RESUMEN
Background: Brazil's Unified Health System (SUS) ensures universal, equitable, and excellent quality health coverage for all. The broad right to health, supported by the Constitution, has led to excessive litigation in the public sector. This has negatively impacted the financial stability of SUS, created inequality in children and adolescents' access to healthcare, and affected communication between the healthcare system and the judiciary. The enactment of Law Number 13.655 on 25 April 2018, proposed significant changes in judicial decisions. This study aimed to investigate decision-making changes in health litigation involving children and adolescents following the implementation of the new normative model. Methods: The study is cross-sectional, analyzing 3753 national judgment documents from all State Courts of Brazil, available on their respective websites from 2014 to 2020. It compares regional legal decisions before and after the promulgation of Law Number 13.655/2018. Data tabulation, statistical analysis, textual analysis, coding, and counting of significant units in the collected documents were performed. The results of data cross-referencing are presented in tables and diagrams. Results: The majority (96.86%) of legal claims (3635 cases) received partial or total provision of what was prescribed by the physician. The Judiciary predominantly handled these cases individually. The analysis indicates that the decisions made did not adhere to the norms established in 2018. Conclusion: Regional heterogeneity in health litigation was observed, and there was no significant variability in decisions during the studied period, even after the implementation of the new normative paradigm in 2018. Technical-scientific support was undervalued by the magistrates. Prioritizing litigants undermines equity in access to Universal Health Coverage for children and adolescents.
Asunto(s)
Accesibilidad a los Servicios de Salud , Cobertura Universal del Seguro de Salud , Humanos , Brasil , Adolescente , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Niño , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Estudios Transversales , Programas Nacionales de Salud/legislación & jurisprudencia , Derecho a la Salud/legislación & jurisprudenciaRESUMEN
INTRODUCTION: The National Health Insurance Scheme (NHIS) was introduced in 2003 to reduce "out-of-pocket" payments for health care in Ghana. Over a decade of its implementation, issues about the financial sustainability of this pro-poor policy remains a crippling fact despite its critical role to go towards Universal Health Coverage. We therefore conducted this study to elicit stakeholders' views on ways to improve the financial sustainability of the operations of NHIS. METHODS: Twenty (20) stakeholders were identified from Ministry of Health, Ghana Health Services, health workers groups, private medical practitioners, civil society organizations and developmental partners. They were interviewed using an interview guide developed from a NHIS policy review and analysis. All interviews were recorded and transcribed verbatim. The data were analysed thematically with the aid of NVivo 12 software. RESULTS: Stakeholders admitted that the NHIS is currently unable to meet its financial obligations. The stakeholders suggested first the adoption of capitation as a provider payment mechanism to minimize the risk of providers' fraud and protection from political interference. Secondly, they indicated that rapid releases of specific statutory deductions and taxes for NHIS providers could reduce delays in claims' reimbursement which is one of the main challenges faced by healthcare providers. Aligning the NHIS with the Community-based Health Planning and Services and including preventive and promotive health is necessary to position the Scheme for Universal Health Coverage. CONCLUSION: The Scheme will potentially achieve UHC if protected from political interference to improve the governance and transparency that affects the finances of the scheme and the expansion of services to include preventive and promotive services and cancers.
Asunto(s)
Programas Nacionales de Salud/economía , Cobertura Universal del Seguro de Salud/economía , Ghana , Política de Salud , Humanos , Entrevistas como Asunto , Programas Nacionales de Salud/legislación & jurisprudencia , Investigación Cualitativa , Estados Unidos , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaRESUMEN
BACKGROUND: Refugees' access to quality healthcare services might be compromised, which can in turn hinder universal health coverage (UHC), and achieving Sustainable Development Goal (SDG), ultimately. Objective: This article aims to illustrate the status of refugees' access to healthcare and main initiatives to improve their health status in Iran. METHODS: This is a mixed-method study with two consecutive phases: qualitative and quantitative. In the qualitative phase, through a review of documents and semi-structured interviews with 40 purposively-selected healthcare providers, the right of refugees to access healthcare services in the Iranian health system was examined. In the quantitative phase, data on refugees' insurance coverage and their utilization from community-based rehabilitation (CBR) projects were collected and analyzed. RESULTS: There are international and upstream policies, laws and practical projects that support refugees' health in Iran. Refugees and immigrants have free access to most healthcare services provided in the PHC network in Iran. They can also access curative and rehabilitation services, the costs of which depend on their health insurance status. In 2015, the government allowed the inclusion of all registered refugees in the Universal Public Health Insurance (UPHI) scheme. Moreover, the mean number of disabled refugees using CBR services was 786 (±389.7). The mean number of refugees covered by the UPHI scheme was 112,000 (±30404.9). CONCLUSION: The United Nations' SDGs ask to strive for peace and reducing inequity. Along its pathway towards UHC, despite limited resources received from the international society, the government of Iran has taken some fundamental steps to serve refugees similar to citizens of Iran. Although the initiative looks promising, more is still required to bring NGOs on board and fulfill the vision of leaving no one behind.
Asunto(s)
Accesibilidad a los Servicios de Salud/normas , Refugiados/legislación & jurisprudencia , Femenino , Humanos , Irán , Masculino , Investigación Cualitativa , Mejoramiento de la Calidad , Refugiados/estadística & datos numéricos , Desarrollo Sostenible , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/estadística & datos numéricosAsunto(s)
Reforma de la Atención de Salud/legislación & jurisprudencia , Medicare , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Humanos , Seguro de Salud/economía , Seguro de Salud/legislación & jurisprudencia , Estados Unidos , Cobertura Universal del Seguro de Salud/economíaRESUMEN
In the midst of the COVID-19 outbreak, health care reform has again taken a major role in the 2020 election, with Democrats weighing Medicare for All against extensions of the Affordable Care Act, while Republicans quietly seem to favor proposals that would eliminate much of the ACA and cut Medicaid. Although states play a major role in health care funding and administration, public and scholarly debates over these proposals have generally not addressed the potential disruption that reform proposals might create for the current state role in health care. We examine how potential reforms influence state-federal relations, and how outside factors like partisanship and exogenous shocks like the COVID-19 pandemic interact with underlying preferences of each level of government. All else equal, reforms that expand the ACA within its current framework would provide the least disruption for current arrangements and allow for smoother transitions for providers and patients, rather than the more radical restructuring proposed by Medicare for All or the cuts embodied in Republican plans.
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COVID-19/epidemiología , Reforma de la Atención de Salud/legislación & jurisprudencia , National Health Insurance, United States/legislación & jurisprudencia , Patient Protection and Affordable Care Act/legislación & jurisprudencia , Humanos , Medicaid/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , National Health Insurance, United States/tendencias , Patient Protection and Affordable Care Act/tendencias , Estados Unidos , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaAsunto(s)
Reforma de la Atención de Salud/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , COVID-19/prevención & control , Interoperabilidad de la Información en Salud/legislación & jurisprudencia , Humanos , Medicare/legislación & jurisprudencia , Estados UnidosAsunto(s)
Infecciones por Coronavirus/prevención & control , Carga Global de Enfermedades/tendencias , Salud Global/legislación & jurisprudencia , Esperanza de Vida/historia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus/aislamiento & purificación , Tasa de Natalidad/tendencias , COVID-19 , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Esperanza de Vida/tendencias , Mortalidad/tendencias , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Factores de Riesgo , SARS-CoV-2 , Factores Socioeconómicos , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaRESUMEN
BACKGROUND: In recent years, health insurance (HI) has been chosen by many low- and middle-income countries to obtain an important health policy target-universal health coverage. Vietnam has recently introduced the Revised Health Insurance Law, and the effects of the voluntary health insurance (VHI) and heavily subsidised health insurance (HSHI) programmes have not yet been analysed. Therefore, this study is aimed at examining the impact of these HI programmes on the utilisation of health care services and out-of-pocket health expenditure (OOP) in general and across different health care providers in particular. METHODS: Using the two waves of Vietnam Household Living Standard Surveys 2014 and 2016 and the difference-in-difference method, the impacts of VHI and HSHI on health care utilisation and OOP in Vietnam were estimated. RESULTS: For both the VHI and HSHI groups, we found that HI increased the probability of seeking outpatient care, the mean number of outpatient visits, the total number of visits, and the mean number of visits at the district level of health care providers in the last 12 months. However, there was no evidence that the HSHI programmes increased the mean number of inpatient visits and the number of visits at the provincial hospital. We also found that while the VHI programme reduced OOP for both outpatient and inpatient care, the HSHI scheme did not result in a reduction in OOP for hospitalisation, although HI lowered the total OOP. Similarly, we found that for both groups, HI reduced OOP when the insured visited district and provincial hospitals. However, the statistically significant impact was not demonstrated when the enrolees of HSHI programmes visited provincial hospitals. CONCLUSION: The study offers evidence that the Vietnamese HI scheme increased health care service utilisation and decreased OOP for the participants of the VHI and HSHI programmes. Therefore, the government should continue to consider improving the HI system as a strategy to achieve universal health coverage.
Asunto(s)
Gastos en Salud , Seguro de Salud , Aceptación de la Atención de Salud , Adulto , Atención Ambulatoria/economía , Atención Ambulatoria/estadística & datos numéricos , Femenino , Encuestas de Atención de la Salud/estadística & datos numéricos , Gastos en Salud/estadística & datos numéricos , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Seguro de Salud/legislación & jurisprudencia , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Puntaje de Propensión , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , VietnamRESUMEN
The role of external actors in national health policy in aid-independent countries has received relatively little attention in the literature, despite the fact that influence continues to be exerted once financial support is curtailed as countries graduate from lower income status. Focusing on a specific health policy in an aid-independent country, this qualitative study explores the role of external actors in shaping Thailand's migrant health insurance. Primary data were collected through in-depth interviews with eighteen key informants from September 2018 to January 2019. The data were analysed using thematic analysis, focusing on three channels of influence, financial resources, technical expertise and inter-sectoral leverage, and their effect on the different stages of the policy process. Given Thailand's export orientation and the importance of reputational effects, inter-sectoral leverage, mainly through the US TIP Reports and the EU carding decision, emerged as a very powerful channel of influence on priority setting, as it indirectly affected the migrant health insurance through efforts aimed at dealing with problems of human trafficking in the context of labour migration, especially after the 2014 coup d'état. This study helps understand the changed role external actors can play in filling health system gaps in aid-independent countries.
Asunto(s)
Política de Salud , Pacientes no Asegurados , Determinantes Sociales de la Salud , Migrantes , Cobertura Universal del Seguro de Salud , Financiación del Capital , Organizaciones de Beneficencia/economía , Países en Desarrollo , Agencias Gubernamentales , Gastos en Salud , Trata de Personas , Humanos , Agencias Internacionales , Colaboración Intersectorial , Entrevistas como Asunto , Pacientes no Asegurados/legislación & jurisprudencia , Organizaciones/economía , Política , Cambio Social , Tailandia , Migrantes/legislación & jurisprudencia , Inmigrantes Indocumentados/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/estadística & datos numéricosRESUMEN
OBJECTIVES: To analyze the fundamentals of the global health agenda from 1944 to 2018, especially regarding Universal Health Coverage, in order to unveil its relations with capital accumulation in health services and to contribute to world social mobilization to change this tendency. METHODS: A historical study was carried out based on a purposeful selection of primary sources on the global health agenda from multilateral organizations and secondary sources about the changes of capitalism from the study period. RESULTS: The global health agenda changed from the state responsibility for health to an insurance healthcare system based on markets. The medical-industrial complex pressured national economies, broke postwar pacts, and urged economic globalization. The neoliberal, neoclassical, and neo-institutional discourse that promoted a new state-market relationship eased the new capital accumulation in healthcare into financial and cognitive capitalism. CONCLUSIONS: Understanding these relationships allows us to provide elements for social mobilization geared to transform the healthcare sector toward a new vision of health with a nature-society relationship that contributes to socially constructing human and environmental health, rather than gaining profits based on illness and chronic suffering.
Asunto(s)
Atención a la Salud/economía , Salud Global/economía , Salud Global/historia , Servicios de Salud/economía , Política , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/historia , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Atención a la Salud/historia , Atención a la Salud/legislación & jurisprudencia , Atención a la Salud/estadística & datos numéricos , Salud Global/legislación & jurisprudencia , Salud Global/estadística & datos numéricos , Servicios de Salud/historia , Servicios de Salud/legislación & jurisprudencia , Servicios de Salud/estadística & datos numéricos , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Cobertura Universal del Seguro de Salud/estadística & datos numéricosAsunto(s)
Betacoronavirus , Centros Comunitarios de Salud/legislación & jurisprudencia , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Boston , COVID-19 , Centros Comunitarios de Salud/organización & administración , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Financiación Gubernamental/legislación & jurisprudencia , Humanos , Patient Protection and Affordable Care Act , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Racismo , SARS-CoV-2 , Estados UnidosAsunto(s)
Atención a la Salud , Atención Primaria de Salud , Cobertura Universal del Seguro de Salud , Brasil , Atención a la Salud/economía , Atención a la Salud/legislación & jurisprudencia , Salud de la Familia , Humanos , Atención Primaria de Salud/economía , Atención Primaria de Salud/legislación & jurisprudencia , Derecho a la Salud/economía , Derecho a la Salud/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaRESUMEN
The year 2019 featured extensive debates on transforming the United States multipayer health care system into a single-payer system. At a time when reimbursement structures are in flux and potential changes in government may affect health care, it is important for neuroradiologists to remain informed on how emerging policies may impact their practices. The purpose of this article is to examine potential ramifications for neuroradiologist reimbursement with the Medicare for All legislative proposals. An institution-specific analysis is presented to illustrate general Medicare for All principles in discussing issues applicable to practices nationwide.
Asunto(s)
Medicare , Neurología , Radiología , Sistema de Pago Simple , Cobertura Universal del Seguro de Salud , Humanos , Medicare/legislación & jurisprudencia , Sistema de Pago Simple/legislación & jurisprudencia , Estados Unidos , Cobertura Universal del Seguro de Salud/legislación & jurisprudenciaRESUMEN
In the context of addressing the pressing health needs for the global population, the World Health Organization has repeatedly called for universal health coverage (UHC) to be prioritised by its member countries. This is to be achieved through a high-quality primary health care (PHC) approach that provides comprehensive and integrated generalist care as close to where people live as well as links the clinical care to health promotion and disease prevention. In this paper, we argue for the introduction of family medicines as a critical player in the healthcare system of Tanzania to strengthen the strategies towards UHC. The paper reviews how PHC is understood, the context of family medicine in sub-Saharan Africa and makes a case for how family medicine can assist in addressing the current burden of disease in Tanzania.
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Medicina Familiar y Comunitaria/métodos , Reforma de la Atención de Salud/métodos , Medicina Familiar y Comunitaria/legislación & jurisprudencia , Medicina Familiar y Comunitaria/estadística & datos numéricos , Reforma de la Atención de Salud/legislación & jurisprudencia , Reforma de la Atención de Salud/estadística & datos numéricos , Humanos , Tanzanía , Cobertura Universal del Seguro de Salud/legislación & jurisprudencia , Cobertura Universal del Seguro de Salud/estadística & datos numéricosRESUMEN
Sustaining universal health coverage requires robust active public participation in policy formation and governance. Thailand's universal coverage scheme was implemented nationwide in 2002, allowing Thailand to achieve full population coverage through three public health insurance schemes and to demonstrate improved health outcomes. Although Thailand's position on the World Bank worldwide governance indicators has deteriorated since 1996, provisions for voice and accountability were embedded in the legislation and design of the universal coverage scheme. We discuss how legislation related to citizens' rights and government accountability has been implemented. Thailand's constitution allowed citizens to submit a draft bill in which provisions on voice and accountability were successfully embedded in the legislative texts and adopted into law. The legislation mandates registration of beneficiaries, a 24/7 helpline, annual public hearings and no-fault financial assistance for patients who have experienced adverse events. Ensuring the right to health services, and that citizens' voices are heard and action taken, requires the institutional capacity to implement legislation. For example, Thailand needed the capacity to register 47 million people and match them with the health-care provider network in the district where they live, and to re-register members who move out of their districts. Annual public hearings need to be inclusive of citizens, health-care providers, civil society organizations and stakeholders such as local governments and patient groups. Subsequent policy and management responses are important for building trust in the process and citizens' ownership of the scheme. Annual public reporting of outcomes and performance of the scheme fosters transparency and increases citizens' trust.
Maintenir la couverture sanitaire universelle exige une forte participation publique à l'élaboration des politiques et à la gouvernance. En Thaïlande, le régime de couverture universelle a été mis en Åuvre dans tout le pays en 2002, permettant de couvrir l'ensemble de la population grâce à trois régimes publics d'assurance maladie et d'améliorer les résultats de santé. Bien que la position de la Thaïlande concernant les Indicateurs de gouvernance mondiaux de la Banque mondiale se soit détériorée depuis 1996, des dispositions en matière d'expression et de reddition de comptes ont été intégrées à la législation et à la structure du régime de couverture universelle. Nous discutons ici de la mise en Åuvre de la législation relative aux droits des citoyens et à la reddition de comptes du gouvernement. En vertu de la constitution de la Thaïlande, les citoyens ont pu soumettre un projet de loi dont les dispositions en matière d'expression et de reddition de comptes ont été intégrées aux textes législatifs et transposées dans la loi. La législation rend obligatoire l'enregistrement des bénéficiaires, une assistance téléphonique 24h/24 et 7 j/7, des auditions publiques annuelles et une aide financière systématique pour les patients qui ont été victimes d'événements indésirables. Pour garantir le droit à des services de santé, permettre aux citoyens de faire entendre leur voix et s'assurer que des mesures soient prises, les institutions doivent être en mesure d'appliquer la législation. Par exemple, la Thaïlande devait pouvoir enregistrer 47 millions de personnes et les rattacher au réseau de prestataires de soins du district où elles vivaient, et réenregistrer les personnes qui changeaient de district. Les auditions publiques annuelles doivent faire participer les citoyens, les prestataires de soins, les organisations de la société civile et les parties prenantes telles que les collectivités locales et les groupes de patients. Les réponses qui en découlent au point de vue des politiques et de la gestion sont importantes pour instaurer la confiance dans le processus et permettre aux citoyens de se l'approprier. Les rapports annuels publics sur les résultats du régime de couverture permettent d'accroître la transparence et de renforcer la confiance des citoyens.
Para mantener la cobertura sanitaria universal se requiere una sólida participación activa del público en la formulación de políticas y la gobernanza. El plan de cobertura universal de Tailandia se implementó en todo el país en 2002, lo que permitió a Tailandia lograr una cobertura completa de la población a través de tres planes de seguro médico público y demostrar mejores resultados en materia de salud. Aunque la posición de Tailandia respecto de los Indicadores mundiales de gobernanza del Banco Mundial ha disminuido desde 1996, las disposiciones relativas a la voz y la rendición de cuentas estaban incorporadas en la legislación y en el diseño del plan de cobertura universal. Se discute cómo se ha implementado la legislación relacionada con los derechos de los ciudadanos y la rendición de cuentas del gobierno. La Constitución de Tailandia permitía a los ciudadanos presentar un proyecto de ley en el que las disposiciones sobre la voz y la rendición de cuentas se incorporaban con éxito en los textos legislativos y se aprobaban como ley. La legislación exige el registro de los beneficiarios, una línea telefónica de ayuda 24 horas al día los 7 días de la semana, audiencias públicas anuales y asistencia financiera gratuita para los pacientes que han sufrido eventos adversos. Para garantizar el derecho a los servicios de salud y que se escuche la voz de los ciudadanos y se adopten medidas, es necesario contar con la capacidad institucional para aplicar la legislación. Por ejemplo, Tailandia necesitaba la capacidad de inscribir a 47 millones de personas y ponerlas en contacto con la red de proveedores de servicios de salud del distrito en el que viven, y de volver a inscribir a los miembros que se trasladan fuera de sus distritos. Las audiencias públicas anuales deben incluir a los ciudadanos, los proveedores de servicios de salud, las organizaciones de la sociedad civil y las partes interesadas, como los gobiernos locales y los grupos de pacientes. Las respuestas políticas y de gestión subsiguientes son importantes para generar confianza en el proceso y en la apropiación del plan por parte de los ciudadanos. El informe público anual sobre los resultados y el rendimiento del plan fomenta la transparencia y aumenta la confianza de los ciudadanos.