Do mobile hospital teams in residential aged care facilities increase health care efficiency: an evaluation of French residential care policy.

CONTEXT: Patients in residential aged care facilities (RACF) are frequently admitted to hospital since the RACF often lack adequate medical resources. Different economic agents, whose missions and funding may conflict, provide care for RACF residents: residential facility, primary care physicians, and hospital. In this article, I estimate the economic impact of employing a mobile hospital team (MHT) in RACF, which modifies the relationship between these three agents by providing care directly in RACF. METHOD: A national, patient level database on RACF from 2014 to 2017 is used to calculate RACF outcome indicators. I analyse the difference between RACFs, that use MHT for the first time during the period (treatment group), and those that did not use MHT at all in the same period using a difference in difference (DID) model. RESULTS: The MHT had a significant impact on health care quality in treated RACFs and reduced the number of patients transferred to hospital and the number of emergency department visits, and increased palliative care utilisation at the end-of-life, without increasing total hospital expenditure. CONCLUSION: MHT appear improve care quality in RACFs by filling the gap in care needs including better end of life care, without increasing health expenditure. Given the high number of hospital transfers especially towards the end of life, securing the right level and mix of social and medical resources in RACFs is essential. Transferring some competencies of MHT teams to residential facilities may improve the quality of life of residents while improving allocative efficiency of public resources.

Preventing tobacco use from the start: Short- and medium-term impacts on the youth.

Adolescent substance use is a persistent global problem and a challenge for society and the public health authorities. In this paper we investigate the impact of a prevention-oriented policy implemented in Icelandic secondary schools from 1997 to 2002 (the "Drug-free Iceland" programme) on country-level smoking rates on the youth. Using a panel data source spanning from 1985 to 2010 and composed both by Iceland and a set of countries where such a type of policy was absent, we apply the Synthetic Control Method to construct the counterfactual of Iceland. Comparing Iceland with this counterfactual, we estimate the effect of the intervention on those aged 15 to 19 -who were the main target of the policy-, during the years of implementation of the programme, and follow their smoking prevalence rates overtime until 2010, when they became adults (25 to 29-years old). Our results show that the intervention reduced youth smoking prevalence on the targeted groups that lasted at least until they became adults. We also find evidence of externalities in the age groups adjacent to those directly targeted by the policy. The results differ by gender, with the impact on females being more marked.

Planos Municipais de Saúde do Estado do Tocantins: uma análise com foco no enfrentamento da obesidade / Municipal Health Plans in Tocantins, Brazil: an analysis focusing on obesity

Resumo O objetivo deste estudo foi avaliar a abrangência do enfrentamento da obesidade nos Planos Municipais de Saúde (PMS) do Estado do Tocantins, dado que, diante da crescente prevalência da obesidade no Brasil, seu enfrentamento deveria estar no foco de ação da saúde pública e previsto nos instrumentos de gestão. Trata-se de um estudo qualitativo, com análise documental, que analisou os PMS no período de vigência de 2018 a 2021 nos 139 municípios desse estado. Foram selecionados dezessete termos relacionados à obesidade e verificada a frequência e contexto nos PMS. Do total de 139 PMS, foram avaliados 129 (92,8%). Os termos "academia da saúde" e "Sisvan" foram os mais frequentes, e "obesidade" apareceu em apenas 28% dos planos, totalizando 71 citações. Destas, somente 32,4% relacionavam-se diretamente com o enfrentamento da doença, com destaque nas regiões de saúde Bico do Papagaio e Médio Norte Araguaia. Os contextos relevantes de abordagem da obesidade mais frequentes foram a caracterização da situação epidemiológica, quadros de metas de ações e indicadores. Concluiu-se que o enfrentamento da obesidade pactuado nos PMS está ausente em mais de 70% dos municípios do Tocantins, e que ações de direcionamento para inclusão dessa doença dentro dos instrumentos de gestão são urgentes.

Abstract This documentary analysis evaluated the scope of addressing obesity in the Municipal Health Plans (PMS) in the state of Tocantins, Brazil, since the growing prevalence of obesity in Brazil should put its confrontation at the center of public health action and management instruments. To analyze the PMS performance from 2018 to 2021 in the 139 municipalities of this state, 17 terms related to obesity were selected and had their frequency and context in the PMS verified. Of the existing 139 PMS, 129 (92.8%) were evaluated. "Health academy" and "SISVAN" were the most frequent terms used, whereas "obesity" appeared in only 28% of the plans, totaling 71 mentions. Of these, only 32.4% were directly related to combating the disease, mainly in the health regions of Bico do Papagaio and Médio Norte Araguaia. Relevant contexts for addressing obesity included the characterization of the epidemiological profile, tables of action goals, and indicators. PMS's role in combating obesity is absent in more than 70% of municipalities in Tocantins, which points to the urgent inclusion of this disease within the management instruments.

Programa Minha Casa Minha Vida (2012-2016): análise da eficiência relativa dos municípios brasileiros na execução de programas federais / Programa Minha Casa Minha Vida (2012-2016): análisis de la eficiencia relativa de los municipios brasileños en la implementación de programas federales / Minha Casa Minha Vida Program (2012-2016): analysis of the relative efficiency of Brazilian municipalities in the implementation of federal programs

Resumo A presente pesquisa busca avaliar a eficiência relativa dos municípios brasileiros na execução do programa Minha Casa Minha Vida. Pretende-se que os resultados deste trabalho permitam a discussão de quais características ou fatores parecem afetar a eficiência municipal na implementação de políticas públicas, de forma a fornecer subsídios teórico-empíricos às pesquisas na área. O programa Minha Casa Minha Vida (MCMV), caso escolhido, compõe o eixo Infraestrutura Social e Urbana do Programa de Aceleração do Crescimento (PAC). O trabalho foi estruturado em duas etapas: a primeira é a classificação de municípios em grupos homogêneos; a segunda refere-se ao levantamento da eficiência relativa dos municípios na implementação do MCMV, por meio da aplicação de Análise Envoltória de Dados (DEA). Como resultado, foi identificado que os municípios brasileiros possuem padrões diversos de estruturação, sendo a maioria classificada como pouco estruturados ou com estrutura mínima, com claro padrão regional, em que Sul e Sudeste apresentam, com maior frequência, municípios bem estruturados em comparação com o Centro-Oeste, o Norte e o Nordeste. Ao analisar a eficiência relativa no MCMV, tendo como universo apenas os municípios que concluíram empreendimentos do PMCMV entre 2012 e 2016, os municípios com melhor estrutura também apresentaram melhores resultados, indicando que a estrutura deve ser determinante para o desempenho no programa. Em contrapartida, a análise regional apresentou o Centro-Oeste, o Norte e o Nordeste com mais municípios eficientes na execução do programa.

Resumen Esta investigación tiene como objetivo evaluar la eficiencia relativa de los municipios brasileños en la implementación del programa Minha Casa Minha Vida (MCMV). Se pretende que los resultados de este trabajo permitan discutir qué características o factores parecen afectar la eficiencia municipal en la implementación de las políticas públicas, a fin de proporcionar apoyo teórico y empírico a la investigación en el área. El programa Minha Casa Minha Vida, si se elige, forma el eje de Infraestructura Social y Urbana del Programa de Aceleración del Crecimiento (PAC). El trabajo fue estructurado en dos etapas: la primera es la clasificación de los municipios en grupos homogéneos; la segunda se refiere al relevamiento de la eficiencia relativa de los municipios en la implementación del MCMV, mediante la aplicación del análisis de envoltura de datos (DEA). Como resultado, identificamos que los municipios brasileños tienen diferentes patrones de estructuración. La mayoría de ellos fueron clasificados como mal estructurados o mínimamente estructurados. Podríamos observar en los datos analizados un patrón regional claro, donde el Sur y el Sudeste tienen municipios mejor estructurados en comparación con el Centro Oeste, el Norte y el Noreste. Al analizar la eficiencia relativa en el MCMV, considerando como universo solo los municipios que completaron proyectos del PMCMV entre 2012 y 2016, los municipios mejor estructurados también presentaron mejores resultados, lo que indica que las condiciones estructurales pueden ser determinantes del desempeño del programa. En contrapartida, el análisis regional presentó el Centro Oeste, Norte y Nordeste con más municipios eficientes en la implementación del programa.

Abstract: This research aims to evaluate the relative efficiency of Brazilian municipalities in the implementation of the Brazilian federal program for affordable housing Minha Casa Minha Vida (MCMV) program. The study discusses characteristics or factors that seem to affect municipal efficiency in policy implementation providing theoretical and empirical support to research in the area. The MCMV program is part of the Social and Urban Infrastructure axis of the Growth Acceleration Program (Programa de Aceleração do Crescimento - PAC). The work was divided into two stages. The first step is the classification of municipalities into homogeneous groups. The second refers to the municipalities' relative efficiency in the MCMV, through the application of data envelopment analysis (DEA). As a result, we identified that Brazilian municipalities have different structuring patterns. The majority of them were classified as poorly structured or minimally structured. In the analyzed data, we observed a clear regional pattern, where South and Southeast have more well-structured municipalities compared to the Central-west, North, and Northeast. By analyzing the relative efficiency in MCMV, considering as universe only municipalities that completed MCMV projects between 2012 and 2016, better-structured municipalities also presented better results, indicating that structural conditions may be determinants of program performance. In contrast, the regional analysis presented that Centralwest, North, and Northeast demonstrated efficient municipalities more often, on average, in implementing the program.

Mortality containment vs. Economics Opening: Optimal policies in a SEIARD model.

We extend the classic approach (SIR) to a SEAIRD model with policy controls. A social planner's objective reflects the trade-off between mortality reduction and GDP, featuring its perception of the value of statistical life (PVSL). We introduce realistic and drastic limitations to the control available to it. Within this setup, we explore the results of various control policies. We notably describe the joint dynamics of infection and economy in different contexts with unique or multiple confinement episodes. Compared to other approaches, our contributions are: (i) to restrict the class of functions accessible to the social planner, and in particular to impose that they remain constant over some fixed periods; (ii) to impose implementation frictions, e.g. a lag in their implementation; (iii) to prove the existence of optimal strategies within this set of possible controls; iv) to exhibit a sudden change in optimal policy as the statistical value of life is raised, from laissez-faire to a sizeable lockdown level, indicating a possible reason for conflicting policy proposals.

Considerações sobre a acessibilidade nos Centros de Atenção Psicossocial no Brasil / Considerations regarding access to Community Psychosocial Centers in Brazil

ResumoO objeto do artigo é a análise da implantação dos serviços comunitários no contexto regional. O artigo descreve o padrão de acesso aos Centros de Atenção Psicossocial (CAPS II) no Estado do Rio de Janeiro na atual década. A partir dos resultados de um inquérito transversal foram identificadas diferentes categoriais de usuários dos serviços comunitários. O artigo recorre ao modelo teórico do isomorfismo organizacional para problematizar a condição de implantação em diferentes contextos municipais. O artigo demonstra que, independente do contexto local, é bastante discrepante a escala de responsabilização dos novos serviços com os usuários, especialmente aqueles saídos de internações de longa permanência ou ainda internados. Conclui que a análise de diferentes categorias de utilização permite problematizar as barreiras de acesso aos serviços comunitários. A identificação destas aos CAPS II pode contribuir para a reflexão crítica sobre a política de saúde mental brasileira atual.

AbstractThe scope of this article is to analyze the implementation of community mental health services in the regional context in Brazil. The article describes the issue of access to community psychosocial centers (CAPS II) in the State of Rio de Janeiro in this decade. By means of a cross-sectional survey, different categories of users of community services were identified. The theoretical models of organizational isomorphism and innovation and diffusion of policies were applied to discuss the adoption and development of community mental health services in different municipal contexts. The article highlights the fact that, irrespective of the local context, there is a considerable discrepancy between the scale of commitment of community mental health to new patient services, especially for those coming out of long-stay hospitalizations or who are still hospitalized. It concludes that the analysis of different categories of users makes it possible to study the problem of barriers of access to community services. The identification of barriers to access CAPS II can contribute to a critical reflection on the current Brazilian mental health policy.