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1.
Rev. panam. salud publica ; 8(1/2): 112-117, July/Aug. 2000. ilus, tab
Artigo em Espanhol | MedCarib | ID: med-16937

RESUMO

In the countries of Latin America and the Caribbean, social security systems have traditionally been almost exclusively the responsibility of the public sector. These systems have had major shortcomings, such as low coverage rates, unbalanced budgets, inadequate funding, and poor management of resources. In order to solve these problems and face the increased demands associated with demographic and epidemiological transitions, in the 1990s a number of countries began to reform their social security systems. These reforms have been characterized by three fundamental features: a) a search for a closer link between contributions and benefits, in order to better balance income and expenses, b) changes in the public-private composition of the systems that allow a greater private role in the financing and delivery of services, and c) an emphasis on market mechanisms as a way to promote efficiency in applying resources, and leaving to the State a role as a regulator and as a guarantor of basic benefits to groups that, because of their socioeconomic conditions, cannot make certain minimum contributions. This article looks at some of the problems raised by the reforms carried out so far, and the lessons that can be learned from them. The piece also analyzes the relationship between universal coverage and societal unity. In addition, the article suggests that the main challenge with social security reforms is that of moving toward universal systems that sinificantly expand coverage. In order to achieve that, it is necessary to strengthen the mechanisms of cohesion in financing and to improve efficiency by introducing market instruments that do not negatively affect the unitarian character of the financing. The piece concludes that it is necessary to increase coverage; improve management; be concerned about the design of the public-private makeup; identify the responsibilities of the private sector and of the government in financing, provision, and regulation of social security systems; and introduce and strengthen unity mechanisms in financing (AU)


Assuntos
Humanos , Previdência Social , América Latina , Setor Público , Reforma dos Serviços de Saúde/métodos , Região do Caribe , Financiamento da Assistência à Saúde , Administração Financeira , Cobertura Universal do Seguro de Saúde
2.
Trop Anim Health Prod ; 30(6): 331-9, Dec. 1998.
Artigo em Inglês | MedCarib | ID: med-1412

RESUMO

Lack of adequate financing was a major reason for the privatization of veterinary services in Jamaica in 1992. The belief was that, with privatization, funding of animal health services delivery would improve, since staff numbers and clinical activities undertaken by the Veterinary Division were reduced. However, analyses of data revealed that, in most cases, privatization neither improved nor stemmed the declines, that had started before privatization, in the measures or indicators used. It was concluded that privatization of veterinary services did not result in any appreciable improvement in the financing of the delivery of public-sector animal health services in Jamaica in the short term (Au)


Assuntos
21003 , Animais Domésticos , Privatização/economia , Setor Público/economia , Medicina Veterinária/economia , Orçamentos/estatística & dados numéricos , Jamaica , Análise dos Mínimos Quadrados , Salários e Benefícios/economia , Privatização/normas , Gastos em Saúde/normas
3.
West Indian med. j ; 47(suppl. 2): 19, Apr. 1998.
Artigo em Inglês | MedCarib | ID: med-1921

RESUMO

A sample of 437 diabetic patients was selected during a six week census to evaluate the quality of diabetic care in three clinics in the private and public sector in Jamaica. A comparison was also made between a dedicated hospital clinic (UHWI) and general medical clinics. The mean age ranged from 54 to 62 years. Median duration of follow up ranged from 6 to 9 years. Less than 10 percent were controlled with diet only and insulin was used more commonly at the UHWI (46 percent) than at the general clinixa (7 percent each). Sulphonylurea drugs alone or in combination with metformin were the commonest agents at the other clinics. There was no significant difference among the clinics in the proportion of patients with satisfactory blood glucose control (< 8 mmol/l post-prandial). Surveillance of hypertension was frequently done (90-98 percent). The proportion of patients treated for concurrent hypertension ranged from 25 percent at UHWI to 71 percent at Spanish Town. Less than 25 percent of hypertensive patients in all clinics had good blood pressure control (BP<140/90 mmHg).(AU)


Assuntos
Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Diabetes Mellitus/terapia , Qualidade da Assistência à Saúde , Jamaica , Guias de Prática Clínica como Assunto , Setor Privado , Setor Público
4.
West Indian med. J ; 46(3): 88-91, Sept. 1997.
Artigo em Inglês | MedCarib | ID: med-1984

RESUMO

We surveyed 161 medical practitioners in Trinidad and Tobago (124 reporting private sector practice and 37 describing government health centre practice) for their views on blood pressure (BP) management. 96 percent of the respondents agreed that BP should be measured on all adults seen and 90 percent agreed that diastolic pressure should be recorded as the disappearance of sounds. There was disagreement over the level of diastolic BP at which drug treatment should be initiated: 63 percent would treat diastolic BP less than 100 mm Hg, but 35 percent would only treat diastolic BP of 110 mm Hg or higher. In private practice 31 percent preferred angiotensin converting enzyme (ACE) inhibitors as treatment for an African Caribbean man with diastolic BP 110 mm Hg, but in public clinics 41 percent preferred thiazide diuretics. ACE inhibitors wre most often preferred as treatment for an Indo-Caribbean man with diabetes and diastolic BP 110 mm Hg in both public and private practice. Doctors considered that non-compliance (66 percent), lack of education (34 percent) and unhealthy lifestyles (25 percent) were important obstacles to BP control. In private practice doctors considered patients' financial constraint to be an obstacle (58 percent), whereas in the public sector limited availablity of drugs (57 percent) was felt to be more important. Less costly and possibly, more appropriate drugs were used in public clinics.(AU)


Assuntos
Adulto , Humanos , Masculino , Padrões de Prática Médica , Hipertensão/tratamento farmacológico , Determinação da Pressão Arterial , Pressão Arterial , Trinidad e Tobago , Setor Privado , Setor Público , Hipertensão/prevenção & controle , Recusa do Paciente ao Tratamento , Complacência (Medida de Distensibilidade)
5.
Soc Sci Med ; 44(2): 157-69, Jan. 1997.
Artigo em Inglês | MedCarib | ID: med-2039

RESUMO

This paper presents the results of a study commissioned by the Latin American and Caribbean Technical Department of the World Bank to document and analyze health expenditures in Latin America and the Caribbean. In 1990, the countries of this region spent US$ 69 billion on health, with an average, per capita health expenditure of US$ 162. On average, the countries spent 6.2 percent of their GDP on health, with the expenditure divided about equally between the public and private sectors. In both the public and private sectors, per capita health expenditures were positively and significantly correlated with per capita income. However, this relationship holds only for the public sector, when health expenditures are measured as a proportion of GDP. While several poorer countries were dependent on external assistance, with increasing income, the countries relied more on public expenditures to finance health care. Based on the limited time series data, it is evident that there was a considerable variation among countries regarding the proportion spent on capital investments, primary health care, and drugs, but not on salaries. Looking ahead, with increasing economic development, the proportion of GDP spent on health expenditure, is likely to increase rapidly, while aid dependency is likely to decline.(AU)


Assuntos
Humanos , Gastos em Saúde/estatística & dados numéricos , Região do Caribe , Organização do Financiamento/estatística & dados numéricos , Previsões , Gastos em Saúde/tendências , Pesquisa sobre Serviços de Saúde , América Latina , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Análise de Regressão
7.
Kingston; s.n; 1996. ix,88 p. tab, graphs.
Tese em Inglês | MedCarib | ID: med-2933

RESUMO

Behavioural research is urgently needed to improve the way that pharmaceuticals are prescribed, dispensed and used. The level of satisfaction of the providers and consumers of pharmaceuticals with several aspects of the delivery of pharmaceutical health care, may provide information about the standards of pharmaceutical services and its limitations. Such information may be the basis on which the functions of the pharmacist are expanded and improved. The population studied was the pharmacy personnel in private retail pharmacies and public pharmacies, as well as the consumers that receive prescribed medications at these pharmacies. The results revealed that the criteria of provision of additional information and counselling was most popular among consumers and supplier in determing the efficiency of the pharmacist. A higher proportion of consumers in the public sector reportedly received this service all of the time, than consumers in private sector, and the majority of consumers and suppliers in the private and public sectors are satisfied with the amount of patient counselling that is given by pharmacist with regard to prescribed medications. There is significant association between the consumers' level of satisfaction with waiting time for prescription filling and the sector of the pharmacy. Most suppliers were satisfied with the waiting time of consumers at the pharmacies. However, most consumers and suppliers ares satisfied with the dispensing function of the pharmacist in the provision of health care and there is no significant difference in the level of satisfaction among these groups in private and public sectors. Convenient location of the pharmacy, the facilites or equipment available and their maintenance, and the courtesy and positive attitude of the pharmacist ranked high among the reasons that consumers visit the pharmacies that they do visit. The vast majority of consumers and suppliers were satisfied with the dispensing role of the pharmacist in the provision of health care. A prescription window designed specifically for patients that are interested in the availability and price of prescribed drugs, and patient counselling regarding proper use of drugs were the most popular services that consumers believe should be performed routinely by a pharmacist. The suppliers of pharmaceuticals that work in the public sector appear to be more satisfied with management than those working in the private sector. (AU)


Assuntos
Humanos , Feminino , Masculino , Farmacêuticos , Comportamento do Consumidor , Jamaica , Prescrições de Medicamentos , Medicamentos Genéricos/diagnóstico , Setor Privado , Setor Público
11.
West Indian med. j ; 37(Suppl. 2): 37, Nov. 1988.
Artigo em Inglês | MedCarib | ID: med-5818

RESUMO

The Jamaica Burn Unit opened at the University Hospital, Mona in mid-1986. To date, it has treated 75 patients with severe burns ranging in age from 2 to 72 years. The Unit is the brainchild of Esso Standard Oil (Jca.) Ltd. and the Dept. of Surgery, U.W.I. It constitutes the nucleus of a broader based Jamaican burn programme. The project has become a co-operative venture of the private and public sectors with the involvement of the Minsitry of Health and, through them, Project Hope. In addition to the acute 4-bed unit at Mona, the programme includes facilities for reconstructive burn surgery, the training of health professionals in the care of burns and an outreach programme for the public in prevention and first aid. A formal, post-basic course for nurses was begun in 1987 at the University Hospital and, to date, 7 nurses have completed the course including 3 from Government Hospitals. In June this year, a 3-day Symposium on burn care was attended by over 190 health professionals. An outreach programme which began officially in 1987 is to be intensified over the next 9 months with more emphasis on the media and on the rural areas. In 1987, the Jamaica Burn Programme was recognized by the Public Relations Society of Jamaica and given its highest award for community service. The programme is administered by the Jamaica Burn Management Committee, an official group of professionals from the Health and Business arenas. This group meets every 3 months and it is to them that much of the success of the programme is due (AU)


Assuntos
Humanos , Unidades de Queimados , Jamaica , Queimaduras/reabilitação , Queimaduras/cirurgia , Setor Público , Setor Privado
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