Modelos estaduais de regulação / State regulatory models

A regulação em saúde pode ser compreendida por diferentes perspectivas, entretanto, de forma geral tem como objetivo equilibrar a oferta e demanda de serviços de saúde de modo a oferecer eficiência ao sistema com geração de resultados positivos (VILARINS et al, 2012). No Brasil, a introdução de ações de natureza regulatória para a assistência à saúde no Sistema Único de Saúde (SUS) tem início de forma mais explícita com a publicação, pelo Ministério da Saúde (MS), da Norma Operacional da Assistência à Saúde (NOAS) em 2001, continua com o Pacto pela Saúde em 2006 e acentua-se com a institucionalização da Política Nacional de Regulação em 2008 (FARIAS, 2011)

Health regulation can be understood from different perspectives, however, in general, it aims to balance the supply and demand of health services in order to offer efficiency to the system with positive results (VILARINS et al, 2012). In Brazil, the introduction of regulatory actions for health care in the Unified Health System (SUS) began more explicitly with the publication, by the Ministry of Health (MS), of the Operational Norm for Health Care (NOAS) in 2001, continued with the Health Pact in 2006 and was accentuated with the institutionalization of the National Regulation Policy in 2008 (FARIAS, 2011)

Crear las comisiones para la conducción de la estrategia nacional de redes integradas de servicios de salud de Guatemala ­ ENRISSG-. Acuerdo ministerial No. 275-2020 / Create the commissions for the conduct of the national strategy of integrated networks of health services in Guatemala - ENRISSG-. Ministerial Agreement No. 275-2020

Siguiendo las directrices del Acuerdo ministerial No. 246-2010 (Normativa para la categorización y habilitación de la red de servicios de salud), este nuevo documento acuerda nombrar comisiones para el cumplimiento de dicha estrategia. Lo define como un "instrumento legal con el propósito de crear las comisiones para la conducción de la referida estrategia". Además, en el documento se hace referencia a otro acuerdo ministerial (no. 152-2017) que puede encontrar en eBlue-Info con el nombre de: "Definir la estrategia para el fortalecimiento de la gestión y atención en salud"

Health in Seychelles - an overview.

Health in Seychelles has improved significantly over the past three decades, largely as a result of investment not only in the health services, but also in other social sectors that have direct impact on child survival and the health of individuals. Through different stages of the evolution of the health care system there have been close links between health policy and strategy, the overall national development efforts and the wider social and economic environment. Awareness of these links are useful in the understanding of current health issues such as the lifestyle related patterns of morbidity and mortality, characterised by non-communicable diseases and HIV/AIDS, the high demands for health care services, and evolving relationships between the public and private sectors.

Red de establecimientos del Ministerio de Salud Pública y Asistencia Social: norma técnica No. 37-2019-DRACES / Network of establishments of the Ministry of Public Health and Social Assistance: technical standard No. 37-2019-DRACES

La tinta del documento está opaca. DRACES [Departamento de Regulación, Acreditación y Control de Establecimientos de Salud] Este documento tiene como objeto: "la regulación, autorización y control de la Red de establecimientos del Ministerio de Salud Pública y Asistencia Social, en concordancia con el Reglamento para la Regulación, Autorización, Acreditación y Control de Establecimientos de Atención para la Salud, Acuerdo Gubernativo 376-2007 y demás leyes sanitarias." Es de carácter obligatorio, por lo que se aplica en todo el territorio nacional. Contiene además, las definiciones de los conceptos relacionados al tema principal, además de la infraestructura que deberá tener cada clínica, incluidos el equipo y recurso humano y técnico. El capítulo II describe la clasificación y especificaciones de los establecimientos del MSPAS.

[Analysis and reflections on the 2019 initiative that reforms Mexico's Ley General de Salud]. / Análisis y reflexiones sobre la iniciativa de reforma a la Ley General de Salud de México 2019.

The initiative including an Act Project for reforming the Ley General de Salud of Mexico, submitted in 2019 to the Congress of the Union, proposes the creation of a system of universal and free access to health services and associated medicines for the population lacking of social security benefits, and the creation of the Instituto de Salud para el Bienestar. This article analyzes the substantive aspects of the project, with the aim of motivating the reflection of the proposed reform and its most important components, to contribute to achieving its aim. The conclusion is that the main themes of the Project require precision in relevant areas, such as the transformation of the financing scheme for care, the strengthening of stewardship and governance, the responsibility in the provision of services, and the regulation and access to medicines. The contributions of academics, decision makers and social organizations will be essential to create a public health policy based on evidence and social equity.

La iniciativa con Proyecto de Decreto por el que se reforma la Ley General de Salud de México presentada en 2019 ante el Congreso de la Unión propone la creación de un sistema de acceso universal y gratuito a los servicios de salud y a medicamentos asociados para la población sin seguridad social y la creación del Instituto de Salud para el Bienestar. Este artículo analiza algunos aspectos sustantivos del Proyecto de Decreto con el objetivo de motivar la reflexión sobre la reforma propuesta y sus componentes más importantes para contribuir a su propósito. Se concluye que los principales temas del proyecto requieren precisión en rubros relevantes, como la transformación del esquema de financiamiento para la atención, el fortalecimiento de la rectoría y gobernanza, la responsabilidad en la provisión de servicios y la regulación y acceso a medicamentos. Las aportaciones de académicos, tomadores de decisiones y organizaciones sociales serán indispensables para una política pública de salud basada en evidencia y con equidad social.

Análisis y reflexiones sobre la iniciativa de reforma a la Ley General de Salud de México 2019 / Analysis and reflections on the 2019 initiative that reforms Mexico's Ley General de Salud

Resumen: La iniciativa con Proyecto de Decreto por el que se reforma la Ley General de Salud de México presentada en 2019 ante el Congreso de la Unión propone la creación de un sistema de acceso universal y gratuito a los servicios de salud y a medicamentos asociados para la población sin seguridad social y la creación del Instituto de Salud para el Bienestar. Este artículo analiza algunos aspectos sustantivos del Proyecto de Decreto con el objetivo de motivar la reflexión sobre la reforma propuesta y sus componentes más importantes para contribuir a su propósito. Se concluye que los principales temas del proyecto requieren precisión en rubros relevantes, como la transformación del esquema de financiamiento para la atención, el fortalecimiento de la rectoría y gobernanza, la responsabilidad en la provisión de servicios y la regulación y acceso a medicamentos. Las aportaciones de académicos, tomadores de decisiones y organizaciones sociales serán indispensables para una política pública de salud basada en evidencia y con equidad social.

Abstract: The initiative including an Act Project for reforming the Ley General de Salud of Mexico, submitted in 2019 to the Congress of the Union, proposes the creation of a system of universal and free access to health services and associated medicines for the population lacking of social security benefits, and the creation of the Instituto de Salud para el Bienestar. This article analyzes the substantive aspects of the project, with the aim of motivating the reflection of the proposed reform and its most important components, to contribute to achieving its aim. The conclusion is that the main themes of the Project require precision in relevant areas, such as the transformation of the financing scheme for care, the strengthening of stewardship and governance, the responsibility in the provision of services, and the regulation and access to medicines. The contributions of academics, decision makers and social organizations will be essential to create a public health policy based on evidence and social equity.

[Social Healthcare Organizations: a phenomenological expression of healthcare privatization in Brazil]. / Organizações Sociais da Saúde: uma expressão fenomênica da privatização da saúde no Brasil.

The study analyzed the expansion of Social Healthcare Organizations (OSS in Portuguese) in Brazil from 2009 to 2014. The ten largest OSS were measured according to their budget funding and their qualifications as non-profit organizations were explored, considering evidence of their expansion and consolidation in the management and provision of health services via strategies proper to for-profit private enterprises. The study is descriptive and exploratory and was based on public-domain documents. In their relations with government, the OSS have benefited from legal loopholes and incentives and have expanded accordingly. There has been a recent trend for these organizations to simultaneously apply for status as charitable organizations, thereby ensuring multiple opportunities for fundraising and additional tax incentives, permission to invest financial surpluses in the capital market, and remunerate their boards of directors. These organizations tend to concentrate in technology-dense hospital services, with clauses concerning increasing financial transfers to the detriment of other regulatory clauses, and special contract modalities for enabling services that are absolutely strategic for the overall functioning of the Brazilian Unified National Health System. Thus, in this study, the OSS are one component of the Health Economic and Industrial Complex, acting in management, provision, and regulation of services in a scenario of intensive commodification of health and the transfer of public funds to the private sector.

A pesquisa analisou o processo de expansão das Organizações Sociais da Saúde (OSS) no Brasil durante o período de 2009-2014. Para tanto, dimensionou as dez maiores OSS segundo recursos financeiros captados, explorou suas qualificações como entidades sem fins lucrativos, tomando em conta as evidências empíricas que apontam para sua expansão e consolidação no processo de gestão e prestação de serviços de saúde via estratégias próprias de organizações privadas lucrativas. O estudo é descritivo e exploratório, e foi realizado com base em fontes documentais de domínio público. No plano das relações com o Estado, as OSS têm se beneficiado das brechas e facilidades concedidas pela lei e apresentado uma notável expansão. Evidenciou-se um movimento recente das OSS pela busca concomitante da condição de entidades filantrópicas, assegurando múltiplas oportunidades de captação de recursos e de benefícios fiscais; a possibilidade de aplicação de excedentes financeiros no mercado de capitais; e a remuneração de seus corpos diretivos. Há uma concentração em serviços hospitalares com maior densidade tecnológica; nítida predominância de cláusulas respeitantes ao incremento de repasses financeiros em detrimento de outras cláusulas regulatórias; existência de modalidades especiais de contratos com serviços-meios absolutamente estratégicos para o funcionamento geral do Sistema Único de Saúde. Portanto, neste estudo as OSS se configuram como um dos componentes do Complexo Econômico Industrial da Saúde, nas vertentes da gestão, da prestação e da regulação de serviços, em um cenário de intensiva mercantilização da saúde e de transferência de fundo público para o setor privado.

La investigación analizó el proceso de expansión de las Organizaciones Sociales de Salud (OSS) en Brasil, durante el período de 2009-2014. Para ello, se dimensionaron las diez mayores OSS, según los recursos financieros captados, exploró sus características, como entidades sin ánimo de lucro, tomando en consideración las evidencias empíricas que apuntan a su expansión y consolidación en el proceso de gestión y prestación de servicios de salud, vía estrategias propias de organizaciones privadas con ánimo de lucro. El estudio es descriptivo y exploratorio, y fue realizado en base a fuentes documentales de dominio público. En el plano de las relaciones con el Estado, las OSS se han beneficiado de las brechas y facilidades concedidas por la ley y presentado una notable expansión. Se evidenció un movimiento reciente de esas organizaciones por la búsqueda concomitante de su condición como entidades filantrópicas, asegurando múltiples oportunidades de captación de recursos y de beneficios fiscales; la posibilidad de inversión de excedentes financieros en el mercado de capitales; y la remuneración de sus cuerpos directivos. Existe una concentración en servicios hospitalarios con una mayor densidad tecnológica; nítida predominancia de cláusulas, respecto al incremento de transferencias financieras, en detrimento de otras cláusulas regulatorias; existencia de modalidades especiales de contratos con servicios-medios absolutamente estratégicos para el funcionamiento general del Sistema Único de Salud. Por tanto, en este estudio las OSS se configuran como uno de los componentes del Complejo Económico Industrial de la Salud, en las vertientes de la gestión, de la prestación y de la regulación de servicios, en un escenario de intensiva mercantilización de la salud y de transferencia de fondos públicos hacia el sector privado.

Fiscal transfers based on inputs or outcomes? Lessons from the Twelfth and Thirteenth Finance Commission in India.

BACKGROUND: There is limited empirical evidence about the efficacy of fiscal transfers for a specific purpose, including for health which represents an important source of funds for the delivery of public services especially in large populous countries such as India. OBJECTIVE: To examine two distinct methodologies for allocating specific-purpose centre-to-state transfers, one using an input-based formula focused on equity and the other using an outcome-based formula focused on performance. MATERIALS AND METHODS: We examine the Twelfth Finance Commission (12FC)'s use of Equalization Grants for Health (EGH) as an input-based formula and the Thirteenth Finance Commission (13FC)'s use of Incentive Grants for Health (IGH) as an outcome-based formula. We simulate and replicate the allocation of these two transfer methodologies and examine the consequences of these fiscal transfer mechanisms. RESULTS: The EGH placed conditions for releasing funds, but states varied in their ability to meet those conditions, and hence their allocations varied, eg, Madhya Pradesh received 100% and Odisha 67% of its expected allocation. Due to the design of the IGH formula, IGH allocations were unequally distributed and highly concentrated in 4 states (Manipur, Sikkim, Tamil Nadu, Nagaland), which received over half the national IGH allocation. DISCUSSION: The EGH had limited impact in achieving equalization, whereas the IGH rewards were concentrated in states which were already doing better. Greater transparency and accountability of centre-to-state allocations and specifically their methodologies are needed to ensure that allocation objectives are aligned to performance.

Organizações Sociais da Saúde: uma expressão fenomênica da privatização da saúde no Brasil / Social Healthcare Organizations: a phenomenological expression of healthcare privatization in Brazil / Organizaciones Sociales de la Salud: una expresión fenoménica de la privatización de la salud en Brasil

Resumo: A pesquisa analisou o processo de expansão das Organizações Sociais da Saúde (OSS) no Brasil durante o período de 2009-2014. Para tanto, dimensionou as dez maiores OSS segundo recursos financeiros captados, explorou suas qualificações como entidades sem fins lucrativos, tomando em conta as evidências empíricas que apontam para sua expansão e consolidação no processo de gestão e prestação de serviços de saúde via estratégias próprias de organizações privadas lucrativas. O estudo é descritivo e exploratório, e foi realizado com base em fontes documentais de domínio público. No plano das relações com o Estado, as OSS têm se beneficiado das brechas e facilidades concedidas pela lei e apresentado uma notável expansão. Evidenciou-se um movimento recente das OSS pela busca concomitante da condição de entidades filantrópicas, assegurando múltiplas oportunidades de captação de recursos e de benefícios fiscais; a possibilidade de aplicação de excedentes financeiros no mercado de capitais; e a remuneração de seus corpos diretivos. Há uma concentração em serviços hospitalares com maior densidade tecnológica; nítida predominância de cláusulas respeitantes ao incremento de repasses financeiros em detrimento de outras cláusulas regulatórias; existência de modalidades especiais de contratos com serviços-meios absolutamente estratégicos para o funcionamento geral do Sistema Único de Saúde. Portanto, neste estudo as OSS se configuram como um dos componentes do Complexo Econômico Industrial da Saúde, nas vertentes da gestão, da prestação e da regulação de serviços, em um cenário de intensiva mercantilização da saúde e de transferência de fundo público para o setor privado.

Abstract: The study analyzed the expansion of Social Healthcare Organizations (OSS in Portuguese) in Brazil from 2009 to 2014. The ten largest OSS were measured according to their budget funding and their qualifications as non-profit organizations were explored, considering evidence of their expansion and consolidation in the management and provision of health services via strategies proper to for-profit private enterprises. The study is descriptive and exploratory and was based on public-domain documents. In their relations with government, the OSS have benefited from legal loopholes and incentives and have expanded accordingly. There has been a recent trend for these organizations to simultaneously apply for status as charitable organizations, thereby ensuring multiple opportunities for fundraising and additional tax incentives, permission to invest financial surpluses in the capital market, and remunerate their boards of directors. These organizations tend to concentrate in technology-dense hospital services, with clauses concerning increasing financial transfers to the detriment of other regulatory clauses, and special contract modalities for enabling services that are absolutely strategic for the overall functioning of the Brazilian Unified National Health System. Thus, in this study, the OSS are one component of the Health Economic and Industrial Complex, acting in management, provision, and regulation of services in a scenario of intensive commodification of health and the transfer of public funds to the private sector.

Resumen: La investigación analizó el proceso de expansión de las Organizaciones Sociales de Salud (OSS) en Brasil, durante el período de 2009-2014. Para ello, se dimensionaron las diez mayores OSS, según los recursos financieros captados, exploró sus características, como entidades sin ánimo de lucro, tomando en consideración las evidencias empíricas que apuntan a su expansión y consolidación en el proceso de gestión y prestación de servicios de salud, vía estrategias propias de organizaciones privadas con ánimo de lucro. El estudio es descriptivo y exploratorio, y fue realizado en base a fuentes documentales de dominio público. En el plano de las relaciones con el Estado, las OSS se han beneficiado de las brechas y facilidades concedidas por la ley y presentado una notable expansión. Se evidenció un movimiento reciente de esas organizaciones por la búsqueda concomitante de su condición como entidades filantrópicas, asegurando múltiples oportunidades de captación de recursos y de beneficios fiscales; la posibilidad de inversión de excedentes financieros en el mercado de capitales; y la remuneración de sus cuerpos directivos. Existe una concentración en servicios hospitalarios con una mayor densidad tecnológica; nítida predominancia de cláusulas, respecto al incremento de transferencias financieras, en detrimento de otras cláusulas regulatorias; existencia de modalidades especiales de contratos con servicios-medios absolutamente estratégicos para el funcionamiento general del Sistema Único de Salud. Por tanto, en este estudio las OSS se configuran como uno de los componentes del Complejo Económico Industrial de la Salud, en las vertientes de la gestión, de la prestación y de la regulación de servicios, en un escenario de intensiva mercantilización de la salud y de transferencia de fondos públicos hacia el sector privado.

O modelo descentralizado e participativo de gerência de unidades de saúde de média e alta complexidade implementado pelo Estado do Acre / The decentralized and participatory model of management of health units of medium and high complexity implemented by the State of Acre

Introdução: Os modelos de gerência centralizados e descentralizados utilizados pela administração pública no Brasil é tema bastante discutido em razão da busca por um atendimento de qualidade prestado à sociedade, não sendo diferente na área da saúde. Nesse sentido o Estado do Acre fez a opção de implementar um modelo de gerência de unidades de saúde que pudesse efetivar a descentralização das unidades de saúde estaduais e estabelecer a participação da comunidade. Objetivos: Analisar o modelo de gerência de unidades de saúde de média e alta complexidade, implementada pelo Estado do Acre, por meio da Lei de Gestão Democrática do Sistema Público de Saúde do Estado do Acre (Lei n.1912/07) e da Lei de Autonomia Financeira das Unidades de Saúde Estaduais (Lei n.1.910/07), no período de 2007 a 2011. Métodos: A pesquisa de natureza qualitativa e descritiva foi realizada no período de 2013 a 2016, utilizando como técnica de coleta de dados secundários a análise de documentos, e de dados primários as entrevistas individuais com informantes-chave. Trata-se de um estudo de caso cuja análise buscou compreender o modelo adotado pelo Estado do Acre. Resultados: A partir do modelo de gerência implementado pelo Estado do Acre, as unidades de saúde sob a gestão estadual passaram a ser geridas por um Conselho Gestor, constituído por gestores, profissionais de saúde e usuários de saúde. O modelo proporciona a descentralização da gerência das unidades de saúde com autonomia para o conselho gestor planejar e executar os recursos financeiros cujo repasse se efetiva com o termo de compromisso. O modelo implementado com a participação da comunidade no conselho gestor executivo apresenta aspectos inovadores e controversos, e sua legalidade fora questionada pelo Tribunal de Contas do Estado do Acre. No entanto, analisando as normas que permitiram a implementação do modelo, verifica-se o cumprimento das normas do Sistema Único de Saúde. Considerações finais: O modelo implementado pelo Estado mostrou ser uma alternativa de gerência de unidades de saúde descentralizado e participativo de modo a incentivar a organização e realização dos conselhos gestores

Introduction: The centralized and decentralized management models used by public administration in Brazil is a topic that is much discussed because of the quest for quality care provided to society, and is not different in the health area. In this sense, the State of Acre made the option of implementing a model of health unit management that could effect the decentralization of state health units and establish community participation. Objectives: To analyze the model of management of health units implemented by the State of Acre through the Law of Democratic Management of the Public Health System of the State of Acre (Law n.1912 / 07) and the Financial Autonomy Law of the Units of State Health (Law n.1.910 / 07) in the period from 2007 to 2011. Methods: The qualitative and descriptive research was carried out in the period from 2013 to 2016, using as secondary data collection technique the analysis of documents and data Primary interviews with key informants. It is a case study whose analysis sought to understand the model adopted by the State of Acre. Results: Based on the management model implemented by the State of Acre, health units under state management were managed by a Management Council, made up of managers, health professionals and health users. The model provides the decentralization of health unit management with autonomy for the managing board to plan and execute the financial resources whose transfer is effective with the term of commitment. The model implemented with the participation of the community in the executive management council presents innovative and controversial aspects and its legality was questioned by the Court of Accounts of the State of Acre. Final considerations: The model implemented by the State has shown to be an alternative for the management of decentralized and participatory health units in order to encourage the implementation of the model. Organization and implementation of management councils

[A proposed organizational model for health districts of the Lazio Region (Italy)]. / Proposta di un modello organizzativo per i Distretti della Regione Lazio.

In the Lazio Region (Italy), health districts were established with Regional Law n. 18 of 1994. In the absence of specific regional recommendations, this was done by taking into account local situations and the needs of individual local health authorities, resulting in a network of markedly heterogeneous health districts. This serious situation has never been dealt with in a concrete manner and no measures have been undertaken over the years to correct it. The Regional Association of healthcare directors, managers and workers, established in 2001, has performed a number of studies to compare corporate acts and healthcare services provided by individual health units; these have confirmed the existence of varied organizational structures. The proposal of a single organizational model for all health districts is particularly important today, following the approval of a commissarial decree (N.373 of 30.7.2015) that states that resources should be used efficiently, health care services should be offered in a homogeneous manner and in compliance with the basic levels of care, and that the number of healthcare units in Rome must be diminished through a process of merging and revision of territorial areas. This reorganization will necessarily face critical issues because of the presence of very different organizational models in the merged healthcare units, making it necessary to develop and implement new homogeneous models in the entire region.

[The prevention of corruption]. / La prevenzione della corruzione.

The escalation of the crisis between society and administration had a negative impact on public administration, as highlighted by criminal acts (bribery, extortion, abuse of power). Other consequences of this crisis have been the bad administration phenomena, such as delays in carrying out the practices, lack of attention to people's questions and failure to comply with working hours. These phenomena culminate in treating people without due respect and necessary kindness. In this context, the so-called applied ethics has developed, consisting of the construction of rules for moral behaviour, adapted to particular fields as well as to the public.

[Conscientious objection in medical practice]. / Objeción de conciencia en la práctica médica.

Medical practice implies the controversial encounter of diverse circumstances in which eventual conflicts between physicians and patients values as well as between physicians values and legal or institutional rules arise. When dealing with these situations, physicians have the right to refuse acting against their moral conscience. This conscientious objection, accepted as a personal right and recognized by several legislations and medical ethics codes, is valid only if it has been reasonably justified and declared in advance. Conversely, it would be invalid if it is based upon convenience or understood as a collective refusal, which may be a form of civil disobedience. Conscientious objection in medicine is considered a limited right even though patients ought to be respected in their demands for legally accepted treatments or interventions. On the other hand, personal conscientious objection is different from the prerogative of institutions to establish their own regulations according to their institutional ideology or ethics codes. However, public hospitals have to offer all treatments or interventions legally allowed, since the state has the obligation to guarantee all citizens an appropriate access to them.

Características de colecistectomía laparoscópica ambulatoria y hospitalaria, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 2012-2013 / Characteristics of outpatient and hospital laparoscopic cholecystectomy, Instituto Hondureño de Seguridad Social, Tegucigalpa, Honduras, 2012-2013

Antecedentes: Colecistectomía Laparoscópica Ambulatoria (CLA) es el procedimiento donde el tiempo entre ingreso y egreso del paciente es <12 horas. En el Hospital de Especialidades (HE) del Instituto Hondureño de Seguridad Social (IHSS), Tegucigalpa, se implementó desde 2007. Objetivo: Determinar las características de CLA y de Colecistectomía Laparoscópica Hospitalaria (CLH), IHSS, 2012-2013. Métodos: Estudio descriptivo transversal en pacientes atendidos en Unidad de Cirugía Ambulatoria y HE IHSS, enero 2012­Enero 2013. Se identificaron características sociodemográficas y clínicas a partir de expedientes seleccionados aleatoriamente. Se estimó costo-beneficio en base a costo/intervención quirúrgica y días de hospitalización e incapacidad. Resultados se presentan como frecuencia y porcentaje, razones de disparidad (OR), intervalo de confianza 95% y valor de p<0.05. Resultados: Se analizaron 100 pacientes en cada grupo. Se asociaron a CLA edad ≤50 (3.8, 2.1

[Privatization of health care management through Social Organizations in the city of São Paulo, Brazil: description and analysis of regulation]. / Privatização da gestão do sistema municipal de saúde por meio de Organizações Sociais na cidade de São Paulo, Brasil: caracterização e análise da regulação.

The article describes and discusses privatization of the municipal health system in São Paulo, Brazil, from an administrative and political perspective. The methodology consisted of a literature review and analysis of legislation and public documents. The study showed that although legislation governing the so-called "Social Organizations" (OS) in Brazil dates to the year 2006, half of the administrative privatization is still regulated by a previous provisional instrument in the form of an "agreement" ("convênio" in Portuguese). In 2011, 61% of services were administered by private organizations, which received 44% of the health budget in 2012. The twenty participating organizations include five of the ten largest health care companies in Brazil. Inspection agencies have detected flaws in the management contracts, but the "agreements" (convênios) are subject to less rigorous control and have proven invisible to inspection. Finally, the legal framework is unstable. The study uses the experience in São Paulo as the basis for discussing the political versus technical nature of private management in the Brazilian Unified National Health System (SUS).

Privatização da gestão do sistema municipal de saúde por meio de Organizações Sociais na cidade de São Paulo, Brasil: caracterização e análise da regulação / Privatization of health care management through Social Organizations in the city of São Paulo, Brazil: description and analysis of regulation / La privatización de la gestión del sistema de salud a través de Organizaciones Sociales en la ciudad de São Paulo, Brasil: caracterización y análisis de la regulación

Este trabalho caracteriza e discute a privatização da gestão do sistema municipal de saúde na cidade de São Paulo, Brasil, com base em uma perspectiva administrativista e política. A metodologia consistiu em levantamento bibliográfico e análise de legislação e documentos públicos. A pesquisa demonstrou que embora a lei de Organizações Sociais (OS) seja de 2006, metade da privatização da gestão ainda é regulada por um ajuste provisório anterior, o convênio. Em 2011, 61% dos serviços eram geridos por entidades privadas que, em 2012, receberam 44% do orçamento da saúde. As vinte entidades envolvidas incluem cinco dos dez maiores grupos privados de serviços médicos do país. Órgãos fiscalizadores evidenciam falhas de controle nos contratos de gestão, mas os convênios, que apresentam controle mais frágil, têm sido invisíveis à fiscalização. Por fim, o marco legal é instável. Valendo-se da experiência paulistana, discute-se o caráter político vs. técnico da regulação da gestão privada no Sistema Único de Saúde (SUS).

The article describes and discusses privatization of the municipal health system in São Paulo, Brazil, from an administrative and political perspective. The methodology consisted of a literature review and analysis of legislation and public documents. The study showed that although legislation governing the so-called "Social Organizations" (OS) in Brazil dates to the year 2006, half of the administrative privatization is still regulated by a previous provisional instrument in the form of an "agreement" ("convênio" in Portuguese). In 2011, 61% of services were administered by private organizations, which received 44% of the health budget in 2012. The twenty participating organizations include five of the ten largest health care companies in Brazil. Inspection agencies have detected flaws in the management contracts, but the "agreements" (convênios) are subject to less rigorous control and have proven invisible to inspection. Finally, the legal framework is unstable. The study uses the experience in São Paulo as the basis for discussing the political versus technical nature of private management in the Brazilian Unified National Health System (SUS).

El trabajo caracteriza y discute la privatización de la gestión del sistema municipal de salud de la ciudad de São Paulo, Brasil, desde una perspectiva administrativa y política. La metodología se basó en un análisis bibliográfico, legislativo y de documentos públicos. La investigación demostró que, aunque la ley de Organizaciones Sociales (OS) sea de 2006, la mitad de la gestión privada está todavía regulada por un instrumento legal provisional anterior, el convenio. En 2011, un 61% de los servicios se encontraban gestionados por entidades privadas que, en 2012, recibieron un 44% del presupuesto de salud. Entre las 20 entidades involucradas, existen 5 de los 10 mayores grupos privados de servicios médicos del país. Órganos fiscalizadores muestran fallos en el control de las OS, pero los convenios, cuyo control es más débil, han sido invisibles a ojos de estos órganos de fiscalización. Finalmente, cabe destacar que el marco legal es inestable. A partir de la experiencia de São Paulo, se discute el carácter técnico vs. político de la regulación en la gestión privada en el Sistema Único de Salud (SUS).

Evidence-Based Policy Making: Balancing Rigor With Real-World Health Care for Veterans and Military Personnel.

The US health care system is undergoing unprecedented policy transformations that will impact veterans and returning service members. Rigorous program evaluations will be crucial as policy makers make tough decisions regarding the value of new policies. Also, more partnerships between scientists and policy makers will be required to implement these designs in light of trade-offs between scientific rigor and political realities.

Liberalising trade in health services: constraints and prospects for South Asian countries.

This paper attempts to examine the prospects and challenges associated with liberalising trade in health services in five South Asian countries, namely Bangladesh, India, Nepal, Pakistan and Sri Lanka. Country-specific secondary information, a brief literature review of empirical studies and debriefing sessions with key stakeholders are employed to explore the issues related to liberalising health services trade. The health sectors in India, Nepal and Pakistan are scheduled under General Agreement on Trade in Services (GATS) classification, whereas those in Bangladesh and Sri Lanka are not. In Bangladesh, there is opportunity for investment in joint venture hospitals under Mode 3. Nonetheless, India is the largest trader in health services under all four modes. In Sri Lanka, cross-border trade in healthcare services is found to be insignificant. Moreover, expertise in eye treatment in Nepal could also attract foreign investment in medical services under Mode 3. In contrast, Pakistan exhibits no potential under Mode 4, because of a lack of healthcare professionals. In this view, the prospects of trade in health services within the South Asian region under the four GATS modes are constrained by infrastructural, regulatory, perception-related, logistical and cultural problems. Considering the level of development and commercial opportunities, regional integration in the health sector could be explored in such areas as telemedicine, medical tourism, cross-border investment and capacity building of health personnel. These developments call for stronger and pro-active government-to-government collaboration in the South Asian Association of Regional Cooperation (SAARC) region in a transparent and accountable manner.