Healthcare and medical tourism - Cascais Municipality case study

The purpose of this work project is to evaluate Cascais’ potential of becoming a reference in Health Care and Medical Tourism in the near future. It is done a careful research about the industry, followed by a thorough analysis of the region. It is concluded that it holds many key characteristics and conditions for the development of this kind of clusters, even though it lacks consumers’ perception regarding this product. Some guidelines are suggested in order to position Cascais as a competitive player in this field.

Modeling and visualization of medical anesthesiology acts

Dissertação para obtenção do Grau de Mestre em Engenharia Informática

Defining health law or the edgewood syndrome

ABSTRACT - The authors’ main purpose is to present ideas on defining Health Law by highlighting the particularities of the field of Health Law as well as of the teaching of this legal branch, hoping to contribute to the maturity and academic recognition of Health Law, not only as a very rich legal field but also as a powerful social instrument in the fulfillment of fundamental human rights. The authors defend that Health Law has several characteristics that distinguish it from traditional branches of law such as its complexity and multidisciplinary nature. The study of Health Law normally covers issues such as access to care, health systems organization, patients’ rights, health professionals’ rights and duties, strict liability, healthcare contracts between institutions and professionals, medical data protection and confidentiality, informed consent and professional secrecy, crossing different legal fields including administrative, antitrust, constitutional, contract, corporate, criminal, environmental, food and drug, intellectual property, insurance, international and supranational, labor/employment, property, taxation, and tort law. This is one of the reasons why teaching Health Law presents a challenge to the teacher, which will have to find the programs, content and methods appropriate to the profile of recipients which are normally non jurists and the needs of a multidisciplinary curricula. By describing academic definitions of Health Law as analogous to Edgewood, a fiction house which has a different architectural style in each of its walls, the authors try to describe which elements should compose a more comprehensive definition. In this article Biolaw, Bioethics and Human Rights are defined as complements to a definition of Health Law: Biolaw because it is the legal field that treats the social consequences that arise from technological advances in health and life sciences; Bioethics which evolutions normally influence the shape of the legal framework of Health; and, finally Human Rights theory and declarations are outlined as having always been historically linked to medicine and health, being the umbrella that must cover all the issues raised in the area of Health Law. To complete this brief incursion on the definition on Health Law the authors end by giving note of the complex relations between this field of Law and Public Health. Dealing more specifically on laws adopted by governments to provide important health services and regulate industries and individual conduct that affect the health of the populations, this aspect of Health Law requires special attention to avoid an imbalance between public powers and individual freedoms. The authors conclude that public trust in any health system is essentially sustained by developing health structures which are consistent with essential fundamental rights, such as the universal right to access health care, and that the study of Health Law can contribute with important insights into both health structures and fundamental rights in order to foster a health system that respects the Rule of Law.-------------------------- RESUMO – O objectivo principal dos autores é apresentar ideias sobre a definição de Direito da Saúde, destacando as particularidades desta área do direito, bem como do ensino deste ramo jurídico, na esperança de contribuir para a maturidade e para o reconhecimento académico do mesmo, não só como um campo juridicamente muito rico, mas, também, como um poderoso instrumento social no cumprimento dos direitos humanos fundamentais. Os autores defendem que o Direito da Saúde tem diversas características que o distinguem dos ramos tradicionais do direito, como a sua complexidade e natureza multidisciplinar. O estudo do Direito da Saúde abrangendo normalmente questões como o acesso aos cuidados, a organização dos sistemas de saúde, os direitos e deveres dos doentes e dos profissionais de saúde, a responsabilidade civil, os contratos entre instituições de saúde e profissionais, a protecção e a confidencialidade de dados clínicos, o consentimento informado e o sigilo profissional, implica uma abordagem transversal de diferentes áreas legais, incluindo os Direitos contratual, administrativo, antitrust, constitucional, empresarial, penal, ambiental, alimentar, farmacêutico, da propriedade intelectual, dos seguros, internacional e supranacional, trabalho, fiscal e penal. Esta é uma das razões pelas quais o ensino do Direito da Saúde representa um desafio para o professor, que terá de encontrar os programas, conteúdos e métodos adequados ao perfil dos destinatários, que são normalmente não juristas e às necessidades de um currículo multidisciplinar. Ao descrever as várias definições académicas de Direito da Saúde como análogas a Edgewood, uma casa de ficção que apresenta um estilo arquitectónico diferente em cada uma de suas paredes, os autores tentam encontrar os elementos que deveriam compor uma definição mais abrangente. No artigo, Biodireito, Bioética e Direitos Humanos são descritos como complementos de uma definição de Direito da Saúde: o Biodireito, dado que é o campo jurídico que trata as consequências sociais que surgem dos avanços tecnológicos na área da saúde e das ciências da vida; a Bioética cujas evoluções influenciam normalmente o quadro jurídico da Saúde; e, por fim, a teoria dos Direitos Humanos e as suas declarações as quais têm estado sempre historicamente ligadas à medicina e à saúde, devendo funcionar como pano de fundo de todas as questões levantadas na área do Direito da Saúde. Para finalizar a sua breve incursão sobre a definição de Direito da Saúde, os autores dão ainda nota das complexas relações entre este último e a Saúde Pública, onde se tratam mais especificamente as leis aprovadas pelos governos para regular os serviços de saúde, as indústrias e as condutas individuais que afectam a saúde das populações, aspecto do Direito da Saúde que requer uma atenção especial para evitar um desequilíbrio entre os poderes públicos e as liberdades individuais. Os autores concluem afirmando que a confiança do público em qualquer sistema de saúde é, essencialmente, sustentada pelo desenvolvimento de estruturas de saúde que sejam consistentes com o direito constitucional da saúde, tais como o direito universal ao acesso a cuidados de saúde, e que o estudo do Direito da Saúde pode contribuir com elementos

Clustering medical tourism in Algarve: setting the first steps for the the health authority

A Work Project, presented as part of the requirements for the Award of a Masters Degree in Management from the NOVA – School of Business and Economics

Análise comparativa do direito de acesso a cuidados de saúde no serviço nacional de saúde português e sistema de saúde norte-americano (EUA)

RESUMO - O presente estudo situa-se nas áreas gerais da Saúde Pública, dos Sistemas de Saúde e do Acesso à Prestação de Cuidados de Saúde e procura analisar o conteúdo e concretização do Direito de Acesso a Cuidados de Saúde na perspectiva de dois sistemas de saúde paradigmaticamente distintos, um sistema de acesso universal, representado pelo Serviço Nacional de Saúde português e um sistema de saúde de “não universal”, cujo paradigma é o modelo existente nos Estados Unidos da América, onde entidades gestoras de cuidados, Managed Care Organizations, são chamadas a desempenhar um papel central no acesso e prestação de cuidados de saúde. O vasto campo de investigação representado pela problemática do acesso a cuidados de saúde e a necessidade de limitar o trabalho de investigação subjazem à definição de quatro vertentes a analisar: (a) a existência ou não de uma base legal que preveja e regule o exercício do direito de acesso a cuidados de saúde; (b) o conteúdo deste direito no âmbito de cada um dos sistemas em estudo; (c) as condições de concretização do acesso a cuidados de saúde em ambos os sistemas, e, por último (d) a existência de garantias de efectivação do mesmo. Analisados os sistemas em estudo à luz das vertentes apresentadas, concluímos que a existência de um quadro normativo próprio, que explicite o conteúdo e condições de efectivação do direito, apresenta maiores garantias de concretização do exercício do Direito de Acesso a Cuidados de Saúde, entendendo-se que um sistema de acesso dependente da actuação de entidades gestoras de cuidados não beneficia o acesso a cuidados de saúde, nomeadamente por não garantir equidade no momento de procura e necessidade de cuidados. Os dados apresentados foram recolhidos através do recurso a uma metodologia qualitativa. A análise documental foi aplicada na recolha dos dados relativos à evolução e caracterização dos sistemas, bem como às condições de acesso. No âmbito do sistema de saúde de acesso universal, ou seja, o caso português, procedeu-se essencialmente à análise dos normativos aplicáveis. No que se refere ao sistema de saúde norte-americano, na ausência de base legal aplicável, recorreu-se sobretudo à análise de literatura e documentos. A participação no vi Second Biennal Seminar in Law and Bioethics1 e na 30th Annual Health Law Professors Conference2, realizados em Bóston, EUA, em Julho de 2007, permitiram uma melhor percepção da actual situação da prestação de cuidados naquele País, nomeadamente de algumas das reformas em curso, bem como um melhor entendimento das características do sistema prestador norte-americano em si mesmo. 1 Seminário organizado nos dias 30 e 31 de Maio, numa colaboração entre a Escola Nacional de Saúde Pública e o Departamento de Direito da saúde, Bioética e Direitos Humanos da Escola de Saúde Pública da Universidade de Bóston, sob o tema: “Law and ethics in rationing Access to care in a high-cost global economy”. A nossa participação deveu-se a um convite da Prof.ª Paula Lobato de Faria para colaborar na sessão sobre o sistema de saúde português. 2 Reunião realizada em Bóston nos dias 31 de Maio a 2 de Junho, sobretudo a sessão dedicada ao tema “New Models for Reform”, sobre os novos modelos de sistema de saúde em desenvolvimento nos EUA.

Integrated care approaches and skills mix policies in Europe

ABSTRACT - Background: Integration of health care services is emerging as a central challenge of health care delivery, particularly for patients with elderly and complex chronic conditions. In 2003, the World Health Organization (WHO) already began to identify it as one of the key pathways to improve primary care. In 2005, the European Commission declared integrated care as vital for the sustainability of social protection systems in Europe. Nowadays, it is recognized as a core component of health and social care reforms across European countries. Implementing integrated care requires coordination between settings, organizations, providers and professionals. In order to address the challenge of integration in such complex scenario, an effective workforce is required capable of working across interdependent settings. The World Health Report 2006 noted that governments should prepare their workforce and explore what tasks the different levels of health workers are trained to do and are capable of performing (skills mix). Comparatively to other European countries, Portugal is at an early stage in what integrated care is concerned facing a growing elderly population and the subsequent increase in the pressure on institutions and professionals to provide social and medical care in the most cost-effective way. In 2006 the Portuguese government created the Portuguese Network for Integrated Care Development (PNICD) to solve the existing long-term gap in social support and healthcare. On what concerns health workforce, the Portuguese government already recognized the importance of redefine careers keeping professional motivation and satisfaction. Aim of the study: This study aims to contribute new evidence to the debate surrounding integrated care and skills mix policies in Europe. It also seeks to provide the first evidence that incorporates both the current dynamics of implementing integrated care in Portugal and the developments of international literature. The first ambition of our study is to contribute to the growing interest in integrated care and to the ongoing research in this area by identifying its different approaches and retrieve a number of experiences in some European countries. Our second goal of this research is to produce an update on the knowledge developed on skills mix to the international healthcare management community and to policy makers involved in reforming healthcare systems and organizations. To better inform Portuguese health policies makers in a third stage we explore the current dynamics of implementing integrated care in Portugal and contextualize them with the developments reported in the international literature. Methodology: This is essentially an exploratory and descriptive study using qualitative methodology. In order to identify integrated care approaches in Europe, a systematic literature review was undertaken which resulted in a paper published in the Journal of Management and Marketing in Health care titled: Approaches to developing integrated care in Europe: a systematic literature review. This article was recommended and included into a list of references identified by The King's Fund Library. A second systematic literature review was undertaken which resulted in a paper published in the International Journal of Healthcare Management titled: Skills mix in healthcare: An international update for the management debate. Semi-structured interviews were performed on experts representing the regional coordination teams of the Portuguese Network for Integrated Care Development. In a last stage a questionnaire survey was developed based on the findings of both systematic literature reviews and semi-structured interviews. Conclusions: Even though integrated care is a worldwide trend in health care reforms, there is no unique definition. Definitions can be grouped according to their sectorial focus: community-based care, combined health and social care, combined acute and primary care, the integration of providers, and in a more comprehensive approach the whole health system. Indeed, models that seek to apply the principles of integrated care have a similar background and are continually evolving and depend on the different initiatives taken at national level. . Despite the fact that we cannot argue that there is one single set typology of models for integrated care, it is possible to identify and categorize some of the basic approaches that have been taken in attempts to implement integrated care according to: changes in organizational structure, workforce reconfiguring, and changes in the financing system. The systematic literature review on skills mix showed that despite the widely acknowledged interest on skills mix initiatives there is a lack of evidence on skills mix implications, constraints, outcomes, and quality impact that would allow policy makers to take sustained and evidence-based decisions. Within the Portuguese health system, the integrated care approach is rather organizational and financial, whereas little attention is given to workforce integration. On what concerns workforce planning Portugal it is still in the stage of analyzing the acceptability of health workforce skills mix. In line with the international approaches, integration of health and social services and bridging primary and acute care are the main goals of the national government strategy. The findings from our interviews clarify perceptions which show no discrepancy with the related literature but are rather scarce comparing to international experience. Informants hold a realistic but narrow view of integrated care related issues. They seem to be limited to the regional context, requiring a more comprehensive perspective. The questionnaire developed in this thesis is an instrument which, when applied, will allow policy makers to understand the basic set of concepts and managerial motivations behind national and regional integrated care programs. The instrument developed can foster evidence on the three essential components of integrated care policies: organizational, financial, and human resources development, and can give additional input on the context in which integrated care is being developed, the type of providers and organizations involved, barriers and constraints, and the workforce skills mix planning related strategies. The thesis was successful in recognizing differences between countries and interventions and the instrument developed will allow a better comprehension of the international options available and how to address the vital components of integrated care programs.

Does the existing Corporate Governance structure and strict Legal Framework, affect the strategic decisionmaking of CEOs?

This thesis is a case study on Corporate Governance and Business Ethics, using the Portuguese Corporate Law as a general setting. The thesis was conducted in Portugal with illustrations on past cases under the Business Judgment Rule of the State of Delaware, U.SA along with illustrations on current cases in Portugal under the Portuguese Judicial setting, along with a comparative analysis between both. A debate is being considered among scholars and executives; a debate on best practices within corporate governance and corporate law, associated with recent discoveries of unlawful investments that lead to the bankruptcy of leading institutions and an aggravation of the crisis in Portugal. The study aimed at learning possible reasons and causes for the current situation of the country’s corporations along with attempts to discover the best way to move forward. From the interviews and analysis conducted, this paper concluded that the corporate governance structure and legal frameworks in Portugal were not the sole influencers behind the actions and decisions of Corporate Executives, nor were they the main triggers for the recent corporate mishaps. But it is rather a combination of different factors that played a significant role, such as cultural and ethical aspects, individual personalities, and others all of which created gray areas beyond the legal structure, which in turn accelerated and aggravated the corporate governance crisis in the country.