care model. These have ranged from the minimalist to the more comprehensive welfare state. Today, as health statistics reveal, the crisis has deepened, not only in the developing world but also in the developed world. It is important to debate the nature of the crisis and understand current policy initiatives and their ideological legitimations. The paper attempts to trace, clarify and account for the shifts in international discourse on universal health care (UHC). It argues that the idea of UHC is still with us, but there have occurred substantial shifts in discourse and meaning, shaped by changing international and national contexts and social forces impinging on health systems. The current concept of universal health coverage has only a notional allusion to universality of Alma Ata and disregards its fundamental principles. It concludes that the shifts are detrimental and its value in promoting health for all is likely to be severely limited.

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.

Strengthening of primary health care: Key to deliver inclusive health care.

Inequity and poverty are the root causes of ill health. Access to quality health services on an affordable and equitable basis in many parts of the country remains an unfulfilled aspiration. Disparity in health care is interpreted as compromise in 'Right to Life.' It is imperative to define 'essential health care,' which should be made available to all citizens to facilitate inclusivity in health care. The suggested methods for this include optimal utilization of public resources and increasing public spending on health care. Capacity building through training, especially training of paramedical personnel, is proposed as an essential ingredient, to reduce cost, especially in tertiary care. Another aspect which is considered very important is improvement in delivery system of health care. Increasing the role of 'family physician' in health care delivery system will improve preventive care and reduce cost of tertiary care. These observations underlie the relevance and role of Primary health care as a key to deliver inclusive health care. The advantages of a primary health care model for health service delivery are greater access to needed services; better quality of care; a greater focus on prevention; early management of health problems; and cumulative improvements in health and lower morbidity as a result of primary health care delivery.

Caracterização do perfil diagnóstico e fluxo de um ambulatório de Fonoaudiologia hospitalar na área de Linguagem infantil / Characterization of the diagnostic profile and flow of a Speech-Language Pathology service in child language within a public hospital

OBJETIVO: Caracterizar o perfil diagnóstico e o fluxo de usuários de um serviço de Fonoaudiologia de um hospital escola público. MÉTODOS: A coleta foi realizada em documentos, arquivos de prontuário, selecionados por código no período entre outubro de 2007 e março de 2009. Após o registro, os resultados foram descritos estatisticamente. RESULTADOS: Houve predomínio do gênero masculino (67,8 por cento); em 58,95 por cento a faixa etária estava entre 0 e 7 anos; 88,48 por cento da população era procedente de municípios da região norte do estado de São Paulo; 43,2 por cento vinham do serviço neurologia do hospital e 33,6 por cento frequentavam escola. Quanto ao diagnóstico 27,5 por cento eram de atraso de linguagem, 20,06 por cento de distúrbios de linguagem e 15,51 por cento de distúrbios da aprendizagem, com prevalências de 0,31, 0,17 e 0,23 casos em 273, respectivamente. As comorbidades foram: retardo do desenvolvimento neuropsicomotor (14,28 por cento) e prematuridade (8,69 por cento). Os encaminhamentos eram para Audiologia (24,77 por cento) e Odontologia (20,18 por cento) e 51,64 por cento dos usuários estavam em lista de espera para terapia no local. CONCLUSÃO: Prevaleceu o diagnóstico de atraso de linguagem em crianças do gênero masculino, com idade entre 0 e 6 anos e 11 meses. Foi identificado um fluxo externo proveniente de município da região e interno (ambulatorial). Parte da demanda foi absorvida pelo serviço, parte aguardava por reabilitação e uma parcela foi contra-referenciada às unidades de origem.

PURPOSE: To characterize the diagnostic profile and the users flow of a Speech-Language Pathology service within a public teaching hospital. METHODS: Data were collected from documents and medical records selected by code between October 2007 and March 2009. Data were subjected to descriptive statistics. RESULTS: There was a predominance of male individuals (67.80 percent); 58.95 percent of the patients/participants were children within the age range from 0 to 7 years; 88.48 percent came from cities in the northern region of the state of São Paulo; 43.2 percent were referred by the hospital's neurology service, and 33.6 percent were attending school. The diagnosis was language delay in 27.5 percent of cases, language disorder in 20.06 percent, and learning disorders in 15.51 percent, with prevalence rates of 0.31, 0.17 and 0.23 in 273 cases, respectively. The co-morbidities were delayed motor development (14.28 percent) and prematurity (8.69 percent). The referrals were for Audiology (24.77 percent) and Dentistry (20.18 percent), and 51.64 percent of the users were on the waiting list for treatment on site. CONCLUSION: It was prevalent the diagnosis of language delay in male children with ages between 0 and 6 years and 11 months. It was identified an external flow coming from nearby cities and an internal flow (outpatient). Part of the demand was absorbed by the institution's Speech-Language Pathology Service, and part was in the waiting list or was counter-referred to their units of origin for follow-up.

O fisioteraupeta no SUS: contribuição para as políticas públicas de saúde em Belém/PA / The physioterapist in SUS: contribution to public health policies in Belém / PA

INTRODUÇÃO: São abordados os históricos da Saúde Pública e da Fisioterapia, tanto no Brasil como em Belém, as representações sociais da Fisioterapia que lhe dão corpo e formatação e a realidade do fisioterapeuta municipal no SUS. O enfoque é dado ao processo de vivência dos fisioterapeutas no SUS, expondo a realidade da entrada da Fisioterapia nos serviços públicos, a partir da visão do fisioterapeuta municipal, participante do processo de municipalização preconizado pelo SUS. OBJETIVO: Esta dissertação analisa o processo de contribuição da Fisioterapia no SUS, a partir de ações mobilizadoras do fisioterapeuta municipal de Belém. MATERIAL E MÉTODO: O estudo foi realizado entrevistando dezoito fisioterapeutas atuantes no município e em posições legais de liderança, fazendo uso de entrevistas semiestruturadas, objetivando analisar suas opiniões acerca da atual conjuntura em que se encontra a Fisioterapia nas Políticas Públicas de Saúde da região. CONCLUSÃO: Conclui-se que o fisioterapeuta, sofre as mesmas dificuldades que muitos profissionais de saúde do município, devido a completa faltade vontade política dos atuais governantes, que só arrastam os problemas para o imediatismo e emergencialismo tardio. Aliado a este aspecto, sobressai a falta de coligação da classe de fisioterapeutas, que só tende a retardar e enfraquecer as possíveis lutas políticas em beneficio próprio, pois seus interesses ainda perpassam por questões individualizadas e desconectadas da necessidade do sistema de saúde vigente do país. Esses fatores se entrelaçam e dificultam a inserção mais contundente da Fisioterapia dentro das Políticas Públicas de Saúde de Belém.

INTRODUCTION: It presents historical issues of Public Health and Physical Therapy areas in Brazil in general and in the city of Belem; social representation issues of the Physical Therapy profession which characterizes its local cultural manifestation and the way physical therapy services are provided in Belem city, and the present conditions physical therapists who work for the Brazilian universal health care system in city health care centers deal with. Focus is given to experiences lived by physical therapists who work for the universal health care system, presenting the real conditions of the onset of physical therapy services in public centers from the perspective of physical therapists who work in city health care centers who participated in the process of municipalization of physical therapy services present in universal health care system.OBJECTIVE: This dissertation thesis analyzes the process of physical therapists ́ contribution to the Brazilian Universal Health Care system focused on advocacy professional actions performed by physical therapists who work at city health care centers. MATERIAL E MÉTODO: In this study, 18 physical therapists who work in city health care centers and who hold leadership positions at their workplaces were interviewed through semi-structured interviews whose goal was analyzing their opinions on the present conjuncture the physical therapy profession deals with concerning health public policies in the North region of Brazil. CONCLUSION: The study reaches the conclusion that the physical therapist faces the same difficulties many other health professionals who work in city health care centers do because of total lack of political will of present government rulers, and this situation just drags problems into immediacy and late emergency actions. Besides this situation, one may highlight lack of physical therapists professional coalition which retards advocacy for the physical therapy profession. The author states that physical therapists act based on individual interests which do not relate to Brazil ́s health care system needs. All these issues are interconnected and make it difficult for more appropriate implementation of physical therapists ́ intervention in public health policies in the city of Belém.

The mortality risks of pneumonia patients with the same levels of health insurance coverage in Thailand before and after the implementation of the universal care project.

Objective: To compare the mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the Universal Health Care Coverage Project (UC). Methods: A retrospective cohort study was conducted. The sample was pneumonia patients admitted to hospitals owned by the Ministry of Public Health (MOPH) of Thailand during 2001-2002. Logistic regression analysis was used to determine whether mortality risks of pneumonia patients with the same levels of health insurance coverage status before and after the implementation of the UC were different after controlling for important variables. Results: Of the 8,577,482 patients admitted to the Thai Ministry of Public Health Hospitals during 2001-2002, there were 112,205 and 115,386 patients diagnosed with a type of pneumonia in 2001 and 2002, respectively. After controlling for sex, age, marital status, hospital type and length of stay, patients admitted after the implementation of the UC who were insured or had UC with 30 baht co-payment coverage had no significant difference in mortality risks (OR = 1.08, P = 0.20; OR = 1.03, p = 0.62; respectively). In contrast, patients who were under the UC without co-payment had higher mortality risk after the implementation of the UC (OR = 1.12, P = 0.001). Conclusion: Before and after the implementation of the UC project, pneumonia patients who had the same levels of health insurance coverage had differences mortality risks regarding to their health insurance coverage status. Whether the results reflected the impact of the UC project, unmeasured differences in quality of care, restricted access to care, or differences in co-morbidities remains to be determined.