La salute detenuta: tra diritto e sicurezza”. Un’ indagine nella Casa Circondariale di Rimini.

The survey approachs the issue of health and the problem of its effective protection in a context of deprivation of liberty and coercion, which is the prison. The theoretical reflection born from the reform of the Legislative Decree 230/99 which marked the transition from an employee by the Prison Health within prison a fully integrated in the National Health Service. The comparison between an institution of health promotion and institution of punishment which may operate on the same subject held produces multiple attrits, making their relationship problematic. The work shows the daily difficulties in the management of prison health within the institution, physician-patient between different health care roles, and between the latter and prison workers. The coexistence, in fact, is not always harmonious though quite often it is common sense and the willingness of operators to reduce barriers: overcrowding, limited resources and insufficient staff make the application of the rule and therefore the right to goal a difficult to be pursued. It is designed for a scheme of semi-structured interview essay is divided into 3 sections covering: "staff and its functions", "health reform" and "health of the prisoner"; questions were directed to doctors, nurses and psychologists engaged inside the prison of Rimini with the specific aim of examining the ambivalent relationship between the demand for health care in prisons and the need for security and a clear - albeit partial - point of view. We tried to reconstruct the situation of prison health care through the perception of prison operators, capturing the problematic issues that deal on both issues is instrumental to the experience of persons detained by analyzing, in terms of operators , what happens inside of a prison institution in everyday health care.

Charity care and community benefits by hospital type in Texas

Hospital care is the largest component of the health care sector. This industry is made up of for profit hospital (FPH) organizations, not for profit (NFP) hospitals, and government (GOV) run hospital facilities. Objectives of this analysis were: (a) to conduct a literature review on NFP hospital legislation at the state level in Texas and at the federal level in the broader U.S.; and (b) to describe the types of charity care and community benefits currently being provided: by NFP hospitals compared to FPH hospitals and GOV hospitals; by hospitals geographic proximity to the Texas-Mexico border; and by hospital community type (rural, suburban, and urban); and (c) propose specific policy changes that may be needed to improve the current Texas State statute. Methods. In describing the historical and current policy context of NFP hospital legislation in the United States, federal legislation was reviewed from 1913 to the present and Texas State legislation was reviewed from 1980 to the present. In describing the provision of charity care, data from the 2008 Annual Cooperative Hospital Survey were examined by hospital organizational type, size, proximity to the border, and community type using linear regression and chi-squared tests to assess differences in charity care and community benefits. Results. The data included 123 NFP hospitals, 114 GOV hospitals, and 123 FPH. Results. Small sized (p<0.001) and medium sized (p<0.001) NFP hospitals provide a greater percent of total charity care when compared to FPH hospitals and to both GOV and FPH hospitals respectively; however, no significant difference in total charity care was found among large sized NFP hospitals when compared to FPH hospitals alone (p=.345) and both GOV and FPH facilities (p=.214). The amount of charity care provided was not found to be different based on proximity to the border or community type. Community benefit planning and budgeting was found to be similar regardless of community type and proximity to the border. Conclusion. No differences in charity care in Texas were found for large sized NFP hospitals compared to FPH and GOV hospitals. Contrary to widely held beliefs, this study did not find the border region to provide a greater amount of charity care or bad debt. Charity care also did not vary by community type. These findings underscore the need for continued collection of transparent data from all hospitals in order to provide policy makers and consumers with information on utilization trends to ensure benefits are being provided to the community. Policy changes or revoking tax-benefits may occur as charity care utilization declines with the implementation of health reform in the next few years.^

A integralidade no cuidado das pessoas vivendo com HIV e AIDS: a experiência do Centro de Referência e Treinamento em DST/AIDS da SES-SP

Ao assumir o compromisso com a prevenção e tratamento, baseada no princípio da integralidade, a estratégia brasileira, fez a diferença na resposta nacional à aids nas décadas de 1980/90 e criou um novo paradigma que mostrou-se avançado do ponto de vista técnico, ético e político, contribuindo para a mudança nas recomendações das agências internacionais (OMS\\Banco Mundial) - do \"não tratar e só prevenir\" do início dos anos 1990, para o \"Tratamento como Prevenção\", base da atual proposta dos 90/90/90. Essa estratégia de controle da epidemia concentra responsabilidade na Rede de Serviços, em um período de discussão sobre mudanças no modelo de atenção a ser priorizado no país. Características relevantes dos contextos político e programáticos permitiram uma maior efetivação do cuidado às PVHA no Estado de São Paulo. O objetivo do presente estudo é recuperar a história do Centro de Referência e Treinamento em DST/Aids (CRT) na gestão e organização programática do cuidado em HIV/Aids no Estado de São Paulo, no período de 1988 a 2015, interpretando-a sob a perspectiva dos aspectos facilitadores e limitadores da incorporação prática do princípio da integralidade às ações de saúde. Realizou-se, nesse sentido, uma revisão narrativa da literatura sobre o tema da integralidade no campo da Saúde Coletiva Brasileira nas últimas cinco décadas. Tomando por base o cotejamento com esse desenvolvimento conceitual, a trajetória do CRT foi analisada por meio de entrevistas com atores-chaves no processo da gestão e organização programática do cuidado das PVHA no Estado de São Paulo, e análise dos documentos produzidos no processo. Esta análise foi organizada em torno de dois grandes eixos temáticos: (1) a criação e estruturação do CRT, e (2) as relações entre o CRT, os Programas Municipais de DST/aids e a rede de serviços assistenciais no Estado de São Paulo. Entre os resultados do estudo, destacam-se o resgate e reflexão crítica sobre o desenvolvimento dos discursos tecnocientíficos sobre integralidade no contexto das propostas de reforma da saúde no Brasil; a incorporação desses construtos às propostas desenvolvidas pelo CRT, especialmente em torno aos conceitos de vulnerabilidade, cuidado, clínica ampliada e direitos humanos em saúde; e a identificação de arranjos institucionais, estratégias técnicas e configurações políticas que permitiram ao CRT o exercício articulado de três níveis de gestão do cuidado (das PVHA, dos serviços e da Rede) numa mesma plataforma. Conclui-se apontando alcances e limites na efetivação da integralidade, que se mostraram desiguais nos três níveis de gestão do cuidado. Aponta-se maiores avanços na dimensão gerencial da rede e as maiores dificuldades na efetivação da integralidade no cuidado das PVHA e na gestão dos serviços de saúde

Mortalidad evitable y políticas en salud: Colombia, 1985-2002

Introducción: La confianza en la capacidad de evitar algunas muertes o diferir su aparición es el fundamento de toda política de salud, uno de cuyos principales resultados debe ser reducir las muertes evitables, y controlar las condiciones que aumentan el riesgo de morir. Objetivos: Establecer variaciones en la tendencia de la mortalidad evitable (ME) registrada en Colombia entre 1985 y 2002, como indicadoras del impacto efectivo que las reformas en la política sanitaria pudieran haber tenido sobre sus determinantes. Métodos: Estudio de la ME con base en los registros oficiales de defunción y en las proyecciones censales de Colombia entre 1985-2002. Para determinar la evitabilidad, se aplicó un inventario de causas de ME (ICME) ajustado a las condiciones epidemiológicas del país durante el período que se analiza. Resultados: De las muertes registradas, 75.3% se clasificaron como evitables. Se identificaron siete patrones de tendencia que reflejan, de manera particular, los efectos de las políticas públicas sobre los determinantes de la mortalidad. Conclusiones: En general, la ME viene disminuyendo en Colombia desde 1985 en la población general y entre los hombres, sin variaciones significativas durante el período. Las variaciones en la tendencia de las tasas ajustadas de varios grupos de causas hacen pensar en un deterioro en el control de sus determinantes, especialmente desde 1990. Los cambios aplicados en las políticas públicas durante los últimos años no se reflejaron en un mejor control de las muertes evitables, aunque el gasto en salud aumentó de modo muy notable en el país.

Lessons learned . . . about curriculum: Five years on and half a world away

The knowledge, skills, and attitudes manifested in health and physical education school curricula are an arbitrary selection of that which is known and valued at a particular place and time. Bernstein's (2000) theories of the social construction of knowledge offer a way to better understand the relationship among the production, selection, and reproduction of curricular knowledge. This article overviews contemporary knowledge in the primary field (production) on which curriculum writers in the recontextualizing field might draw. It highlights tensions in the knowledge generated within the primary field and, using a case of the USXs National Standards for Physical Education (NASPE), demonstrates how particular discourses become privileged when translated into curriculum documents in the recontextualizing field

Revolution or evolution:the challenges of conceptualizing patient and public involvement in a consumerist world

Background Changing the relationship between citizens and the state is at the heart of current policy reforms. Across England and the developed world, from Oslo to Ontario, Newcastle to Newquay, giving the public a more direct say in shaping the organization and delivery of healthcare services is central to the current health reform agenda. Realigning public services around those they serve, based on evidence from service user's experiences, and designed with and by the people rather than simply on their behalf, is challenging the dominance of managerialism, marketization and bureaucratic expertise. Despite this attention there is limited conceptual and theoretical work to underpin policy and practice. Objective This article proposes a conceptual framework for patient and public involvement (PPI) and goes on to explore the different justifications for involvement and the implications of a rights-based rather than a regulatory approach. These issues are highlighted through exploring the particular evolution of English health policy in relation to PPI on the one hand and patient choice on the other before turning to similar patterns apparent in the United States and more broadly. Conclusions A framework for conceptualizing PPI is presented that differentiates between the different types and aims of involvement and their potential impact. Approaches to involvement are different in those countries that adopt a rights-based rather than a regulatory approach. I conclude with a discussion of the tension and interaction apparent in the globalization of both involvement and patient choice in both policy and practice. © 2009 Blackwell Publishing Ltd.

Economic Evaluations of State Policies

Thesis (Ph.D.)--University of Washington, 2016-08

Defences in medical negligence : to what extent has tort law reform in Australia limited the liability of health professionals?

Tort law reform has resulted in legislation being passed by all Australian jurisdictions in the past decade implementing the recommendations contained in the Ipp Report. The report was in response to a perceived crisis in medical indemnity insurance. The objective was to restrict and limit liability in negligence actions. This paper will consider to what extent the reforms have impacted on the liability of health professionals in medical negligence actions. The reversal of the onus of proof through the obvious risk sections has attempted to extend the scope of the defence of voluntary assumption of risk. There is no liability for the materialisation of an inherent risk. Presumptions and mandatory reductions for contributory negligence have attempted to reduce the liability of defendants. It is now possible for reductions of 100% for contributory negligence. Apologies can be made with no admission of legal liability to encourage them being made and thereby reduce the number of actions being commenced. The peer acceptance defence has been introduced and enacted by legislation. There is protection for good samaritans even though the Ipp Report recommended against such protection. Limitation periods have been amended. Provisions relating to mental harm have been introduced re-instating the requirement of normal fortitude and direct perception. After an analysis of the legislation, it will be argued in this paper that while there has been some limitation and restriction, courts have generally interpreted the civil liability reforms in compliance with the common law. It has been the impact of statutory limits on the assessment of damages which has limited the liability of health professionals in medical negligence actions.

Defences in medical negligence : to what extent has tort law reform in Australia limited the liability of health professionals?

Tort law reform has resulted in legislation being passed by all Australian jurisdictions in the past decade implementing the recommendations contained in the Ipp Report. The report was in response to a perceived crisis in medical indemnity insurance. The objective was to restrict and limit liability in negligence actions. This paper will consider to what extent the reforms have impacted on the liability of health professionals in medical negligence actions. After an analysis of the legislation, it will be argued in this paper that while there has been some limitation and restriction, courts have generally interpreted the civil liability reforms in compliance with the common law. It has been the impact of statutory limits on the assessment of damages through thresholds and caps which has limited the liability of health professionals in medical negligence actions.

Health and safety regulatory reform in Australia : challenges and issues for smaller ethnic firms

In recent times significant change has occurred to the Australian health and safety regulatory context. In this paper we consider the potential response of smaller firms in general, and ethnic owned and/or operated smaller firms in particular. We draw on literature examining smaller firms' responses to regulation and apply this to what little we know about smaller ethnic firms in Australia in the context of the regulatory change. We highlight the challenges to owner managers and what could be done to engage and support smaller ethnic firms to realise the opportunities resulting from this regulatory change.

Health complaints and regulatory reform: Implications for vulnerable populations?

Complaints and disciplinary processes play a significant role in health professional regulation. Many countries are transitioning from models of self-regulation to greater external oversight through systems including meta regulation, responsive (risk–based) regulation, and “networked governance”. Such systems harness, in differing ways, public, private, professional and non-governmental bodies to exert influence over the conduct of health professionals and services. Interesting literature is emerging regarding complainants’ motivations and experiences, the impact of complaints processes on health professionals and identification of features such as complainant and health professional profiles, types of complaints and outcomes. This paper concentrates on studies identifying vulnerable groups and their participation in health care regulatory systems.

Health insurance as a strategy for access : Streamlined facts of the Colombian Health Care Reform

La reforma colombiana al sistema de salud (Ley 100 de 1993) estableció, como estrategia para facilitar el acceso, la universalidad de un seguro de salud que se adquiere mediante la cotización en el régimen contributivo o mediante la afiliación gratuita al régimen subsidiado, con la meta de cubrir a toda la población con un plan de beneficios único que comprende servicios de todos los niveles de atención. En el documento se analizan los principales hechos estilizados de la reforma en cuanto a cobertura del seguro y acceso y, mediante modelos logit, se estiman los determinantes de la afiliación y del acceso, con datos de las encuestas de calidad de vida de 1997 y 2003. Se destaca que la cobertura pasó del 20% de la población en 1993 al 60% en 2004, aunque parece imposible alcanzar la universalidad; la estructura y evolución de la cobertura muestran que los dos regímenes son complementarios, de modo que mientras el contributivo tiene mayor presencia en las ciudades y entre la población con empleo formal, el subsidiado tiene mayor peso entre la población rural y con bajos niveles de ingresos; por otra parte, el seguro tiene ventajas para la población subsidiada, con una mayor probabilidad de utilización de servicios, aunque el plan es inferior al del contributivo y existen barreras para el acceso.

Essays on health care reform, wealth inequality, and demography

This thesis contains three chapters. The first chapter uses a general equilibrium framework to simulate and compare the long run effects of the Patient Protection and Affordable Care Act (PPACA) and of health care costs reduction policies on macroeconomic variables, government budget, and welfare of individuals. We found that all policies were able to reduce uninsured population, with the PPACA being more effective than cost reductions. The PPACA increased public deficit mainly due to the Medicaid expansion, forcing tax hikes. On the other hand, cost reductions alleviated the fiscal burden of public insurance, reducing public deficit and taxes. Regarding welfare effects, the PPACA as a whole and cost reductions are welfare improving. High welfare gains would be achieved if the U.S. medical costs followed the same trend of OECD countries. Besides, feasible cost reductions are more welfare improving than most of the PPACA components, proving to be a good alternative. The second chapter documents that life cycle general equilibrium models with heterogeneous agents have a very hard time reproducing the American wealth distribution. A common assumption made in this literature is that all young adults enter the economy with no initial assets. In this chapter, we relax this assumption – not supported by the data – and evaluate the ability of an otherwise standard life cycle model to account for the U.S. wealth inequality. The new feature of the model is that agents enter the economy with assets drawn from an initial distribution of assets. We found that heterogeneity with respect to initial wealth is key for this class of models to replicate the data. According to our results, American inequality can be explained almost entirely by the fact that some individuals are lucky enough to be born into wealth, while others are born with few or no assets. The third chapter documents that a common assumption adopted in life cycle general equilibrium models is that the population is stable at steady state, that is, its relative age distribution becomes constant over time. An open question is whether the demographic assumptions commonly adopted in these models in fact imply that the population becomes stable. In this chapter we prove the existence of a stable population in a demographic environment where both the age-specific mortality rates and the population growth rate are constant over time, the setup commonly adopted in life cycle general equilibrium models. Hence, the stability of the population do not need to be taken as assumption in these models.