Um desafio para a regulação do mercado de assistência à saúde no Brasil: a escolha do consumidor de planos de saúde

The objective of this dissertation is to discover and to analyze the way how the consumer uses his/her perception to decide contracting a health plan, to supply elements that can serve to subsidize the State, the market and the consumers, in relation to the knowledge on the process of choice of the consumer and the decisions of purchase and contracting services of private health. The estimated one is to evidence that the brand of health plan is an important variable and decisive to the consumer contracting the service of a company that operates in these sector, because mean for the consumer security about the product, through the symbolism that the same one represents, despite the consumer not knowing to the certainty what is contracting in quality and amount. The theoretical construction is carried through using literature of anthropology of the consumption, theory of modernity, theory of the regulation, economic utilitarism, and marketing. Moreover, referential specific theoretician on the regulation of the market of health plans in Brazil. The health plan market in Brazil is anti-symmetrical and the consumer doesn¿t have knowledge technician who makes possible it to form judgment and to carry through rationality choices. Than the consumer uses to his/her decision symbolic elements that are available to his/her and supply to his/her the security that is look likes in the consumption of this kind of good. These symbolic elements related the confidence and security and are into the strong brands of the companies and are transmitted to the consumer through the mass media. In this dissertation are used as sources of data some information of the regulatory agency of the sector ¿ ANS -, a research of public opinion with health plans users and the results of the application of proper questionnaires for this research.

A Síndrome de Burnout no trabalho de assistência à saúde : estudo junto aos profissionais de equipe de enfermagem do Hospital Santa Casa de Misericórdia de Porto Alegre

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Saúde indígena na Amazônia brasileira : estudo de caso sobre a experiência de gestão conveniada da assistência à saúde da população indígena do alto rio Negro -AM

Esta pesquisa é um estudo de caso que analisa a experiência realizada pela Federação das Organizações Indígenas do Rio Negro – FOIRN, em convênio com a Fundação Nacional de Saúde – FUNASA, na gestão do sistema de serviços de saúde para a população indígena do alto rio Negro – Amazonas, no período de 2002 a 2006. Foram realizadas entrevistas com atores-chave por meio de roteiro semi-estruturado e analise de documentos. Os resultados indicam uma falta de articulação entre as conveniadas. Verificou-se que não houve transparência de decisões entre as partes, ou preocupação com a qualificação para tratar de uma questão tão complexa quanto a saúde dos indígenas do rio negro. Ainda, os recursos eram transferidos de maneira irregular e em volume insuficiente, causando descontinuidade e problemas de gestão da política. Conclui-se que ainda exista um caminho a ser percorrido pelas organizações que se submeteram a executar a gestão da saúde indígena dos povos rio-negrinos para a obtenção de um serviço de qualidade em razão de suas especificidades e a da complexidade da gestão.

Regionalização dos serviços de assistência à saúde: uma nova configuração estratégica da operadora Fesp

O segmento suplementar de saúde no Brasil apresenta hoje, substancial importância no cenário nacional, não só por sua abrangência e capilaridade, mas também por sua relevância econômica. Neste cenário, destaca-se o segmento de cooperativas médicas Unimed, que atendem hoje cerca de 8% da população brasileira e detém mais de 33% do marketshare do setor. Desde o advento do marco regulatório do setor no Brasil, a saúde suplementar vem sendo submetida a um rigoroso processo de reestruturação enquanto segmento econômico, que ano após ano, vem reduzindo a autonomia de livre negociação de preços e ampliando o rol de procedimentos obrigatórios para as operadoras. Diante deste cenário e sob a temática da estratégia empresarial, propôs-se um estudo exploratório da Federação das Unimeds do Estado de São Paulo (Fesp), avaliando criticamente o modelo de regionalização adotado em sua operadora, caracterizando-se como uma nova configuração estratégica, alinhada à realidade regulatória do setor e ao ambiente competitivo de mercado no qual está inserida.

É possível a participação de capital estrangeiro em operadoras de planos privados de assistência à saúde com rede própria?

Este estudo objetiva averiguar a possibilidade de participação direta ou indireta de capital estrangeiro em operadoras de planos privados de assistência à saúde, no Brasil, que possuem rede própria. Utilizando técnicas interpretativas da hermenêutica jurídica, como o método histórico evolutivo, sistemático e teleológico, busca-se entender a inteligência exegética do artigo 199, §3o, da Constituição Federal. Considerando-se que este dispositivo constitucional vedou a participação direta ou indireta de capital estrangeiro na assistência à saúde, salvo nos casos previstos em lei, o estudo revela em que hipóteses a vedação foi excepcionada e se a exceção infraconstitucional abrange as operadoras de plano de saúde que possuem rede própria. Ademais, o estudo analisa o posicionamento da Agência Nacional de Saúde (ANS), na aquisição da Amil Participações S.A, pela operadora norte-americana United Health Group Incorporated. A análise desta operação se torna de muita relevância ao estudo, pois envolve a maior operadora de planos de saúde com rede própria do país, além de ter a presença da maior importância de capitais estrangeiros na assistência à saúde na história do Brasil.

Carga de trabalho de enfermagem e infecções relacionadas à assistência à saúde na unidade de terapia intensiva

In recent decades, the search for quality care has been widely discussed by the institutions and health professionals. In this context, it is the nurse coordinator of the process of providing nursing staff, reflecting the commitment to quality of care. In this process, it is the appearance of Infections Related to health care and its potential association with the workload in nursing as a valuable indicator of quality of care. Thus, this research contributes to studies to characterize the demand of nursing work to promote a safe healthcare practice. This study aimed to identify the association of nursing workload with the number of cases of Ventilator-Associated Pneumonia, urinary tract infection and central venous catheter infection in the intensive care unit. This is a quantitative research approach, descriptive, cross-sectional and prospective, held at Unimed Hospital in Natal-RN. The study population consisted of all patients treated in the Intensive Care Unit, Hospital for a period of 90 consecutive days in 2011. The convenience sample was compostapelos patients admitted to the ICU during the period of data collection, a total sample of 286 patients. To perform the data analysis software were used: Statistica 6.0, SPPS (Statistical Package for Social Sciences) version 17.0 (2004) and Excel 2007. In the descriptive analysis, we used Measures of Central Tendency and Measures of Dispersion or Variability and the use of nonparametric tests. Of the 286 patients, 88 were from the ICU and 198 ICU II II. Males predominated in the ICU I (51.1%) and female ICU II (57.6%) patients in the ICU I were aged 61-80 years (39.8%) followed by greater than 80 years (39.8%). In the ICU II, most of the patients were aged 61-80 years (38.9%) and then from 41 to 60 years (24.2%). In relation to the class of TISS inlet predominant class II in the two ICUs (59.1%), followed by Class III also in the two units (34.6%). Most patients (70.6%) out of the ICUs belonging to class II TISS. In the ICU I, the average number of forms of the TISS 28 was 6, has in ICU II this value drops to 3.2 forms. The overall mean was 19.9 TISS points in ICU patients I and ICU II.the 17 points in the average hours required to provide adequate nursing care to patients in the ICU I found that is 10 , 7 hours, and the ICU II 9.2 hours. It was found that the time provided by the nursing staff were higher in ICU II, with an average of 19 hours available for nurses in this sector. In the ICU I, which showed higher need of available hours, it was found that the mean value of 12.7 available hours. It was found that only 2.4% of patients had these units Ventilator-Associated Pneumonia, 1.0% were infected central venous catheter and 1.4% of patients had urinary tract infection. Infection associated with health care occurs, on average, on the tenth day of hospitalization. In the ICU II, this average value extends to the twelfth day with an excess of 2.7 hours of nursing care while in ICU I value decays to the ninth day of hospitalization with a deficiency of 12-hour assistance. It is concluded that patients generally showed a need for classification of semi-intensive care and has been assisted in their need to load. As for his association with the Related Infections Health will assist this analysis could not be performed due to the small number of notifications in this period. It is suggested further study how other factors related to infections me a longer period of analysis

Avaliação clínica da saúde bucal de crianças com neoplasias malignas atendidas no Hospital Infantil Varela Santiago em Natal-RN

The childhood cancer is characterized by a predominance of hematogenic and lymphatic system neoplasm, although a fTequency of the central nervous system tumors and sarcomas are widely common. Particularities of many childhood cancers and the adverses effect of the antineoplastic agents can change radically the oral environrnent and predisposes to the risk of oral complications. This study assessment clinically the oral health of 40 children on treatment for different types of malignant neoplasm with age range of O to 1S years old (Group I) and compared to 38 nonnal children in the same age range (Group lI). The results shown that nonnal patients had a gingival bleeding index (GBI) and caries experience minar than patients of Group lI, the visivel plaque index (VPI) was lightly higher in patients of Group 1. There was not difference statistically significant in the variables. Sixteen patients of Group I developed together 61 oral complications with predominance of mucositis, followed by spontaneous oral bleeding, candidiasis and xerostomy, that complication were most commons in patients with systemic neoplasm. Its was concluded that patients submitted to antineoplastic therapy with poor oral health had a higher risk to develop oral complications

Avaliação da estratégia saúde da família na capital potiguar

This research aimed to evaluate the Family Health Strategy (FHS) in Natal, Rio Grande do Norte, through its managers, professionals and users, having as its support the Theory of Belief and the Cognitive-Behavioral Theory. This is a multimethod research and is divided into three sub-studies. In the first study, nine managers answered to a semi-structured interview, to verify the knowledge and beliefs on SUS; the quantitative data were analyzed with descriptive statistics with the aid of SPSS software and the qualitative data were submitted to lexical analysis with support of ALCESTE software. In the second study, we have a descriptive correlational research in which the antecedent variables are related to working conditions in the family health units (FHUs) and to the professionals‟ profile; the corresponding variables refer to the evaluations of the FHS; a stratified probabilistic sample with 475 professionals, who answered to two scales, both consisting of three factors: Physical infrastructure, Material resources, and Treatment effectiveness, and data were analyzed using descriptive, bivariate and multivariate statistics, with the aid of SPSS. The third study is a descriptive correlational research in which the antecedent variables refer to the treatment in the FHUs and to the users‟ profile, and the corresponding variables refer to the evaluations of the FHS, with a stratified non-probabilistic sample with 390 users, who contributed to the construction of a new scale with a factor, effectiveness in treatment, analyzed through descriptive, bivariate and multivariate statistics, with the aid of SPSS. The results showed problems which start from management, under the shape of admission due to political indication and lack of knowledge on SUS and the FHS; they pass through the low tenure of professionals and insufficient professional; and they end up spreading all over the analyzed items: infrastructure of FHUs, material resources, professionals‟ training, accessibility and referral system. One concludes that, despite following an ideal model, the FHS is in need of changes with regard to the barriers to its operational reality

O Serviço Social nas operadoras de planos privados de assistência à saúde: demandas, atribuições e respostas profissionais

The present study deals with the exercise of professional social workers in private health care plans registered with the Regional Council of Medicine/RN, in the city of Natal/RN, with regards to the demands/tasks, work conditions, and the professional response, given the climate of restructuring the capital. The set of socio-historical transformations, as a results of the dynamic capitalist, is a process of new configurations in relation to state and society that interfere directly in relation to working conditions, social rights historically won by workers. In this context, the operator of health plans arises as a possibilities to provide services in health, through the logic of the market, in which the subjects of law, become consumers contributing to the displacement of the responsibilities of the State. Obligating workers to lessen the burden with the reproduction of their workforce. This involves changing societal context for social service, since it is one of the professions that are active in terms of the immediate social issue, and come as part of the collective worker. From qualitative research based on a theoretical and methodological perspective and critical dialectics, it was possible to unveil some features and trends of the exercise of(a) social operators in private health care plans. The survey results indicated that : a) the demands and duties for certain social service, are associated with the redevelopment of the capital, whose requirements and responsibilities professionals have with their needs, particularly the guarantee of profit, services rendered; b) in the conditions of work there is a trend of insecurity uncertainty and dismantling of professionals; c) the answers professionals suffer the limits and contradictions present in the daily training, mainly depending one the characteristics of management and operation of the operators, which has professional relative autonomy

Avaliação da atenção à saúde da criança no contexto da Saúde da Família no município de Teixeiras, Minas Gerais (MG, Brasil)

Este estudo tem como objetivo analisar a atenção à saúde da criança pelo Programa de Saúde da Família (PSF) do município de Teixeiras, MG, Brasil. Foi aplicado um questionário a 161 mães de crianças menores de dois anos. Utilizou-se um sistema de escores específicos para análise das dimensões de estrutura, processo e resultado e seus respectivos atributos, classificando o município nos cenários incipiente, intermediário e avançado. Configurou-se, na síntese, um cenário intermediário (49,6%) para o PSF, caracterizado por uma atenção à saúde da criança fragmentada, mas com avanços na organização da atenção para este grupo. Foram consideradas incipientes as instalações físicas, a qualidade do cuidado no controle da diarréia e das infecções respiratórias, a participação comunitária e a intersetorialidade. Os avanços estiveram relacionados ao acolhimento realizado pelo programa, no entanto, as atividades preventivas e promocionais do PSF demonstram que o programa surge como um suporte do hospital e mais um local de atendimento médico. A atuação do PSF na atenção a saúde das crianças distancia-se da proposta de reorientação do modelo assistencial hegemônico, pela qual foi criado, dificultando estratégias na prevenção de doenças e na promoção da saúde.

Associação entre condição periodontal de gestantes e variáveis maternas e de assistência à saúde

Objective: To evaluate the periodontal condition of pregnant women and to analyze the influence of maternal variables - socioeconomic-demographic data, health, deleterious habits and access to dental service - and the existence of the Family Health Program (FHP) at the public assistance services to pregnant women. Method: This evaluation was part of a cohort study with pregnant women and children conducted in two cities of the São Paulo State, one of which with an implemented FHP. Oral examinations were done using the Community Periodontal and Periodontal Attachment Loss Indexes, and semi-structured interviews with the pregnant women at their homes. Data were analyzed statistically by the chi-square test and Fisher's exact test at 5% significance level (α=0.05). Results: All pregnant women (n=119) registered at the public health service of each city were examined. The mean age was 24.7 years; 61.4% were black or black/white mixed-race women; most (65.5%) earned 2-3 minimum wages, and only 6.7% initiated higher education. Only 8% of the patients presented periodontal health. Bleeding and calculus were observed in 66% of them, and shallow and deep periodontal pockets in 20%. Periodontal attachment loss > 4 mm was observed in 24% of the pregnant women. The group was homogeneous as to the maternal characteristics, age (p=0.0384) and smoking (p=0.0102) being the only factors associated with periodontal disease. The existence of a FHP at the public assistance service was not associated with a lower prevalence of the disease. Conclusion: The findings of this study show a high prevalence of periodontal alterations during pregnancy, with no influence from the existence of a FHP on the observed conditions. Among the risk variables, age and smoking were the factors associated with the presence of periodontal disease. There is a need for a better planing and accomplishment of oral health actions during the prenatal period.

Aplicação de sistema de informações geográficas para avaliação de risco à saúde humana

Pós-graduação em Geociências e Meio Ambiente - IGCE

Avaliação da assistência ao parto no Hospital das Clínicas da Faculdade de Medicina de Botucatu

Pós-graduação em Ginecologia, Obstetrícia e Mastologia - FMB

Estudo da ocorrência de atitudes discriminatórias na assistência à saúde de pessoas com HIV/AIDS

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação do acesso à saúde aos níveis de atenção de maior complexidade no município de Marília/SP, sob a ótica da integralidade

Pós-graduação em Enfermagem (mestrado profissional) - FMB