Avaliação da qualidade da atenção básica nos municípios do Departamento Regional de Saúde de Sorocaba

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Integração regional, fundos estruturais e estabilidade institucional no Mercosul: a criação do FOCEM

Este artigo analisa a criação e implementação do Fundo para Convergência Estrutural do Mercosul (FOCEM) frente ao contexto político-institucional do bloco e às estratégias de política externa dos seus sócios. Procura demonstrar que, para além de seu objetivo declarado de promover a convergência estrutural e a coesão social entre os Estados-membros, o fundo estabeleceu-se também como instrumento para evitar o descontentamento das menores economias com os resultados da integração e, assim, contribuir para a estratégia dos sócios maiores, calcada na estabilidade sem aprofundamento institucional do Mercosul.

Complexo regional de segurança da América do Sul: uma nova perspectiva

The current article aims to update the discussion on the South American context making use of the theory of Regional Security Regional Complexes (RSC). It begins with a theoretical discussion, based on Buzan and Wæver's work. It then presents the hypothesis that, differently from what is assumed in the literature, the South American RSC is not a standard one, but a centred one, in which the centre is not a global power. An empirical analysis follows, showing that Brazil possesses the necessary resources, and has presented some cogent political initiatives, such as the creation of the Union of South American Nations (Unasur) and its Defense Council (SDC), but in other moments has been reluctant take a leadership role in South America. The analysis concludes that, regarding its configuration, the South American RSC corroborates the authors' hypothesis and that Brazil should consolidate its role at the centre of such a complex.

Autonomia, integração regional e política externa brasileira: Mercosul e Unasul

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Autonomia e integração regional no contexto do Mercosul. Uma análise considerando a posição do Brasil

This paper aims to examine regional integration processes in South America, particularly in Mercosur. The point of departure is the study of Brazilian foreign policy in the region. Possible consequences of international changes will be discussed, as well as the significance of new social and political forces. Continuity and ruptures in Brazilian behaviour as regards integration will be identified to understand strengths and weaknesses in building an independent position and in search of balance among other international power centres.

The Grounding of Regional Integration for Brazil: Universalism, Sovereignty and Elite Perception

The aim of this article is to analyse the meaning of Mercosur for Brazilian foreign policy. To this end, we discuss the perceptions of the Brazilian elites concerning the regional integration process. The defence of the principle of inter-governmentalism is related to the conception of Mercosur's place within Brazil's international relations. The fact that principles such as universalism and sovereignty are very highly valued ends up affecting the deepening of the integration. The hypothesis of this article is that the Mercosur structure is in line with the perceptions of part of the Brazilian elites, which has put less emphasis on integration since the late 1990s. Our argument is that the current structure is insufficient to guarantee the dynamics of integration.

The Changing Nature of Multilateralism and Brazilian Foreign Policy

An important characteristic of the current international setting is the crisis of the structure in existence, rather than the emergence of a new order. The rise of new interests and demands, as well as the speed of the transformation make the current understanding of global governance more complex. Brazil, like other medium powers, has an interest in institutionalised multilateralism as a means of increasing its bargaining capacity and hindering the unilateralism of major powers, without being antagonistic to them. It is attempting to increase its weight in traditional international bodies, which provide the grounding for international legitimacy, as well as in new informal arrangements. While this strategy could lead to the establishment of a new hierarchy that brings in countries of growing relative importance, it has put the weight of regional integration into another perspective in Brazilian foreign policy.

Hidrovia e desenvolvimento regional: estudo dos projetos de desenvolvimento dos vales do Tietê e Paraná no Estado de São Paulo

"This paper aims to examine three regional development plans proposed for the region of the valleys of rivers Tietê and Paraná: Rail Project (ISCO, 1994), the Development Plan (CESP, 1996) and Máster Plan (ADTP, 1996). The interest in conducting the study relies on the possibility that it may contribute to the debate on the reshaping of public policy and style necessary to establish a new pattern of regional development in the country"

A internacionalização de empresas brasileiras na América do Sul: impactos da política externa recente e da integração regional

Pós-graduação em Relações Internacionais (UNESP - UNICAMP - PUC-SP) - FFC

Análise das internações por condições sensíveis à Atenção Primária em hospital de referência regional, SP/Brasil

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Metropolitan and regional health planning: dilemmas of the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil

This paper focuses on the relationship between metropolitan and regional health planning based on the processes of regionalization and the Pact for Health in the Baixada Santista Metropolitan Area, Sao Paulo State, Brazil. The method used was a case study in two stages, namely during initial implementation of the Pact for Health (2007) and the Regional Administration Committees (CGR) and in 2010. Municipal and regional health systems managers and the director of the Metropolitan Agency were interviewed, and records were analyzed from ten years of meetings of the Regional Inter-Administration Committee and the Regional Development Council. Four issues emerged: financing and infrastructure; health services utilization; inefficiency of the Regional Health Administration's instruments and decision-making levels; and the relationship between different levels in the Administration. Metropolitan health management remained as an underlying issue, appearing only incidentally or tangentially to regional management. Despite some limitations, the CGR has been legitimized as a space for regional health management.

Regional differences in clinical care among patients with type 1 diabetes in Brazil: Brazilian Type 1 Diabetes Study Group

Background To determine the characteristics of clinical care offered to type 1 diabetic patients across the four distinct regions of Brazil, with geographic and contrasting socioeconomic differences. Glycemic control, prevalence of cardiovascular risk factors, screening for chronic complications and the frequency that the recommended treatment goals were met using the American Diabetes Association guidelines were evaluated. Methods This was a cross-sectional, multicenter study conducted from December 2008 to December 2010 in 28 secondary and tertiary care public clinics in 20 Brazilian cities in north/northeast, mid-west, southeast and south regions. The data were obtained from 3,591 patients (56.0% females and 57.1% Caucasians) aged 21.2 ± 11.7 years with a disease duration of 9.6 ± 8.1 years (<1 to 50 years). Results Overall, 18.4% patients had HbA1c levels <7.0%, and 47.5% patients had HbA1c levels ≥ 9%. HbA1c levels were associated with lower economic status, female gender, age and the daily frequency of self-blood glucose monitoring (SBGM) but not with insulin regimen and geographic region. Hypertension was more frequent in the mid-west (32%) and north/northeast (25%) than in the southeast (19%) and south (17%) regions (p<0.001). More patients from the southeast region achieved LDL cholesterol goals and were treated with statins (p<0.001). Fewer patients from the north/northeast and mid-west regions were screened for retinopathy and nephropathy, compared with patients from the south and southeast. Patients from the south/southeast regions had more intensive insulin regimens than patients from the north/northeast and mid-west regions (p<0.001). The most common insulin therapy combination was intermediate-acting with regular human insulin, mainly in the north/northeast region (p<0.001). The combination of insulin glargine with lispro and glulisine was more frequently used in the mid-west region (p<0.001). Patients from the north/northeast region were younger, non-Caucasian, from lower economic status, used less continuous subcutaneous insulin infusion, performed less SBGM and were less overweight/obese (p<0.001). Conclusions A majority of patients, mainly in the north/northeast and mid-west regions, did not meet metabolic control goals and were not screened for diabetes-related chronic complications. These results should guide governmental health policy decisions, specific to each geographic region, to improve diabetes care and decrease the negative impact diabetes has on the public health system.

Business Clusters in Eastern Europe: Policy Analysis and Cluster Performance

Clusters have increasingly become an essential part of policy discourses at all levels, EU, national, regional, dealing with regional development, competitiveness, innovation, entrepreneurship, SMEs. These impressive efforts in promoting the concept of clusters on the policy-making arena have been accompanied by much less academic and scientific research work investigating the actual economic performance of firms in clusters, the design and execution of cluster policies and going beyond singular case studies to a more methodologically integrated and comparative approach to the study of clusters and their real-world impact. The theoretical background is far from being consolidated and there is a variety of methodologies and approaches for studying and interpreting this phenomenon while at the same time little comparability among studies on actual cluster performances. The conceptual framework of clustering suggests that they affect performance but theory makes little prediction as to the ultimate distribution of the value being created by clusters. This thesis takes the case of Eastern European countries for two reasons. One is that clusters, as coopetitive environments, are a new phenomenon as the previous centrally-based system did not allow for such types of firm organizations. The other is that, as new EU member states, they have been subject to the increased popularization of the cluster policy approach by the European Commission, especially in the framework of the National Reform Programmes related to the Lisbon objectives. The originality of the work lays in the fact that starting from an overview of theoretical contributions on clustering, it offers a comparative empirical study of clusters in transition countries. There have been very few examples in the literature that attempt to examine cluster performance in a comparative cross-country perspective. It adds to this an analysis of cluster policies and their implementation or lack of such as a way to analyse the way the cluster concept has been introduced to transition economies. Our findings show that the implementation of cluster policies does vary across countries with some countries which have embraced it more than others. The specific modes of implementation, however, are very similar, based mostly on soft measures such as funding for cluster initiatives, usually directed towards the creation of cluster management structures or cluster facilitators. They are essentially founded on a common assumption that the added values of clusters is in the creation of linkages among firms, human capital, skills and knowledge at the local level, most often perceived as the regional level. Often times geographical proximity is not a necessary element in the application process and cluster application are very similar to network membership. Cluster mapping is rarely a factor in the selection of cluster initiatives for funding and the relative question about critical mass and expected outcomes is not considered. In fact, monitoring and evaluation are not elements of the cluster policy cycle which have received a lot of attention. Bulgaria and the Czech Republic are the countries which have implemented cluster policies most decisively, Hungary and Poland have made significant efforts, while Slovakia and Romania have only sporadically and not systematically used cluster initiatives. When examining whether, in fact, firms located within regional clusters perform better and are more efficient than similar firms outside clusters, we do find positive results across countries and across sectors. The only country with negative impact from being located in a cluster is the Czech Republic.

A regional environmental accounting matrix and integrated environmental economic analyses to support regional planning

This research deals with the deepening and use of an environmental accounting matrix in Emilia-Romagna, RAMEA air emissions (regional NAMEA), carried out by the Regional Environment Agency (Arpa) in an European project. After a depiction of the international context regarding the widespread needing to integrate economic indicators and go beyond conventional reporting system, this study explains the structure, update and development of the tool. The overall aim is to outline the matrix for environmental assessments of regional plans, draw up sustainable reports and monitor effects of regional policies in a sustainable development perspective. The work focused on an application of a Shift-Share model, on the integration with eco-taxes, industrial waste production, energy consumptions, on applications of the extended RAMEA as a policy tool, following Eurostat guidelines. The common thread is the eco-efficiency (economic-environmental efficiency) index. The first part, in English, treats the methodology used to build a more complete tool; in the second part RAMEA has been applied on two regional case studies, in Italian, to support decision makers regarding Strategic Environmental Assessments’ processes (2001/42/EC). The aim is to support an evidence-based policy making by integrating sustainable development concerns at all levels. The first case study regards integrated environmental-economic analyses in support to the SEA of the Regional Waste management plan. For the industrial waste production an extended and updated RAMEA has been developed as a useful policy tool, to help in analysing and monitoring the state of environmental-economic performances. The second case study deals with the environmental report for the SEA of the Regional Program concerning productive activities. RAMEA has been applied aiming to an integrated environmental-economic analysis of the context, to investigate the performances of the regional production chains and to depict and monitor the area where the program should be carried out, from an integrated environmental-economic perspective.

Essays in policy evaluation

This dissertation consists of three empirical studies that aim at providing new evidence in the field of public policy evaluation. In particular, the first two chapters focus on the effects of the European cohesion policy, while the third chapter assesses the effectiveness of Italian labour market incentives in reducing long-term unemployment. The first study analyses the effect of EU funds on life satisfaction across European regions , under the assumption that projects financed by structural funds in the fields of employment, education, health and environment may affect the overall quality of life in recipient regions. Using regional data from the European Social Survey in 2002-2006, it resorts to a regression discontinuity design, where the discontinuity is provided by the institutional framework of the policy. The second study aims at estimating the impact of large transfers from a centralized authority to a local administration on the incidence of white collar crimes. It merges a unique dataset on crimes committed in Italian municipalities between 2007 and 2011 with information on the disbursement of EU structural funds in 2007-2013 programming period, employing an instrumental variable estimation strategy that exploits the variation in the electoral cycle at local level. The third study analyses the impact of an Italian labour market policy that allowed firms to cut their labour costs on open-ended job contracts when hiring long-term unemployed workers. It takes advantage of a unique dataset that draws information from the unemployment lists in Veneto region and it resorts to a regression discontinuity approach to estimate the effect of the policy on the job finding rate of long-term unemployed workers.