Commodification of health care systems: The Catalan case

Commodification of the public healthcare system has been a growing process in recent decades, especially in universal healthcare systems and in high-income countries like Spain.  There are substantial differences in the healthcare systems of each autonomous region of Spain, among which Catalonia is characterized by having a mixed healthcare system with complex partnerships and interactions between the public and private healthcare sectors.  Using a narrative review approach, this article addresses various aspects of the Catalan healthcare system, characterizing the privatization and commodification of health processes in Catalonia from a historical perspective with particular attention to recent legislative changes and austerity measures.  The article approximates, the eventual effects that commodification and austerity measures will have on the health of the population and on the structure, accessibility, effectiveness, equity and quality of healthcare services.

Hospital público português: da crise à renovação?

RESUMO - Este artigo descreve a evolução do estatuto jurídico do hospital público português, com o intuito de o caracterizar, em especial do ponto de vista da sua autonomia. Considera-se que, pelo menos em parte, o estatuto jurídico do hospital público português é responsável pela limitada autonomia de que estas instituições gozaram nos últimos sessenta anos, com as consequentes ineficiências na produção e produtividade, fraca equidade no acesso e aumento de custos com a prestação de cuidados, de discutível qualidade. Nessa medida, várias reformas foram implementadas com o intuito de conferir ao hospital maior autonomia: ao nível da gestão, do financiamento e também reformas organizacionais. De um sistema regionalizado, estabelecido em 1946, até ao Serviço Nacional de Saúde e ao hospital dos nossos dias foram adoptados diversos modelos estatutários. A reforma de 2002 pretende estabelecer uma clara fronteira entre o hospital público, administrativo, burocratizado e aquele que assume natureza empresarial, numa clara viragem — demasiado precoce? — com as «experiências inovadoras » subsequentes à Lei de Bases da Saúde, que permitiram concluir que à maior autonomia correspondiam atitudes e resultados pró-activos e positivos. Por outro lado, ultima-se a preparação da construção de dez novos hospitais com recurso a parcerias público-privadas (PPP), sem ainda estarem definidos quais os estatutos, grau de autonomia e forma de gestão destas entidades. Ainda é cedo para avaliar esta última reforma; não deverá, no entanto, perder-se de vista que a implementação de um novo estatuto jurídico para os hospitais terá necessariamente de permitir a sua renovação sem descurar a sua secular missão de solidariedade.

De un modelo tradicional de concesión a un esquema renovado de app para el desarrollo de proyectos de infraestructura vial en Colombia

En la presente investigación se contrasta el Modelo Tradicional de Concesión con el Renovado Esquema de Asociación Público Privada propuesto por la Ley 1508 de 2011 y sus decretos reglamentarios, para establecer, a partir de puntos de contacto y fuga entre una y otra institución, que existe una verdadera transformación del paradigma; y que, este modelo mejorado de participación privada que cuenta con sus propios rasgos definitorios, se erige en principio, como una solución a las exigencias actuales de los proyectos viales de la Cuarta Generación de Concesiones en Colombia, pero a la vez da apertura al debate para la construcción académica del conocimiento, por su reciente implementación.

Essays on incentives, procurement and regulation

Esta tese é composta de três artigos. No primeiro artigo, "Simple Contracts under Simultaneous Adverse Selection and Moral Hazard", é considerado um problema de principal-agente sob a presença simultânea dos problemas de risco moral e seleção adversa, em que a dimensão de seleção adversa se dá sobre as distribuições de probabilidade condicionais as ações do agente. No segundo artigo, "Public-Private Partnerships in the Presence of Adverse Selection" é analisada a otimalidade de parcerias público-privadas sob a presença de seleção adversa. No terceiro artigo, "Regulation Under Stock Market Information Disclosure", por sua vez, é considerado o problema da regulação de firmas de capital aberto, onde as firmas possuem incentivos para mandar sinais opostos para o regulador e o mercado.

Parcerias com o setor privado em serviços de saúde e inovações na gestão da atenção básica: o caso da rede municipal de Suzano, SP

O objetivo dessa pesquisa é fazer uma avaliação dos resultados obtidos por novas políticas de saúde implementadas em escala municipal. Essa avaliação foi feita pela caracterização do processo de cessão parcial da rede de Atenção Básica de um município de médio porte - Suzano, SP - para gestão pelo setor privado por meio de convênio. A parceria com o setor privado na prestação de serviços de saúde é uma das mais importantes políticas introduzidas no Sistema Único de Saúde (SUS) desde sua criação; contudo, existem poucos estudos que avaliem o seu impacto na saúde da população ou no acesso aos serviços de saúde, e isso se deve à falta de compreensão sobre os variados tipos de interação entre o sistema de saúde e os atores sociais e instituições que estão envolvidos em sua implementação e gestão. O estudo foi realizado com pesquisa bibliográfica sobre a contratualização, convênios e parcerias na saúde brasileira, seguida de trabalho de campo no município de Suzano. Lá foram ouvidos gestores públicos na Secretaria Municipal de Saúde (SMS) e, depois, foram realizadas 19 entrevistas semi-estruturadas com gerentes, médicos e enfermeiros de 12 equipamentos de saúde da rede de Atenção Básica municipal. Depois foram realizadas outras 4 entrevistas com gestores da SMS. O conjunto de unidades investigado reflete a diversidade de bairros, populações e necessidades de saúde de um município de porte médio, com uma rede de saúde bastante sofisticada e avaliada positivamente dentro dos parâmetros nacionais. Verificou-se que, apesar das dificuldades e dos objetivos que ainda não foram alcançados, existe um padrão recorrente na gestão do SUS que é bastante positivo: as reformas federais que foram implementadas paulatinamente desde 1990 têm baseado-se em avaliações corretas sobre os problemas do SUS e, ainda que lentamente, têm conseguido produzir transformações positivas no mesmo.

Estudo da gestão de aterros sanitários através de consórcios públicos e públicos-privados

The growing population, purchasing power and changing the profile of Brazilian consumers are the facts to justify the increase in waste production in the country. According to the National Research Sanitation made by IBGE in 2000, Brazil produced 241,614 tons of waste per day, equivalent to approximately 90 million tons per year. This growth leads researchers to consider a better way to dump this material in order to mitigate the damage to population health and the environment. For this, one of the possible actions is the search for alternative disposal technological development, a possible solution being the construction of landfills. But many cities, especially those from regions of poor or agricultural base, do not always have sufficient resources and open spaces for the construction of a landfill as required by law. Fits like a context in which it operates as an alternative technology for inter-municipal consortia landfill and public-private partnerships in order to contribute to the sustainable development of cities. The law that regulates public consortia is the Federal Law 11.107 of April 2005, as the law that regulates and makes possible the Public-Private Partnership is the Federal Law 11.079 of 2004. Consortia are entities that bring together several municipalities, with or without the State and the Union to carry out joint actions that if were borne singly, not would achieve the same results or would lose a greater volume of resources, and would demand more time. The public-private partnership consist of one or more municipalities and a private company, selected by public tender, which becomes responsible for implementation, maintenance and operation of the landfill. This practice can performed on the model of concession, in which public administration is direct or indirect user, with or without installation and ... (Complete abstract click eletronic access below)

Economic crisis and national health system

The text analyzes the impact of the economic crisis in some critical aspects of the National Health System: outcomes, health expenditure, remuneration policy and privatization through Private Public Partnership models. Some health outcomes related to social inequalities are worrying. Reducing public health spending has increased the fragility of the health system, reduced wage income of workers in the sector and increased heterogeneity between regions. Finally, the evidence indicates that privatization does not mean more efficiency and better governance. Deep reforms are needed to strengthen the National Health System.

Tourism education in Ireland : an analysis of the provision of third level tourism education in Ireland focusing on the needs of the public, private and voluntary sectors

Tourism education in Ireland has witnessed a transformation within the last four decades since CERT introduced the first fundamentals of training in the 1960’s. An analysis of the provision of tourism education in Ireland, focusing on the needs of the public, private and voluntary sectors was the main focus of this study and concentrates mainly on third level provision of tourism education within the island of Ireland. The study examines the role of tourism education in Ireland, establishing any current or emerging trends in third level tourism provision. It identifies and analyses the main stakeholders in the public, private and voluntary sectors and investigates if any requirements exist in the provision of third level education. The multi-faceted nature of the tourism industry has resulted in the provision of a diverse range of educational courses. As a result of this diversity, a question hangs over the status of tourism as a professional discipline within itself. Other issues identified through this study are the over provision of tourism courses and the current and future disparity within tourism education. The qualitative nature of the research involved questioning of major stakeholders and educators who influence tourism education provision and developing an overview of the current status of tourism education provision in Ireland identifying the present needs of each sector. Finally several strategies are suggested which may enhance third level tourism education in the future.

The private and fiscal returns to schooling and the effect of public policies on private incentives to invest in education: a general framework and some results for the EU

This paper develops a comprehensive framework for the quantitative analysis of the private and fiscal returns to schooling and of the effect of public policies on private incentives to invest in education. This framework is applied to 14 member states of the European Union. For each of these countries, we construct estimates of the private return to an additional year of schooling for an individual of average attainment, taking into account the effects of education on wages and employment probabilities after allowing for academic failure rates, the direct and opportunity costs of schooling, and the impact of personal taxes, social security contributions and unemployment and pension benefits on net incomes. We also construct a set of effective tax and subsidy rates that measure the effects of different public policies on the private returns to education, and measures of the fiscal returns to schooling that capture the long-term effects of a marginal increase in attainment on public finances under c

The Private and fiscal returns to schooling and the effect of public policies on private incentives to invest in education: a general framework and some results for the EU

This paper develops a comprehensive framework for the quantitative analysis of the private and fiscal returns to schooling and of the effect of public policies on private incentives to invest in education. This framework is applied to 14 member states of the European Union. For each of these countries, we construct estimates of the private return to an additional year of schooling for an individual of average attainment, taking into account the effects of education on wages and employment probabilities after allowing for academic failure rates, the direct and opportunity costs of schooling, and the impact of personal taxes, social security contributions and unemployment and pension benefits on net incomes. We also construct a set of effective tax and subsidy rates that measure the effects of different public policies on the private returns to education, and measures of the fiscal returns to schooling that capture the long-term effects of a marginal increase in attainment on public finances under conditions that approximate general equilibrium.

Inequality in education in Costa Rica: The gap between students in public and private schools. An analysis of the results of the Programme for International Student Assessment (PISA)

Includes bibliography.

Statewide Economic Impacts of Disaster-Related Payments to Support Household and Private and Public Sector Recovery in Iowa, January 2010

There have been a multitude of programs providing assistance to the state of Iowa in the past 18 months. Springtime 2008 disasters resulted in tornado damage and widespread flood damage to large fractions of the state. In consequence, there was a very large flow of federal and state resources dedicated to assisting community and statewide recovery efforts. The nation was in recession as well and continued to be in recession through much of 2009. A sizeable amount of assistance found its way to Iowa under the American Recovery and Reinvestment Act of 2009 in the forms of infrastructure stimulus spending, income supports and other safety net spending for households, and stabilization assistance for essential public services like education. On top of that, the state of Iowa authorized the I Jobs program as an additional infrastructure development program, and as a jobs stimulus program. The total amount of spending for all types of programs, disaster or economic recovery related, is perhaps as high as $7.5 billion over the next few years.

The effect of mastery learning on a course in accounting information system (AIS): A comparison within public and private universities in Taiwan

The Accounting Information System (AIS) is an important course in the Department of Accounting (DoAc) of universities in Taiwan. This course is required for seniors not only because it meets the needs of the profession, but also because it provides continual study for the department's students.^ The scores of The National College and University Joint Entrance Examination (NUEE) show that students with high learning ability are admitted to public universities with high scores, while those with low learning ability are admitted only to private universities. The same situation has been found by the researcher while teaching an AIS course in DoAc of The Public Chun Shin University (CSU) and The Private Chinese Culture University (CCU).^ The purpose of this study was to determine whether low ability students enrolled in private universities in Taiwan in a mastery learning program could attain the same level as high ability students from public universities enrolled in a traditional program. An experimental design was used. The mastery learning method was used to teach three groups of seniors with low learning ability studying in the DoAc at CCU. The traditional method was used to teach the control group which consisted of senior students of DoAc of CSU with high learning ability. As a part of the mastery learning strategy, a formative test, quizzes, and homework were completed by the experimental group only, while the mid-term examination was completed by both groups as part of the course. The dependent variable was the summative test, the final examination. It was completed by both groups upon the course's completion.^ As predicted, there were significant differences between the two groups' results on the pretest. There were no significant differences between the two groups' results on the posttest. These findings support the hypothesis of the study and reveal the effectiveness of mastery learning strategies with low learning ability students. ^