A Comprehensive, Valid, and Reliable Tool to Assess the Degree of Responsibility of Digital Health Solutions That Operate With or Without Artificial Intelligence: 3-Phase Mixed Methods Study.

BACKGROUND: Clinicians' scope of responsibilities is being steadily transformed by digital health solutions that operate with or without artificial intelligence (DAI solutions). Most tools developed to foster ethical practices lack rigor and do not concurrently capture the health, social, economic, and environmental issues that such solutions raise. OBJECTIVE: To support clinical leadership in this field, we aimed to develop a comprehensive, valid, and reliable tool that measures the responsibility of DAI solutions by adapting the multidimensional and already validated Responsible Innovation in Health Tool. METHODS: We conducted a 3-phase mixed methods study. Relying on a scoping review of available tools, phase 1 (concept mapping) led to a preliminary version of the Responsible DAI solutions Assessment Tool. In phase 2, an international 2-round e-Delphi expert panel rated on a 5-level scale the importance, clarity, and appropriateness of the tool's components. In phase 3, a total of 2 raters independently applied the revised tool to a sample of DAI solutions (n=25), interrater reliability was measured, and final minor changes were made to the tool. RESULTS: The mapping process identified a comprehensive set of responsibility premises, screening criteria, and assessment attributes specific to DAI solutions. e-Delphi experts critically assessed these new components and provided comments to increase content validity (n=293), and after round 2, consensus was reached on 85% (22/26) of the items surveyed. Interrater agreement was substantial for a subcriterion and almost perfect for all other criteria and assessment attributes. CONCLUSIONS: The Responsible DAI solutions Assessment Tool offers a comprehensive, valid, and reliable means of assessing the degree of responsibility of DAI solutions in health. As regulation remains limited, this forward-looking tool has the potential to change practice toward more equitable as well as economically and environmentally sustainable digital health care.

How can entrepreneurs experience inform responsible health innovation policies? A longitudinal case study in Canada and Brazil.

AIM: To foster equity and make health systems economically and environmentally more sustainable, Responsible Innovation in Health (RIH) calls for policy changes advocated by mission-oriented innovation policies. These policies focus, however, on instruments to foster the supply of innovations and neglect health policies that affect their uptake. Our study's aim is to inform policies that can support RIH by gaining insights into RIH-oriented entrepreneurs' experience with the policies that influence both the supply of, and the demand for their innovations. METHODS: We recruited 16 for-profit and not-for-profit organisations engaged in the production of RIH in Brazil and Canada in a longitudinal multiple case study. Our dataset includes three rounds of interviews (n = 48), self-reported data, and fieldnotes. We performed qualitative thematic analyses to identify across-cases patterns. FINDINGS: RIH-oriented entrepreneurs interact with supply side policies that support technology-led solutions because of their economic potential but that are misaligned with societal challenge-led solutions. They navigate demand side policies where market approval and physician incentives largely condition the uptake of technology-led solutions and where emerging policies bring some support to societal challenge-led solutions. Academic intermediaries that bridge supply and demand side policies may facilitate RIH, but our findings point to an overall lack of policy directionality that limits RIH. CONCLUSION: As mission-oriented innovation policies aim to steer innovation towards the tackling of societal challenges, they call for a major shift in the public sector's role. A comprehensive mission-oriented policy approach to RIH requires policy instruments that can align, orchestrate, and reconcile health priorities with a renewed understanding of innovation-led economic development.

Responsible innovation in health and health system sustainability: Insights from health innovators' views and practices.

Although healthcare managers make increasingly difficult decisions about health innovations, the way they may interact with innovators to foster health system sustainability remains underexplored. Drawing on the Responsible Innovation in Health (RIH) framework, this paper analyses interviews (n=37) with Canadian and Brazilian innovators to identify: how they operationalize inclusive design processes; what influences the responsiveness of their innovation to system-level challenges; and how they consider the level and intensity of care required by their innovation. Our qualitative findings indicate that innovators seek to: 1) engage stakeholders at an early ideation stage through context-specific methods combining both formal and informal strategies; 2) address specific system-level benefits but often struggle with the positioning of their solution within the health system; and 3) mitigate staff shortages in specialized care, increase general practitioners' capacity or patients and informal caregivers' autonomy. These findings provide empirical insights on how healthcare managers can promote and organize collaborative processes that harness innovation towards more sustainable health systems. By adopting a RIH-oriented managerial role, they can set in place more inclusive design processes, articulate key system-level challenges, and help innovators adjust the level and intensity of care required by their innovation.

Fostering Responsible Innovation in Health: An Evidence-Informed Assessment Tool for Innovation Stakeholders.

BACKGROUND: Responsible innovation in health (RIH) emphasizes the importance of developing technologies that are responsive to system-level challenges and support equitable and sustainable healthcare. To help decision-makers identify whether an innovation fulfills RIH requirements, we developed and validated an evidence-informed assessment tool comprised of 4 inclusion and exclusion criteria, 9 assessment attributes and a scoring system. METHODS: We conducted an inter-rater reliability assessment to establish the extent to which 2 raters agree when applying the RIH Tool to a diversified sample of health innovations (n=25). Following the Tool's 3-step process, sources of information were collected and cross-checked to ensure their clarity and relevance. Ratings were reported independently in a spreadsheet to generate the study's database. To measure inter-rater reliability, we used: a non-adjusted index (percent agreement), a chance-adjusted index (Gwet's AC) and the Pearson's correlation coefficient. Results of the Tool's application to the whole sample of innovations are summarized through descriptive statistics. RESULTS: Our findings show complete agreement for the screening criteria, "almost perfect" agreement for 7 assessment attributes, "substantial" agreement for 2 attributes and "almost perfect" agreement for the RIH overall score. A large portion of the sample obtained high scores for 6 attributes (health relevance, health inequalities, responsiveness, level and intensity of care and frugality) and low scores for 3 attributes (ethical, legal, and social issues [ELSIs], inclusiveness and eco-responsibility). At the rating step, 88% of the innovations had a sufficient number of attributes documented (≥ 7/9), but the assessment was based on sources of moderate to high quality (mean score ≥ 2 points) for 36% of the sample. While "Almost all RIH features" were present for 24% of the innovations (RIH mean score between 4.1-5.0 points), "Many RIH features" were present for 52% of the sample (3.1-4.0 points) and "Few RIH features" were present for 24% of the innovations (2.1-3.0 points). CONCLUSION: By confirming key aspects of the RIH Tool's reliability and applicability, our study brings its development to completion. It can be jointly put into action by innovation stakeholders who want to foster innovations with greater social, economic and environmental value.

Competências com ênfase na segurança do paciente durante a formação em enfermagem / Competencies with an emphasis on patient safety during nursing training / Competencias con énfasis en la seguridad del paciente durante la formación de enfermería

Objetivo: Sintetizar o conhecimento disponível na literatura nacional e internacional sobre as competências desenvolvidas na durante a formação em Enfermagem com ênfase na segurança do paciente. Método: revisão integrativa da literatura realizada nas bases de dados eletrônicas Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science e Medline, que incluiu estudos publicados no período de 2012 a 2018. Resultados: Foram identificados 19 artigos, que desvelaram as competências como identificação, notificação, prevenção e gerenciamento de eventos, controle de infecção, trabalho em equipe, comunicação efetiva, utilização de evidências, informação, agir ético, liderança, aprendizagem contínua e compreensão humana. Conclusão: Os estudos analisados revelam as competências desenvolvidas durante a formação em Enfermagem com ênfase na segurança do paciente têm sido pouco abordadas no processo formativo, configurando-se na necessidade de reforma inovadora.

Objective: To synthesize the knowledge available in national and international literature on the skills developed during nursing education with an emphasis on patient safety. Method: integrative literature review carried out in the electronic databases Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science and Medline, which included studies published from 2012 to 2018. Results: 19 articles were identified, who unveiled competences such as identification, notification, prevention and management of events, infection control, teamwork, effective communication, use of evidence, information, ethical action, leadership, continuous learning and human understanding. Conclusion: The studies analyzed reveal the skills developed during nursing training with an emphasis on patient safety have been little addressed in the training process, configuring the need for innovative reform.

Objetivo: Sintetizar los conocimientos disponibles en la literatura nacional e internacional sobre las habilidades desarrolladas durante la formación en enfermería con énfasis en la seguridad del paciente. Método: revisión integradora de la literatura realizada en las bases de datos electrónicas Scielo, BDENF, LILACS, Mediline, PubMed, CINAHL, Scopus, Web of Science y Medline, que incluyó estudios publicados entre 2012 y 2018. Resultados: Se identificaron 19 artículos, quien develó competencias como identificación, notificación, prevención y gestión de eventos, control de infecciones, trabajo en equipo, comunicación efectiva, uso de evidencia, información, acción ética, liderazgo, aprendizaje continuo y entendimiento humano. Conclusión: Los estudios analizados revelan que las habilidades desarrolladas durante la formación en enfermería con énfasis en la seguridad del paciente han sido poco abordadas en el proceso formativo, configurando la necesidad de una reforma innovadora

Aspectos constitutivos de militantes na Enfermagem: a produção de sujeitos políticos / Constitutive aspects of nursing militants: production of political subjects

Resumo Introdução: trata-se de um estudo com base filosófica de Michel Foucault que buscou analisar a constituição do sujeito; no caso em questão, buscou-se compreender a enfermeira que milita pela profissão. Objetivo: analisar os aspectos constitutivos de militantes na Enfermagem. Métodos: pesquisa com método histórico, que usa o método de história oral, com uma abordagem qualitativa; foram entrevistadas 11 enfermeiras que militaram ou militam por situações profissionais. Após o uso da técnica de entrevista semiestruturada, os dados foram organizados no software n-vivo 10, e o método de análise foi a hermenêutica dialética. Resultados: as enfermeiras se constituíram militantes a partir de vivências comunitárias, familiares, nos movimentos sociais e na militância profissional, e de convívio com as diferenças éticas e sociais. Os discursos apontam para a constituição de sujeitos militantes fora dos espaços instituídos da sala de aula. Conclusões: ao olhar para a constituição de sujeitos militantes sob a ótica da hermenêutica dialética, encontramos a convergência interna entre as subcategorias apontadas, a produção de sujeitos militantes e as categorias analíticas deste estudo. Identificamos possibilidades formativas de sujeitos militantes e indicamos a necessidade de revisão dos processos formativos de enfermeiras.

Resumen Introducción: se trata de un estudio con base filosófica de Michel Foucault que buscó analizar la constitución del sujeto. En este caso, se intentó entender a la enfermera que milita por la profesión. Objetivo: analizar los aspectos constitutivos de militantes en Enfermería. Métodos: investigación histórica, basada en el método de historia oral con enfoque cualitativo, realizada con 11 enfermeras que militaron o militan por situaciones profesionales. Los datos recopilados de entrevistas semiestructuradas se organizaron en el software n-vivo 10, y se analizaron mediante la hermenéutica dialéctica. Resultados: las enfermeras se convirtieron en militantes basadas en experiencias comunitarias, familiares, en movimientos sociales y militancia profesional, y en la convivencia con las diferencias éticas y sociales. Los discursos apuntan a la constitución de sujetos militantes fuera de los espacios establecidos en el salón de clases. Conclusiones: al observar la constitución de los sujetos militantes desde la hermenéutica dialéctica, encontramos la convergencia interna entre las subcategorías mencionadas, la producción de sujetos militantes y las categorías analíticas de este estudio. Identificamos posibilidades de capacitación de sujetos militantes y señalamos la necesidad de revisar los procesos formativos de las enfermeras.

Abstract Introduction: this study is based on Michel Foucault's philosophical theories and sought to address the constitution of the subject. In this particular case, we sought to understand nurses who militate for their profession. Objective: to study the constitutive aspects of nursing activists. Methods: historical research, based on the oral history method with a qualitative approach, was carried out with 11 nurses who worked or currently work for professional-related situations. Data collected through semi-structured interviews was organized using N-vivo software 10 and then analyzed based on dialectical hermeneutics. Results: nurses became militants due to personal experiences, including: community, social movements, living with ethical and social differences, professional activism, and family life. The speech points to the constitution of militant subjects outside the established spaces of classrooms. Conclusions: by looking at the constitution of militant subjects from the point of view of dialectical hermeneutics, we find an internal convergence between the subcategories above, the production of militant subjects, and the analytical categories of this study. We identified training possibilities for militant subjects and highlight the need to review nursing education processes.

Transforming Disciplinary Traditions Comment on "Problems and Promises of Health Technologies: The Role of Early Health Economic Modeling".

Grutters et al show that economic assessments can inform the development of new health technologies at an early stage. This is an important contribution to health services and policy research, which implies a "shift away" from the more traditional forms of academic health economic modeling. Because transforming established disciplinary traditions is both valuable and demanding, we invite scholars to further the discussion on how the value of health innovations should be appraised in view of today's societal challenges.

[Incorporation of technologies by the Canadian and Brazilian health systems: prospects for progress in assessment processes]. / Incorporação de tecnologias nos sistemas de saúde do Canadá e do Brasil: perspectivas para avanços nos processos de avaliação.

One of the main challenges for modern health systems is to guarantee equitable access to technologies with proven quality, safety, efficacy, and cost-effectiveness, as well as to ensure that their use is based on high-quality scientific evidence. Health technology assessment (HTA) is one of the most widely used strategies in the world to support decisions on health technologies. The article analyzes how HTA systems are organized in Brazil and Canada and discusses the implications for planning the incorporation of technologies in Brazil, considering the challenges posed by the regionalization process and the establishment of healthcare networks. This is an exploratory comparative study based on secondary data. The results show that both countries have fragmented HTA systems with different levels of maturity. The systems are characterized by multiple organizations working in the field of HTA, the scope of activities, and the concentration of activities in national agencies/bodies. Both systems have weaknesses, but the Brazilian case presents a series of factors (insufficient resources, impact of court rulings, heavy dependence on foreign technologies, and incipient regional HTA processes and planning) that make the scenario more complex. The article argues that the regionalized structure for planning the incorporation of technologies in Canada can serve as an interesting experience for the Brazilian system, despite the different contexts in the two countries.

Garantir o acesso equitativo a tecnologias que têm qualidade, segurança, eficácia e custo-efetividade comprovados, bem como assegurar que sua utilização seja baseada em evidências científicas de qualidade, constitui um dos principais desafios dos modernos sistemas de saúde. A avaliação de tecnologias em saúde (ATS) é uma das estratégias mais usadas em todo o mundo para apoiar a tomada de decisão relativa às tecnologias em saúde. O objetivo do artigo é examinar como os sistemas de ATS estão organizados no Brasil e no Canadá e discutir suas implicações para o planejamento da incorporação de tecnologias no Brasil, considerando os desafios impostos pelo processo de regionalização e da constituição das redes de atenção à saúde. Trata-se de um estudo exploratório, em perspectiva comparada, com base em dados secundários. Os resultados mostram que os dois países contam com sistemas de ATS fragmentados, com níveis diferenciados de maturidade. Caracterizam-se pela multiplicidade de organizações que atuam no campo da ATS, pela abrangência do escopo das atividades desenvolvidas e pela concentração das atividades em agências/órgãos nacionais. Os dois sistemas têm fragilidades, mas o caso brasileiro apresenta um conjunto de fatores (recursos insuficientes, impacto das decisões judiciais, forte dependência de tecnologias provenientes do exterior, e processos e planejamentos regionais incipientes no campo da ATS) que torna o cenário mais complexo. Argumenta-se que a estrutura regionalizada para o planejamento da incorporação de tecnologias no Canadá pode ser uma experiência interessante para o sistema brasileiro, a despeito das diferenças de contexto entre os dois países.

Garantizar el acceso equitativo a tecnologías que poseen calidad, seguridad, eficacia y costo-efectividad comprobados, así como asegurar que su utilización esté basada en evidencias científicas de calidad, constituye uno de los principales desafíos de los sistemas de salud modernos. La evaluación de tecnologías en salud (ETS) es una de las estrategias más usadas en todo el mundo para apoyar en la toma de decisiones relativa a las tecnologías en salud. El objetivo del artículo es examinar cómo los sistemas de ETS están organizados en Brasil y en Canadá y discutir sus implicaciones para la planificación de la incorporación de tecnologías en Brasil, considerando los desafíos impuestos por el proceso de regionalización y la constitución de las redes de atención a la salud. Se trata de un estudio exploratorio, desde una perspectiva comparada, basado en datos secundarios. Los resultados muestran que los dos países cuentan con sistemas de ETS fragmentados, con niveles diferenciados de madurez. Se caracterizan por la multiplicidad de organizaciones que actúan en el campo de la ETS, por la amplitud del alcance de las actividades desarrolladas y por la concentración de las actividades en agencias/órganos nacionales. Los dos sistemas tienen fragilidades, pero el caso brasileño presenta un conjunto de factores (recursos insuficientes, impacto de decisiones judiciales, fuerte dependencia de tecnologías provenientes del exterior, y procesos y planificaciones regionales incipientes en el campo de la ETS) que hacen que el escenario sea más complejo. Se argumenta que la estructura regionalizada para la planificación de la incorporación de tecnologías en Canadá puede ser una experiencia interesante para el sistema brasileño, a pesar de las diferencias de contexto entre ambos países.

What Health System Challenges Should Responsible Innovation in Health Address? Insights From an International Scoping Review.

BACKGROUND: While responsible innovation in health (RIH) suggests that health innovations could be purposefully designed to better support health systems, little is known about the system-level challenges that it should address. The goal of this paper is thus to document what is known about health systems' demand for innovations. METHODS: We searched 8 databases to perform a scoping review of the scientific literature on health system challenges published between January 2000 and April 2016. The challenges reported in the articles were classified using the dynamic health system framework. The countries where the studies had been conducted were grouped using the human development index (HDI). Frequency distributions and qualitative content analysis were performed. RESULTS: Up to 1391 challenges were extracted from 254 articles examining health systems in 99 countries. Across countries, the most frequently reported challenges pertained to: service delivery (25%), human resources (23%), and leadership and governance (21%). Our analyses indicate that innovations tend to increase challenges associated to human resources by affecting the nature and scope of their tasks, skills and responsibilities, to exacerbate service delivery issues when they are meant to be used by highly skilled providers and call for accountable governance of their dissemination, use and reimbursement. In countries with a low and medium HDI, problems arising with infrastructure, logistics and equipment were described in connection with challenges affecting procurement, supply and distribution systems. In countries with a medium and high HDI, challenges included a growing demand for drugs and new technology and the management of rising costs. Across all HDI groups, the need for flexible information technologies (IT) solutions to reach rural areas was underscored. CONCLUSION: Highlighting challenges that are common across countries, this study suggests that RIH should aim to reduce the cost of innovation production processes and attend not only to the requirements of the immediate clinical context of use, but also to the vulnerabilities of the broader system wherein innovations are deployed. Policy-makers should translate system-level demand signals into innovation development opportunities since it is imperative to foster innovations that contribute to the success and sustainability of health systems.

Identidade profissional da enfermeira: uma revisão integrativa / La identidad profesional de la enfermera: revisión integrativa / The professional identity of female nurses: an integrative review

Objetivo identificar os principais achados em artigos científicos sobre a identidade profissional da enfermeira. Método estudo do tipo revisão integrativa da literatura, desenvolvido com base na pesquisa bibliográfica sobre artigos científicos a respeito do tema. Utilizada a base de dados da Biblioteca Virtual em Saúde. Compuseram a amostra final 12 publicações científicas. Para análise dos dados, utilizou-se a técnica de análise de conteúdo. Resultados os dados evidenciaram que a identidade profissional da enfermeira está relacionada com o sentido religioso, com intercessões com os sentidos militar e profissional oriundos da origem da profissão. Conclusão a identidade profissional da enfermeira está fortemente relacionada com a questão religiosa, sofreu influência da organização militar e apresenta indícios que demonstram seu objetivo de se firmar como profissão e ciência.

Objetivo identificar las mayores descubiertas de artículos científicos sobre la identidad profesional de la enfermera. Método revisión integrativa de la literatura, desarrollada por medio de una investigación bibliográfica de artículos científicos sobre el tema. Se utilizó la base de datos de la Biblioteca Virtual en Salud. La muestra final se constituyó de 12 publicaciones científicas. Para analizar los datos, se utilizó la técnica de análisis de contenido. Resultados los dados indicaron que la identidad profesional de la enfermera está relacionada con su sentido religioso y tiene intersecciones con los sentidos militar y profesional, todos derivados de los orígenes de la profesión. Conclusión la identidad profesional de la enfermera está fuertemente relacionada con la religión, sufrió interferencias de la organización militar, y presenta indicativos del objetivo de establecerse como profesión y ciencia.

Objective identifying the main findings by scientific articles on the professional nurse identity. Method this is an integrative literature review, developed through a bibliographic research involving scientific articles on the theme. The Virtual Health Library database was used. The final sample was made up of 12 scientific publications. To analyze data, the technique of content analysis was applied. Results the data made clear that the professional identity of nurses is related to a religious meaning, intersecting with military and professional relations of meaning, which derive from the origins of the profession. Conclusion the professional nurse identity is strongly related to religious issues, has been influenced by military organization, and presents signs that show its objective of being recognized as a profession and a science.

Introducing responsible innovation in health: a policy-oriented framework.

The scholarship on responsible research and innovation (RRI) aims to align the processes and outcomes of innovation with societal values by involving a broad range of stakeholders from a very early stage. Though this scholarship offers a new lens to consider the challenges new health technologies raise for health systems around the world, there is a need to define the dimensions that specifically characterise responsible innovation in health (RIH). The present article aims to introduce an integrative RIH framework drawing on the RRI literature, the international literature on health systems as well as specific bodies of knowledge that shed light on key dimensions of health innovations. Combining inductive and deductive theory-building strategies and concomitant with the development of a formal tool to assess the responsibility of innovations, we developed a framework that is comprised of nine dimensions organised within five value domains, namely population health, health system, economic, organisational and environmental. RIH provides health and innovation policy-makers with a common framework that supports the development of innovations that can tackle significant system-level challenges, including sustainability and equity.

Neoliberal meritocracy and financial capitalism: consequences for social protection and health. / Meritocracia neoliberal e capitalismo financeiro: implicações para a proteção social e a saúde.

There is inherent tension between the idea of health as a social right and of health as a private good. From the latter perspective, healthcare provision is brought closer to the logic of ownership, where access depends on ability to pay. The prioritization of markets (over governments), economic incentives (over social or cultural norms), and entrepreneurship (over collective or community action), one of the hallmarks of neoliberalism, constitutes a project to dismantle the welfare state, defined as a set of policy mechanisms designed to meet collective needs. This article examines the above process and its consequences for social protection and health by reflecting upon two phenomena that threaten the principle of health as a social right: neoliberal ideas and policies; and financial capitalism. We argue that the common good must be defended or insulated from the negative effects of financial capitalism and from the erosion and fragmentation of public institutions and social protection systems caused by neoliberalism.

Existe uma tensão inerente à ideia de saúde como direito social e de saúde como bem econômico e individual, na medida em que esta ultima aproxima a prestação de serviços de saúde da lógica proprietária, cujo acesso depende da capacidade de pagamento de cada indivíduo ou família. A preferência por mercados (sobre os governos), incentivos econômicos (sobre normas sociais ou culturais) e empreendedorismo individual (sobre a ação coletiva ou comunitária) é uma característica marcante do neoliberalismo e, por isso mesmo, um projeto de desmonte do estado social, definido como um conjunto de dispositivos que visam atender às necessidades coletivas. O objetivo do artigo é examinar esse processo e suas implicações para a proteção social e a saúde, mediante algumas reflexões sobre dois fenômenos que ameaçam a saúde como direito social: as ideias e as políticas neoliberais, de um lado, e a financeirização da riqueza, de outro. Argumentamos que o bem comum precisa ser defendido ou insulado tanto da devassa provocada pelo capital financeiro quanto pela erosão e fragmentação provocada pelo neoliberalismo nas instituições públicas e nos sistemas de proteção social.

Meritocracia neoliberal e capitalismo financeiro: implicações para a proteção social e a saúde / Neoliberal meritocracy and financial capitalism: consequences for social protection and health

Resumo Existe uma tensão inerente à ideia de saúde como direito social e de saúde como bem econômico e individual, na medida em que esta ultima aproxima a prestação de serviços de saúde da lógica proprietária, cujo acesso depende da capacidade de pagamento de cada indivíduo ou família. A preferência por mercados (sobre os governos), incentivos econômicos (sobre normas sociais ou culturais) e empreendedorismo individual (sobre a ação coletiva ou comunitária) é uma característica marcante do neoliberalismo e, por isso mesmo, um projeto de desmonte do estado social, definido como um conjunto de dispositivos que visam atender às necessidades coletivas. O objetivo do artigo é examinar esse processo e suas implicações para a proteção social e a saúde, mediante algumas reflexões sobre dois fenômenos que ameaçam a saúde como direito social: as ideias e as políticas neoliberais, de um lado, e a financeirização da riqueza, de outro. Argumentamos que o bem comum precisa ser defendido ou insulado tanto da devassa provocada pelo capital financeiro quanto pela erosão e fragmentação provocada pelo neoliberalismo nas instituições públicas e nos sistemas de proteção social.

Abstract There is inherent tension between the idea of health as a social right and of health as a private good. From the latter perspective, healthcare provision is brought closer to the logic of ownership, where access depends on ability to pay. The prioritization of markets (over governments), economic incentives (over social or cultural norms), and entrepreneurship (over collective or community action), one of the hallmarks of neoliberalism, constitutes a project to dismantle the welfare state, defined as a set of policy mechanisms designed to meet collective needs. This article examines the above process and its consequences for social protection and health by reflecting upon two phenomena that threaten the principle of health as a social right: neoliberal ideas and policies; and financial capitalism. We argue that the common good must be defended or insulated from the negative effects of financial capitalism and from the erosion and fragmentation of public institutions and social protection systems caused by neoliberalism.