An��lise comparativa do direito de acesso a cuidados de sa��de no servi��o nacional de sa��de portugu��s e sistema de sa��de norte-americano (EUA)

RESUMO - O presente estudo situa-se nas ��reas gerais da Sa��de P��blica, dos Sistemas de Sa��de e do Acesso �� Presta����o de Cuidados de Sa��de e procura analisar o conte��do e concretiza����o do Direito de Acesso a Cuidados de Sa��de na perspectiva de dois sistemas de sa��de paradigmaticamente distintos, um sistema de acesso universal, representado pelo Servi��o Nacional de Sa��de portugu��s e um sistema de sa��de de ���n��o universal���, cujo paradigma �� o modelo existente nos Estados Unidos da Am��rica, onde entidades gestoras de cuidados, Managed Care Organizations, s��o chamadas a desempenhar um papel central no acesso e presta����o de cuidados de sa��de. O vasto campo de investiga����o representado pela problem��tica do acesso a cuidados de sa��de e a necessidade de limitar o trabalho de investiga����o subjazem �� defini����o de quatro vertentes a analisar: (a) a exist��ncia ou n��o de uma base legal que preveja e regule o exerc��cio do direito de acesso a cuidados de sa��de; (b) o conte��do deste direito no ��mbito de cada um dos sistemas em estudo; (c) as condi����es de concretiza����o do acesso a cuidados de sa��de em ambos os sistemas, e, por ��ltimo (d) a exist��ncia de garantias de efectiva����o do mesmo. Analisados os sistemas em estudo �� luz das vertentes apresentadas, conclu��mos que a exist��ncia de um quadro normativo pr��prio, que explicite o conte��do e condi����es de efectiva����o do direito, apresenta maiores garantias de concretiza����o do exerc��cio do Direito de Acesso a Cuidados de Sa��de, entendendo-se que um sistema de acesso dependente da actua����o de entidades gestoras de cuidados n��o beneficia o acesso a cuidados de sa��de, nomeadamente por n��o garantir equidade no momento de procura e necessidade de cuidados. Os dados apresentados foram recolhidos atrav��s do recurso a uma metodologia qualitativa. A an��lise documental foi aplicada na recolha dos dados relativos �� evolu����o e caracteriza����o dos sistemas, bem como ��s condi����es de acesso. No ��mbito do sistema de sa��de de acesso universal, ou seja, o caso portugu��s, procedeu-se essencialmente �� an��lise dos normativos aplic��veis. No que se refere ao sistema de sa��de norte-americano, na aus��ncia de base legal aplic��vel, recorreu-se sobretudo �� an��lise de literatura e documentos. A participa����o no vi Second Biennal Seminar in Law and Bioethics1 e na 30th Annual Health Law Professors Conference2, realizados em B��ston, EUA, em Julho de 2007, permitiram uma melhor percep����o da actual situa����o da presta����o de cuidados naquele Pa��s, nomeadamente de algumas das reformas em curso, bem como um melhor entendimento das caracter��sticas do sistema prestador norte-americano em si mesmo. 1 Semin��rio organizado nos dias 30 e 31 de Maio, numa colabora����o entre a Escola Nacional de Sa��de P��blica e o Departamento de Direito da sa��de, Bio��tica e Direitos Humanos da Escola de Sa��de P��blica da Universidade de B��ston, sob o tema: ���Law and ethics in rationing Access to care in a high-cost global economy���. A nossa participa����o deveu-se a um convite da Prof.�� Paula Lobato de Faria para colaborar na sess��o sobre o sistema de sa��de portugu��s. 2 Reuni��o realizada em B��ston nos dias 31 de Maio a 2 de Junho, sobretudo a sess��o dedicada ao tema ���New Models for Reform���, sobre os novos modelos de sistema de sa��de em desenvolvimento nos EUA.

Complexit��, m��decine g��n��rale et r��formes des syst��mes de sant�� [Complexity, general practice and reforms of health systems].

The family doctor facing complexity must decide in situations of low certainty and low agreement. Complexity is in part subjective but can also be measured. Changes in the health systems aim to reduce health costs. They tend to give priority to simple situations and to neglect complexity. One role of an academic institute of family medicine is to present and promote the results of scientific research supporting the principles of family medicine, taking into account both the local context and health systems reforms. In Switzerland the new challenge is the introduction of managed care.

Epidemiological Profile for Iowa, 2002

This statewide profile describes the epidemiology of HIV, AIDS, and other sexually transmitted diseases in Iowa through December, 2002. The report characterizes the distribution of these diseases in terms of geography, race, gender, age, and associated causal factors. This epidemiological profile has been prepared to assist in developing a comprehensive HIV/AIDS Prevention and Care Plan. This description of the HIV epidemic in the state serves to guide prevention and service efforts, to quantify unmet need for prevention and care programs, and to evaluate programs and policies in Iowa. Five key questions are addressed: 1. What are the sociodemographic characteristics of Iowa���s population? 2. What is the epidemiology, including the geographical distribution, of HIV, AIDS, and other sexually transmitted diseases (STDs) in Iowa? 3. Who is at the greatest risk of becoming infected with HIV and other STDs in Iowa? 4. What are the patterns of utilization of HIV services throughout the state? 5. What are the number and characteristics of persons who know they are HIV-positive, but who are not receiving primary medical care?

Financiaci��n capitativa, articulaci��n entre niveles asistenciales y descentralizaci��n de las organizaciones sanitarias

Public organisations are subjected to weak incentivesfor competition. Therefore, institutional Darwinismcannot apply. Regulation and performance monitoring isrequired to protect the public interest. This isparticularly the case of organisations in the healthcare arena, since strong incentives may risk the wholesupply of public health services. Regarding to the pathdependence of the Spanish public health institutionswith respect to the international experience and theobserved health technological changes, this paper triesto ground some theoretical bases for the organisationalchange in our health system. We do this by building ourargument from the very basic public goal: the improvementof the health status of the Spanish population. Thisrequires a better integration of health care services.To this regard, capitation in finance shows somecomparative advantages: it takes an integral view forthe care of the population, it allows for a betterdecentralisation ('deconcentration') of risks to healthproviders and favours managed care under a globalperspective, replacing partial payment to differentproviders. However, the paper shows some potentiallimitations for this purpose and the need of a gradualstrategy for its implementation.

Eliciting preferences for collectively financed health programmes : the "willingness to assign" approach

Improving public involvement in health system decision making stands as a primary goal in health systems reform. However, still limited evidence is found on how best to elicit preferences for health care programs. This paper examines a contingent choice technique to elicit preferences among health programs so called, willingness to assign (WTAS): Moreover, we elicited contingents rankings as well as the willingness to pay extra taxes for comparative purposes. We argue that WTAS reveals relative ( monetary-based) values of a set of competing public programmes under a hypothetical healthcare budget assessment. Experimental evidence is reported from a delibertive empirical study valuing ten health programmes in the context of the Catalan Health Services. Evidence from a our experimental study reveals that perferences are internally more consistent and slightly less affected by "preference reversals" as compared to values revealed from the willingness to pay (WTP) extra taxes approach. Consistent with prior studies, we find that the deliberative approach helped to avoid possible misunderstandings. Interestingly, although programmes promoting health received the higher relative valuation, those promoting other health benefits also ranked highly

Bureau of HIV, STD, & Hepatitis Quarterly Newsletter, January ��� March 2011, Vol. 1

This newsletter of the Bureau of HIV, STD, and Hepatitis. The idea of the newsletter was to improve communication between the bureau and those who are delivering HIV, STD, and hepatitis prevention, surveillance, and care programs across the state. More specifically, we would like to use the newsletter as a vehicle through which we can improve prevention and care services in Iowa. We will try to do this by describing the services and programs we fund, and by reflecting on data that we collect to help prevention and care providers make decisions on policies, unmet needs, and service gaps in the state. At the same time, we will try to keep you abreast of new programs, resources, and policies that may affect the work that you do and the lives of those living with or affected by HIV, STDs, and viral hepatitis.

Bureau of HIV, STD, & Hepatitis Quarterly Newsletter, April-August 2011, Vol. 2

This newsletter of the Bureau of HIV, STD, and Hepatitis. The idea of the newsletter was to improve communication between the bureau and those who are delivering HIV, STD, and hepatitis prevention, surveillance, and care programs across the state. More specifically, we would like to use the newsletter as a vehicle through which we can improve prevention and care services in Iowa. We will try to do this by describing the services and programs we fund, and by reflecting on data that we collect to help prevention and care providers make decisions on policies, unmet needs, and service gaps in the state. At the same time, we will try to keep you abreast of new programs, resources, and policies that may affect the work that you do and the lives of those living with or affected by HIV, STDs, and viral hepatitis.

Eliciting preferences for collectively financed health programmes : the "willingness to assign" approach

Improving public involvement in health system decision making stands as a primary goal in health systems reform. However, still limited evidence is found on how best to elicit preferences for health care programs. This paper examines a contingent choice technique to elicit preferences among health programs so called, willingness to assign (WTAS): Moreover, we elicited contingents rankings as well as the willingness to pay extra taxes for comparative purposes. We argue that WTAS reveals relative ( monetary-based) values of a set of competing public programmes under a hypothetical healthcare budget assessment. Experimental evidence is reported from a delibertive empirical study valuing ten health programmes in the context of the Catalan Health Services. Evidence from a our experimental study reveals that perferences are internally more consistent and slightly less affected by "preference reversals" as compared to values revealed from the willingness to pay (WTP) extra taxes approach. Consistent with prior studies, we find that the deliberative approach helped to avoid possible misunderstandings. Interestingly, although programmes promoting health received the higher relative valuation, those promoting other health benefits also ranked highly

L'acolliment familiar especialitzat: avaluaci�� d'una experi��ncia

En aquest article es presenten els resultats relatius a l'evaluaci�� del programa d'acolliment especialitzat dut a terme a Catalunya des de la perspectiva de les fam��lies acollidores. Recull un an��lisi i una valoraci�� de com s'han implementat cada una de les fases del programa, matizat, en cada cas, per les expectatives, emocions i sentiments que han acompanyat tot el proc��s. Un proc��s on, sens dubte, les fam��lies d'acollida han estat una de les parts directamet implicades. El rpoc��s de reflexi�� sobre la pr��pia experi��ncia que fa cadascuna de les fam��lies a partir de les entrevistes permetr�� un apropament als factors relacionats amb l'��xit en les primeres fases del programa i valorar�� la utilitat i adequaci�� del programa en la seva totalitat.

Does a mandatory telemedicine call prior to visiting a physician reduce costs or simply attract good risks?

This paper aims to estimate empirically the efficiency of a Swiss telemedicine service introduced in 2003. We used claims' data gathered by a major Swiss health insurer, over a period of 6 years and involving 160 000 insured adults. In Switzerland, health insurance is mandatory, but everyone has the option of choosing between a managed care plan and a fee-for-service plan. This paper focuses on a conventional fee-for-service plan including a mandatory access to a telemedicine service; the insured are obliged to phone this medical call centre before visiting a physician. This type of plan generates much lower average health expenditures than a conventional insurance plan. Reasons for this may include selection, incentive effects or efficiency. In our sample, about 90% of the difference in health expenditure can be explained by selection and incentive effects. The remaining 10% of savings due to the efficiency of the telemedicine service amount to about SFr 150 per year per insured, of which approximately 60% is saved by the insurer and 40% by the insured. Although the efficiency effect is greater than the cost of the plan, the big winners are the insured who not only save monetary and non-monetary costs but also benefit from reduced premiums. Copyright �� 2010 John Wiley & Sons, Ltd.

An��lisis del modelo de atenci��n de una aseguradora estadounidense para identificar oportunidades de mejoramiento que se puedan adaptar al sistema de salud colombiano

Teniendo en cuenta las dificultades que ha presentado el Sistema de Salud colombiano caracterizado por la corrupci��n, las barreras administrativas para el acceso a los servicios de salud y la falta de una estructura administrativa, que le permita desarrollar mecanismos para ser eficiente en la prestaci��n de servicios de salud, entre otros (Pantoja, 2011) (Colprensa, 2011) (Ru��z G��mez, 2012); el presente proyecto de investigaci��n busca determinar los factores clave de ��xito de una aseguradora Estadounidense y que se podr��an adaptar al Sistema de Salud colombiano. Para lograr el prop��sito de este proyecto, se realiz�� una b��squeda de art��culos donde se describieran los factores claves de ��xito del modelo de aseguramiento y prestaci��n de la aseguradora Kaiser Permanente, con el fin de analizar si dichos factores se pueden implementar de acuerdo al marco normativo en el que se desarrolla el sistema de salud colombiano. De acuerdo al an��lisis de la informaci��n y a la revisi��n de la normatividad que modela el Sistema de Salud colombiano, se pudo determinar que el Sistema General de Seguridad Social en Salud (SGSSS) cuenta con los mecanismos normativos que le permiten adoptar e implementar los factores claves de ��xito que caracterizan el modelo de aseguramiento y prestaci��n de servicios de Kaiser Permanente; por otra parte, es necesario tener en cuenta que en el modelo colombiano se permite la integraci��n vertical s��lo en un 40% , lo que no se ha estudiado es si este modelo de integraci��n es beneficioso o no, a la hora de buscar la eficiencia en la prestaci��n en salud, ya que el modelo Kaiser se caracteriza por aplicar una integraci��n vertical del 100%, caracter��stica que le permite, por la evidencia encontrada, ser eficiente en la atenci��n de sus usuarios.

Influencia del bajo peso al nacer en el cumplimiento del esquema de vacunaci��n en Colombia

INTRODUCCION. En Colombia y a nivel mundial la vacunaci��n es una estrategia que ha reducido la mortalidad infantil, sin embargo existen bajas coberturas en algunas zonas del pa��s, dentro de las causas de la no vacunaci��n se encuentra el bajo peso al nacer, tema de gran importancia y poco estudiado, encontr��ndose como una causa controlable y que permitir��a a la poblaci��n acceder a la protecci��n frente a enfermedades inmunoprevenibles. MATERIALES Y METODOS. Se realiz�� un estudio de tipo observacional de corte trasversal, la muestra fue tomada de la ENDS realizada por Profamilia en el a��o 2010, se tom�� el n��mero total de los encuestados que cumpl��an con los criterios de inclusi��n, en total fueron 9694 registros a los que se les realizo; an��lisis descriptivo, bivariado y multivariado. RESULTADOS. Los ni��os con bajo peso al nacer tienen menor probabilidad de estar vacunados con el esquema completo con respecto a los ni��os con peso normal, OR 0762 (IC 95% 0,650; 0,895), se observ�� que las vacunas en forma individual tienen un comportamiento similar al esquema completo, espec��ficamente en la aplicaci��n en el tiempo indicado para su aplicaci��n, exceptuando triple viral donde no se encontr�� asociaci��n. CONCLUSION. El bajo peso es un factor determinante en la vacunaci��n a tiempo de los menores y del cumplimiento posterior del esquema, se encontraron variables asociadas al no cumplimiento como el lugar del parto, el ��ndice de pobreza y pertenecer a la etnia afrodescendiente.

Impacto financiero de la unificaci��n del plan obligatorio de salud subsidiado (pos-s) en las empresas sociales del estado (ese) de mediana complejidad de Cundinamarca

A partir de la Ley 100 de 1993, el sistema de salud en Colombia ha presentado una serie de trasformaciones que buscan mejorar la prestaci��n de los servicios y lograr cubrimiento de la poblaci��n no favorecida y excluida del Plan Obligatorio de Salud (POS). Sin embargo, las Empresas sociales del Estado (ESE), en aras de dar cumplimiento a las disposiciones y normatividades que exige la ley, funcionan y prestan sus servicios acorde con los objetivos corporativos planteados por ellas mismas, a pesar de tener una gran cartera por parte de las Entidades Promotoras de Salud (EPS). El prop��sito de esta investigaci��n es evaluar el impacto financiero en una muestra de cuatro hospitales p��blicos de Cundinamarca (las ESE San Rafael de Facatativ��, Fusagasug��, C��queza, y el Salvador de Ubat��), luego de la aplicaci��n del Acuerdo 032 del 2012 de la Comisi��n de Regulaci��n en Salud (CRES). Se seleccionaron cuatro hospitales p��blicos de mediana complejidad de Cundinamarca, por ser uno de los departamentos m��s representativos en hospitales de este tipo. Se encontr�� una mayor convergencia en t��rminos de estructura administrativa y financiera, lo que hace posible que la informaci��n obtenida sea comparable y ��til para la medici��n en t��rminos de presupuesto y liquidez. El incremento de la cartera y la disminuci��n de la rotaci��n de la misma, con la afectaci��n respectiva de la liquidez y la rentabilidad, dificultan el logro de las instituciones como lo son la sostenibilidad y perdurabilidad. El cambio del pagador despu��s de la aplicaci��n de la norma incidi�� directamente en lo anterior; igualmente, traspasar la poblaci��n no cubierta al r��gimen subsidiado elimin�� el desembolso por parte de la Secretar��a de Salud y lo traslad�� a las EPS subsidiados, afectando directamente los tiempos de rotaci��n de cartera como se documenta en el an��lisis.

Pulsioximetr��a de pacientes en hemodi��lisis, de la unidad de terapia renal ��� fundaci��n cardioinfantil, an��lisis para establecer recomendaciones

Introducci��n. En Colombia, el 80% de los pacientes con enfermedad renal cr��nica en hemodi��lisis tienen f��stula arteriovenosa perif��rica (FAV) que asegura el flujo de sangre durante la hemodi��lisis (1), la variabilidad en el flujo de sangre en el brazo de la FAV hacia la parte distal, puede afectar la lectura de la oximetr��a de pulso (SpO2) (2), llevando a la toma de decisiones equivocadas por el personal de salud. El objetivo de este estudio es aclarar si existe diferencia entre la SpO2 del brazo de la FAV y el brazo contralateral. Materiales y m��todos. Se realiz�� un estudio de correlaci��n entre los valores de SpO2 del brazo con FAV contra el brazo sin FAV, de 40 pacientes que asistieron a hemodi��lisis. La recolecci��n de los datos se llev�� a cabo, con un formato que incluy�� el resultado de la pulsioximetria y variables asociadas, antes, durante y despu��s de la hemodi��lisis. Se compar�� la mediana de los deltas de las diferencias con pruebas estad��sticas T Student ��� Mann Whitney, aceptando un valor significativo de p < 0,05. Resultados. No se encontraron diferencias estad��sticamente significativas de la SpO2 entre el brazo con FAV y el brazo sin FAV, antes, durante y despu��s de la di��lisis, sin embargo si se apreci�� una correlaci��n positiva estad��sticamente significativa. Conclusiones. Se encontr�� correlaci��n positiva estad��sticamente significativa, donde no hubo diferencias en el resultado la pulsioximetr��a entre el brazo con FAV y brazo sin FAV, por lo tanto es v��lido tomar la pulsioximetr��a en cualquiera de los brazos.

Handl��ggning av intrauterin fosterd��d : En kartl��ggning av v��rdprogram vid Sveriges kvinnokliniker

Background: Parents that loose a child in connection to labour are in great need of support.Health care provider treatment and support is of great importance to how the parents will experience something that is doomed from the beginning to be one of the most tragic events the parents will ever experience. For care givers to live up to this it is incredibly important that there are worked out guidelines to follow at these situations.Aim: To chart and describe Swedish maternity wards care program with reference to ���IUFD���.Method: All clinics in Sweden have been questioned regarding care program for handling of ���IUFD���. Care programs has been gathered, charted and described.Results: 87% (29 of 33) off the maternity wards has a plan for treatment and guidelines for ���IUFD���. Care programs are more or less explanatory and a number of variables are present in different extents.Conclusion: That ones children die is the most tragic thing that can happen to a parent.The writer is of the opinion that it is of outmost importance that these parents get the best thinkable nursing and care.There are good guidelines regarding ���IUFD��� at the majority of the clinics, but to safeguard the quality the writer is of the opinion that it would be good if there where national guidelines for the shaping of these care programs.