Decentralization and privatization in Portuguese health reforms

ABSTRACT - The Portuguese National Health Service (SNS), a universal, centralized and public owned health care system, exhibits an extraordinary record of equalization in the access to health care and health gains in the late thirty years. However, the most recent history of the Portuguese health reform is pervaded by the influence of decentralization and privatization. Decentralization has been present in the system design since the 1976 Constitution, at least in theory. Private ownership of health care suppliers and out-ofpocket expenditures, on the financing side, both have a long tradition of relevance in the NHS mix of services. The initial aim of this study was to demonstrate expected parallelism between health reforms and public administration reforms, where a common pattern of joint decentralization and privatization was observed in many countries. Observers would be tempted to consider these two movements as common signs of new public management (NPM) developments. They have common objectives, are established around the core concepts of gains in effectiveness, efficiency, equity and quality of public services, through improved accountability. However, in practice, in Portugal, each movement was developed in a totally separated way. Besides those rooted in the NPM theory, there are few visible signs of association between decentralization and privatization. Decentralization, in the Portuguese SNS, was never intended to be followed by a privatization movement; it was seen merely as a public administration tool. Private management of health services, as stated in the most recent SNS legislation, was never intended to have decentralization as a condition or as a consequence. Paradoxically, in the Portuguese context, it has led invariably to centralized control. While presented as separate instruments for a common purpose, the association between decentralization and privatization still lacks a convincing demonstration. Many common health care management stereotypes remain to be checked out if we want to look for eventual associations between these two organizational tools.

Reforms of the pre-graduate curriculum for medical students: the Bologna process and beyond.

For several years, all five medical faculties of Switzerland have embarked on a reform of their training curricula for two reasons: first, according to a new federal act issued in 2006 by the administration of the confederation, faculties needed to meet international standards in terms of content and pedagogic approaches; second, all Swiss universities and thus all medical faculties had to adapt the structure of their curriculum to the frame and principles which govern the Bologna process. This process is the result of the Bologna Declaration of June 1999 which proposes and requires a series of reforms to make European Higher Education more compatible and comparable, more competitive and more attractive for Europeans students. The present paper reviews some of the results achieved in the field, focusing on several issues such as the shortage of physicians and primary care practitioners, the importance of public health, community medicine and medical humanities, and the implementation of new training approaches including e-learning and simulation. In the future, faculties should work on several specific challenges such as: students' mobility, the improvement of students' autonomy and critical thinking as well as their generic and specific skills and finally a reflection on how to improve the attractiveness of the academic career, for physicians of both sexes.

Le prince des Asturies [Alphonse de Bourbon en soldat] : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59713

Le prince des Asturies [Alphonse de Bourbon] et le prince Don Jaime en soldats : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59714

Le prince des Asturies [Alphonse de Bourbon] en soldat : [photographie de presse] / [Agence Rol]

Référence bibliographique : Rol, 59715

« Le Livre des faiz monseigneur saint Loys », composé à la requête du « cardinal de Bourbon » et de la « duchesse de Bourbonnois ».

Commençant par : « Jehan, arcedyacre de Salisbery, docteur bien renommé, en son IIe prologue de son livre intitulé : Policraticon, par forme de question interrogatoyre dit et demande... » et finissant par : «... et l'a à present plus grande en paradis, où il est glorieux avecques Dieu, nostre Createur, duquel le regne est et sera sans fin perdurablement en gloyre » .

Mémoires authentiques de Jacques-Nompar de Caumont, duc de La Force,... et de ses deux fils, les marquis de Montpouillan et de Castelnaut, suivis de documents curieux et de correspondances inédites de Jeanne d'Albret, Henri III, Henri IV, Catherine de Bourbon,... et autres personnages marquants, depuis la Saint-Barthélemy jusqu'à la Fronde, pour faire suite à toutes les collections de mémoires sur l'histoire de France / recueillis, mis en ordre et précédés d'une introduction, par le Mis de La Grange,...

Comprend : [Correspondance inédite] ; Lettres ; Correspondances inédites...

Mémoires authentiques de Jacques-Nompar de Caumont, duc de La Force,... et de ses deux fils, les marquis de Montpouillan et de Castelnaut, suivis de documents curieux et de correspondances inédites de Jeanne d'Albret, Henri III, Henri IV, Catherine de Bourbon,... et autres personnages marquants, depuis la Saint-Barthélemy jusqu'à la Fronde, pour faire suite à toutes les collections de mémoires sur l'histoire de France / recueillis, mis en ordre et précédés d'une introduction, par le Mis de La Grange,...

Comprend : [Correspondance inédite] ; Lettres ; Correspondances inédites...