Federalism and health policy: the intergovernmental committees in Brazil

OBJECTIVE To analyze the dynamics of operation of the Bipartite Committees in health care in the Brazilian states.METHODS The research included visits to 24 states, direct observation, document analysis, and performance of semi-structured interviews with state and local leaders. The characterization of each committee was performed between 2007 and 2010, and four dimensions were considered: (i) level of institutionality, classified as advanced, intermediate, or incipient; (ii) agenda of intergovernmental negotiations, classified as diversified/restricted, adapted/not adapted to the reality of each state, and shared/unshared between the state and municipalities; (iii) political processes, considering the character and scope of intergovernmental relations; and (iv) capacity of operation, assessed as high, moderate, or low.RESULTS Ten committees had advanced level of institutionality. The agenda of the negotiations was diversified in all states, and most of them were adapted to the state reality. However, one-third of the committees showed power inequalities between the government levels. Cooperative and interactive intergovernmental relations predominated in 54.0% of the states. The level of institutionality, scope of negotiations, and political processes influenced Bipartite Committees’ ability to formulate policies and coordinate health care at the federal level. Bipartite Committees with a high capacity of operation predominated in the South and Southeast regions, while those with a low capacity of operations predominated in the North and Northeast.CONCLUSIONS The regional differences in operation among Bipartite Interagency Committees suggest the influence of historical-structural variables (socioeconomic development, geographic barriers, characteristics of the health care system) in their capacity of intergovernmental health care management. However, structural problems can be overcome in some states through institutional and political changes. The creation of federal investments, varied by regions and states, is critical in overcoming the structural inequalities that affect political institutions. The operation of Bipartite Committees is a step forward; however, strengthening their ability to coordinate health care is crucial in the regional organization of the health care system in the Brazilian states.

Problems in the regulatory policy of the drug market

OBJECTIVE Analyze the implementation of drug price regulation policy by the Drug Market Regulation Chamber.METHODS This is an interview-based study, which was undertaken in 2012, using semi-structured questionnaires with social actors from the pharmaceutical market, the pharmaceuticals industry, consumers and the regulatory agency. In addition, drug prices were compiled based on surveys conducted in the state of Sao Paulo, at the point of sale, between February 2009 and May 2012.RESULTS The mean drug prices charged at the point of sale (pharmacies) were well below the maximum price to the consumer, compared with many drugs sold in Brazil. Between 2009 and 2012, 44 of the 129 prices, corresponding to 99 drugs listed in the database of compiled prices, showed a variation of more than 20.0% in the mean prices at the point of sale and the maximum price to the consumer. In addition, many laboratories have refused to apply the price adequacy coefficient in their sales to government agencies.CONCLUSIONS The regulation implemented by the pharmaceutical market regulator was unable to significantly control prices of marketed drugs, without succeeding to push them to levels lower than those determined by the pharmaceutical industry and failing, therefore, in its objective to promote pharmaceutical support for the public. It is necessary reconstruct the regulatory law to allow market prices to be reduced by the regulator as well as institutional strengthen this government body.

How to Measure the Deterrence Effects of Merger Policy: Frequency or Composition?

We show that the number of merger proposals (frequency-based deterrence) is a more appropriate indicator of underlying changes in merger policy than the relative anti-competitiveness of merger proposals (composition-based deterrence). This has strong implications for the empirical analysis of the deterrence effects of merger policy enforcement, and potential implications regarding how to reduce anti-competitive merger proposals.

Somewhere near reality: artistic portrayal of violence in post WWII British realistic drama

ABSTRACT - I will explore and present the portrayal of violence in some British plays that were staged between 1951 and 1965, in order to discuss the role, impact and aim of its representation. Thus, I will consider John Whiting’s Saint’s Day (1951), Ann Jelicoe’s The Sport of my Mad Mother (1956), Arnold Wesker (Chicken Soup with Barley (1958), Harold Pinter’s Birthday Party (1958), David Rudkin’s Afore Night Come (1962) and Edward Bond’s Saved (1965). My aim is to discuss the way how theatre in the post WWII changed the traditional ways of representing violence. On one hand, violence and reality became more and more familiar and domestic, permitting a representation of multiple and non-agonic violence; and, on the other hand, the violence that was depicted often changed the way one perceived reality itself, being part of a socially engaged artistic attitude.

Convergence to the European Energy Policy in European countries: case studies and comparison

Purpose – Our paper aims at analyzing how different European countries cope with the European Energy Policy, which proposes a set of measures (free energy market, smart meters, energy certificates) to improve energy utilization and management in Europe. Design/methodology/approach – The paper first reports the general vision, regulations and goals set up by Europe to implement the European Energy Policy. Later on, it performs an analysis of how some European countries are coping with the goals, with financial, legal, economical and regulatory measures. Finally, the paper draws a comparison between the countries to present a view on how Europe is responding to the emerging energy emergency of the modern world. Findings – Our analysis on different use cases (countries) showed that European countries are converging to a common energy policy, even though some countries appear to be later than others In particular, Southern European countries were slowed down by the world financial and economical crisis. Still, it appears that contingency plans were put into action, and Europe as a whole is proceeding steadily towards the common vision. Research limitations/implications – European countries are applying yet more cuts to financing green technologies, and it is not possible to predict clearly how each country will evolve its support to the European energy policy. Practical implications – Different countries applied the concepts and measures in different ways. The implementation of the European energy policy has to cope with the resulting plethora of regulations, and a company proposing enhancement regarding energy management still has to possess robust knowledge of the single country, before being able to export experience and know-how between European countries. Originality/Value – Even though a few surveys on energy measures in Europe are already part of the state-of-the-art, organic analysis diagonal to the different topics of the European Energy Policy is missing. Moreover, this paper highlights how European countries are converging on a common view, and provides some details on the differences between the countries, thus facilitating parties interesting into cross-country export of experience and technology for energy management.

Inter-sectoral health policy in Portugal : competition, cooperation and control

Comunicação apresentada na «19th International Conference on Health Promoting Hospitals and Health Services», Turku, Finlândia de 1 a 3 de Junho de 2011.

The role of public policy in health care promotion: a comparative perspective

Comunicação apresentada na 17th International conference on Health Promotio Hospitals and Health Services em Hersonissis, Crete, Grécia de 6-8 de maio de 2009

Impact of europeanization in policy network governance pattrons

Comunicação apresentada na 30th Sunbelt Social Networks Conference, em Riva del Garda, Itália, a 3 de Julho de 2010.

The debate on health in Portugal: governance of health care and the welfare modernization agenda

Comunicação apresentada na "Second Biennial Conference of the Standing Group on Regulation and Governance do ECPR Regulation & Governance, com o tema: (Re)Regulation in the Wake of Neoliberalism’ Consequences of Three Decades of Privatization and Market Liberalization, realizada na Universidade de Utrecht, the Netherlands, de 5 a 7 de Junho de 2008.

Public works policy in Portugal: a case study in unsustainability

International Journal of Engineering and Industrial Management, nº 1, p. 195-208

Environmental performance policy indicators for the public sector: The case of the defence sector

Journal of Environmental Management, nº 82 p. 410–432

Does a Tougher Competition Policy Reduce or Promote Investment?

The question of how interventions from the Competition Authority (CA) affect investment is not a straightforward one: a tougher competition policy might, by reducing the ability to exert market power, either stimulate firms to invest more to counter the restrictions on their actions, or make firms invest less because of the reduced ability to have a return on investment. This tension is illustrated using two models. In one model investment is own-cost-reducing whereas in the other investment is anti-competitive. Anti-competitive investments are defined as investments that increase competitors’ costs. In both models the optimal level of investment is reduced with a tougher competition policy. Furthermore, while in the case of an anti-competitive investment a tougher authority necessarily leads to lower prices, in the case of a cost- reducing investment the opposite may happen when the impact of the investment on cost is sufficiently high. Results for total welfare are ambiguous in the cost- reducing investment model, whereas in the anti-competitive investment model welfare unambiguously increases due to a tougher competition polic

The impact of pharmaceutical policy measures: a structural-break approach

Pharmaceutical spending in many other countries has had a steep increase in the last decade. The Portuguese Government has adopted several measures to reduce pharmaceutical expenditure growth, ranging from increased co-payments to price decreases determined administratively. Promotion of generic consumption has also ranked high in political priorities. We assess the overall impact of the several policy measures on total pharmaceutical spending, using monthly data over the period January 1995 – August 2008. Endogenous structural breaks (time-series) methods were employed. Our findings suggest that policy measures aimed at controlling pharmaceutical expenditure have been, in general, unsuccessful. Two breaks were identified. Both coincide with administratively determined price decreases. Measures aimed at increasing competition in the market had no visible effect on the dynamics of Government spending in pharmaceutical products. In particular, the introduction of reference pricing had only a transitory effect of less than one year, with historical growth resuming quickly. The consequence of it is a transfer of financial burden from the Government to the patients, with no apparent effect on the dynamics of pharmaceutical spending. This strongly suggests that pharmaceutical companies have been able to adjust to policy measures, in order to sustain their sales. It remains a challenge for the future to identify firms’ strategies that supported continued growth of sales, despite the several policy measures adop

How composite indicators of innovation can influence technology policy decision?

Based on the report for Project III of the PhD programme on Technology Assessment and prepared for the Winter School that took place at Universidade Nova de Lisboa, Caparica Campus on the 6th and 7th of December 2010.