Parents' attitudes towards the No Jab No Play legislation in Western Australia: a mixed methods study.

BACKGROUND: Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA). METHODS: This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants. RESULTS: Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents' beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities. CONCLUSIONS: Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.

A conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs).

Building effective medicine pricing policies is a challenging task in all high-, middle- and low-income countries. In high-income countries have stable health systems in place, trained workforce, as well as specialised agencies to evaluate innovative drugs for reimbursement. However, in low- and middle-income countries (LMICs) the challenges are manifold. A large majority of low- and middle-income countries lack technical expertise either to evaluate new medicines or to set efficient medicine prices. The countries also lack comparator reference pricing data to set prices. Also, there are significant out-of-pocket expenditures as people pay for medicines by themselves. An effective medicine pricing policy is vital in the context that it can be used as a tool to improve access and affordability among the masses. This discussion paper presents a conceptual framework to build effective medicine pricing policies for low and middle-income countries (LMICs). The enablers to build effective medicine pricing policies are also discussed. This includes (a) data and statistics on the pharmaceutical situation of the country (b) Having a national medicine policy in the country (c) The availability of the medicine pricing data and (d) Human resources and technical capacity. WHO has recommended several strategies including External Price Referencing (EPR), Internal Reference pricing, Value-based pricing, Cost-plus pricing, and Generic medicine policies to build a pricing policy. However, this information is generic and it's a complex task for countries to tailor to their needs, hence a critical analysis is provided on these policies. The concepts related to fair medicine pricing, providing information to consumers and price transparency are also discussed.

Reconciling devolution with health financing and public financial management: challenges and policy options for the health sector.

The interplay between devolution, health financing and public financial management processes in health-or the lack of coherence between them-can have profound implications for a country's progress towards universal health coverage. This paper explores this relationship in seven Asian and African countries (Burkina Faso, Kenya, Mozambique, Nigeria, Uganda, Indonesia and the Philippines), highlighting challenges and suggesting policy solutions. First, subnational governments rely heavily on transfers from central governments, and most are not required to allocate a minimum share of their budget to health. Central governments channelling more funds to subnational governments through conditional grants is a promising way to increase public financing for health. Second, devolution makes it difficult to pool funding across populations by fragmenting them geographically. Greater fiscal equalisation through improved revenue sharing arrangements and, where applicable, using budgetary funds to subsidise the poor in government-financed health insurance schemes could bridge the gap. Third, weak budget planning across levels could be improved by aligning budget structures, building subnational budgeting capacity and strengthening coordination across levels. Fourth, delays in central transfers and complicated procedures for approvals and disbursements stymie expenditure management at subnational levels. Simplifying processes and enhancing visibility over funding flows, including through digitalised information systems, promise to improve expenditure management and oversight in health. Fifth, subnational governments purchase services primarily through line-item budgets. Shifting to practices that link financial allocations with population health needs and facility performance, combined with reforms to grant commensurate autonomy to facilities, has the potential to enable more strategic purchasing.

Do coronary stent policies affect the cost-effectiveness of percutaneous coronary intervention among patients with acute coronary syndrome in Shanghai? A retrospective cohort study based on real-world and propensity score-matched data.

OBJECTIVES: This study aimed to assess whether the national centralised volume-based procurement policy and the Shanghai government's supportive measures (coronary stent policies) implemented in Shanghai, China, on 20 January 2021 affected the cost-effectiveness of percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS) in the year after surgery. DESIGN: A retrospective cohort study based on real-world data and propensity score (PS)-matched data was conducted to compare the cost-effectiveness of PCI before and after policy implementation. PATIENTS AND SETTING: Patients with ACS who had undergone first-time PCI over 1 year previously in hospitals in Shanghai and were discharged between 1 March 2019 and 30 April 2022 were included in the study. OUTCOME MEASURES: In the present study, cost was defined as total direct medical expenses, and effectiveness was defined as the prevention of major adverse cardiac events (MACEs). Incremental cost-effectiveness ratios (ICERs) were used to measure the cost-effectiveness of PCI in patients with ACS 1 year after surgery. RESULTS: The study included 31 760 patients. According to real-world and PS-matched data, the implementation of coronary stent policies in Shanghai reduced the total medical cost of patients with ACS 1 year after PCI by 24.39% (p<0.0001) and 22.26% (p<0.0001), respectively. The ICERs were ¥-1131.72 and ¥-842.00 thousand per MACE avoided, respectively. The ICERs were robust to parameter uncertainty, and there was a substantial chance for policy implementation to improve the cost-effectiveness of PCI among patients with ACS in the short term. CONCLUSIONS: The implementation of coronary stent policies has improved the cost-effectiveness of PCI for patients with ACS in the short term. The long-term impact of coronary stent policies on the cost-effectiveness of PCI in patients with ACS or other coronary heart diseases should be assessed in the future.

La ética y la medicina social: la perspectiva de Michel Foucault / Ethics and social medicine: Michel Foucault's perspective

Resumen La preocupación de Michel Foucault por la medicina, su historia y su impacto en la sociedad, es una constante en su obra. El objetivo de este trabajo es contrastar el contenido de las conferencias que Foucault impartió en Río de Janeiro, en octubre de 1974, con los materiales preparatorios de las mismas que forman parte de los fondos adquiridos por la Biblioteca Nacional de Francia. Una de las cuestiones clave en dichas conferencias es la relación entre la ética y la medicina social contemporánea. Esa cuestión, analizada desde el punto de vista de Foucault, constituye el trasfondo e interés último del presente trabajo.

Abstract Michel Foucault's preoccupation with medicine, its history and its impact on society, is a constant in his work. The goal of this study is to contrast the content of the lectures Foucault gave in Rio de Janeiro, in October 1974, with the preparatory notes for them which are part of the archival holdings acquired by the National Library of France. One of the key questions in those lectures is the relationship between ethics and contemporary social medicine. This question, analyzed from Foucault's point of view, constitutes the background and ultimate interest of this article.

Democracy and Health: reflections and challenges before the 16th Brazilian National Health Conference / Democracia e Saúde: reflexões e desafios frente à 16ª Conferência Nacional de Saúde

ABSTRACT This text aimed to analyze characteristics and challenges of the 16th Brazilian National Health Conference based on the conference three thematic axes: Health as a right; Consolidation of the Brazilian Unified Health System (SUS) principles; Adequate and enough funding for SUS. Given the initiatives to dismantle the social security model and the setbacks of social protection policies, to delimitate health in an expanded sense is essential to defend the SUS project. We analyzed the proposal of Universal Health Coverage as an alternative to universal systems. We then presented the restrictions of universal coverage and how the restrictions can threaten the SUS principles. We also discussed insufficient SUS funding and possible worsening in the face of fiscal austerity policies. To strengthen social participation and to monitor the proposals approved at the conference are necessary.

RESUMO Este texto teve por objetivo analisar as características e os desafios da 16ª Conferência Nacional de Saúde a partir dos três eixos temáticos da conferência: Saúde como direito; Consolidação dos princípios do Sistema Único de Saúde (SUS); Financiamento adequado e suficiente para o SUS. Diante das iniciativas de desmonte do modelo de seguridade social e dos retrocessos das políticas de proteção social, a delimitação da saúde em sentido ampliado é fundamental para a defesa do projeto do SUS. Analisamos a proposta da Cobertura Universal de Saúde como alternativa aos sistemas universais. Apresentamos as restrições da cobertura universal e as ameaças que podem significar aos princípios do SUS. Discutimos a insuficiência do financiamento do SUS e os possíveis agravamentos diante das políticas de austeridade fiscal. É necessário o fortalecimento da participação social e o monitoramento das propostas aprovadas na conferência.

COVID-19, neoliberalismo y sistemas sanitarios en 30 países de Europa: repercusiones en el número de fallecidos / COVID-19, neoliberalism and health systems in 30 European countries: relationship to deceases

OBJETIVO: El estudio se fundamentó en la necesidad de entender el elevado número de fallecimientos por COVID-19 en la pandemia mundial declarada desde Diciembre de 2019, y cómo golpeó de forma distinta en los países de Europa. La hipótesis planteada fue que una menor inversión en el sistema de sanidad pública, el número de médicos por habitante y el número de camas hospitalarias disponibles para la población provocaron un mayor número de fallecidos tras la llegada de la COVID-19 a cada país estudiado. El objetivo fue analizar la relación entre el número de fallecimientos por COVID-19 en la pandemia mundial declarada desde diciembre de 2019 y las políticas e inversión sanitarias en los países de Europa. MÉTODOS: Se realizó un estudio de investigación en el que se analizaron un total de seis variables con datos oficiales y contrastados: gasto público en salud per cápita; médicos por cada 1.000 habitantes; número de camas por cada 1.000 personas; muertes por COVID-19 por cada millón de habitantes; número de test para detectar COVID-19 por cada 1.000 habitantes; y Coeficiente GINI para medir el grado de desigualdad social en cada país. Se llevó a cabo en 30 países europeos. Se realizaron análisis de frecuencias y correlaciones (Pearson). RESULTADOS: Se encontraron 5 países, que fueron los que dieron valores por encima de 300 fallecidos por millón (datos de 27 de abril de 2020): Reino Unido; (305,39), Francia (350,16), Italia (440,67), España (495,99) y Bélgica (612,1). Precisamente, en los países que más muertes registraron (Reino Unido, Francia, Italia, España y Bélgica) a fecha de 27 de abril, no encontramos valores elevados de realización de TEST. En nuestros análisis, obtuvimos que a menos inversión de gasto público en salud (per cápita), se daba un mayor número de muertes por COVID-19 por cada millón de habitantes, una menor cobertura en camas hospitalarias, y un menor número de doctores. Finalmente, comprobamos que a menor fue el gasto en salud pública, más alto era el coeficiente GINI (por tanto mayor desigualdad social). CONCLUSIONES: Se detecta un efecto negativo en término de muertes cuando la inversión en salud pública es menor. El mayor número de muertes por COVID-19 está correlacionado (p < 0,005) con una mayor desigualdad social (coeficiente GINI) y con una menor inversión en salud pública (p < 0,001). Esto ha incidido en el menor número de camas disponibles y una baja cobertura de médicos por cada 1.000 habitantes

OBJECTIVE: The study was motivated by the need to understand the high number of deaths caused by COVID-19 in the global pandemic declared since December 2019, and how it impacted differently in European countries. The hypothesis was that less investment in the public health system, the number of doctors per inhabitant and the number of hospital beds available to the population led to a higher number of deaths after the arrival of COVID-19 in each country studied. The objective was to analyze the relationship between the number of deaths from COVID-19 in the global pandemic declared since December 2019 and health policies and investment in European countries. METHODS: A research study was conducted in which a total of six variables were analyzed with official and contrasted data: public health expenditure per capita; doctors per 1,000 inhabitants; number of beds per 1,000 people; deaths from COVID-19 per million inhabitants; number of tests to detect COVID-19 per 1,000 inhabitants; and GINI Coefficient to measure the degree of social inequality in each country. It was carried out in 30 European countries. Frequency and correlation analyses were carried out (Pearson). RESULTS: Five countries were found, which gave values above 300 deaths per million (data from April 27, 2020): United Kingdom; (305.39), France (350.16), Italy (440.67), Spain (495.99) and Belgium (612.1). Precisely, in the countries that recorded the most deaths (United Kingdom, France, Italy, Spain and Belgium) on April 27, we did not find high values of TEST performance. In our analysis, we found that the lower the investment of public spending in health (per capita), the higher the number of deaths per COVID-19 per million inhabitants, the lower the coverage of hospital beds, and the lower the number of doctors. Finally, we found that the lower the expenditure on public health, the higher the GINI coefficient (thus greater social inequality). CONCLUSIONS: A negative effect in terms of deaths was detected when investment in public health was lower; the higher number of deaths from COVID-19 was correlated (p < 0.005) with greater social inequality (GINI coefficient) and with lower investment in public health (p < 0.001); this had an impact on the lower number of available beds and low physician coverage per 1,000 inhabitants

Nuevos problemas de un nuevo sistema de salud: la creación de una política pública nacional de atención de enfermedades raras en Brasil (1990-2014) / New problems of a new health system: the creation of a national public policy of rare diseases care in Brazil (1990s-2010s)

RESUMEN En este trabajo se analizan los movimientos de actores e instituciones que llevaron a la promulgación, en 2014, de la Resolución 199 del Ministerio de Salud de Brasil, que establece la Política Nacional de Atención Integral a las Personas con Enfermedades Raras. Tomando como fuentes los principales periódicos, proyectos de ley y bibliografía secundaria sobre el tema, comenzamos nuestro análisis a principios de la década de 1990 con la creación de las primeras asociaciones de pacientes en Brasil, para reclamar fundamentalmente más fondos para la investigación de enfermedades genéticas, y llegamos a fines de la década de 2010 con las negociaciones para una política nacional. La Resolución 199 es parte de un proceso en curso, en el que el camino hacia la promulgación y las complicaciones posteriores nos dan elementos para discutir aspectos actuales de la salud pública brasileña. Sobre la base de la historia del tiempo presente y los estudios sociales de la ciencia, argumentamos que hay dos aspectos que han sido fundamentales para crear una política nacional: enmarcar diferentes enfermedades en la terminología "enfermedades raras" y la construcción de una percepción pública sobre el derecho a la salud, que se garantiza en la Constitución brasileña de 1988.

ABSTRACT This study discusses actors and institution movements leading to the disclosure in 2014 of Resolution 199 by the Brazilian Ministry of Health, which establishes the National Policy for the Comprehensive Care of Persons with Rare Diseases. Taking as sources the mainstream newspapers, drafts law, and secondary literature on the subject, we begin our analysis in the early 1990s when the first patient associations were created in Brazil - mainly for claiming more funds for research on genetic diseases - and arrive at the late 2010s when negotiations for a national policy are taking place in the National Congress. Resolution 199 is part of an ongoing process and the path towards its disclosure and the complications that followed have given us elements to discuss contemporary aspects of the Brazilian public health. Based on the references of the history of the present time and the social studies of science, we argue that two aspects have been fundamental to creating a national policy: framing different illnesses within the terminology "rare diseases" and the construction of a public perception about the right of health which is guaranteed by the 1988 Brazilian Constitution.

Access to high-cost medications for psoriatic arthritis in the National Health System in Brazil: the long path up to dispensation

Abstract Background: Pharmaceutical Assistance (PA) is a dynamic and multidisciplinary process that aims to supply health systems, programs or services with quality medicines, enabling access and health care, in an efficient and timely manner. The objective of the study was to evaluate the profile of administrative processes for the treatment of PsA, identify the time elapsed in the flow of processes and its associated factors. Methods: A cross-sectional study of medication requests for the treatment of PsA was carried out between November 2014 and December 2016. Linear regression was used to verify the factors associated with time to delivery. Results: A total of 218 cases containing 250 drugs were analyzed. The median time between the medical appointment and the first dispensation was 66 days (interquartile range, 44-90). The State proceedings, which includes requesting the drug until the authorization of treatment, was the stage that most contributed to the total time spent. The factors associated with the longer time to delivery of medications were prescriptions coming from clinics and specialty centers, from dermatologists, non-authorized processes and non-persistent patients in the treatment in 12 months. Conclusion: The median time to receive medicines for the PsA treatment in Belo Horizonte health region after a medical prescription was higher than 2 months. The time between the solicitation of the medicines and the authorization of the treatment in the SUS (State administrative procedure) was the main component of the total time spent.

Crisis, gasto público sanitario y política / Crisis, Public Spending on Health and Policy

OBJETIVO: La crisis económica española se inició en el año 2008 y según el Ministerio de Economía, Industria y Competitividad concluyó en el año 2014. Durante la crisis los principales indicadores macroeconómicos tuvieron una evolución adversa y los efectos se han prolongado durante más de seis años hasta la actualidad. El objetivo de este trabajo fue valorar la influencia en el gasto público (sanitario y farmacéutico) que han tenido las políticas gobernantes y el tiempo de crisis sufrido. MÉTODOS: Se compara el gasto público por habitante (sanitario y farmacéutico) según el período de estudio (pre, crisis y post), la ideología política del partido gobernante (conservador/ progresista) y cada comunidad autónoma en referencia al PIB por habitante en cada una de ellas respecto de la media nacional (pobres, en la media o ricas) según los cuartiles. Las fuentes de los datos han sido el INE (PIB y habitantes de cada CCAA y periodo de estudio) y del Ministerio de Sanidad, Servicios Sociales e Igualdad (gasto público sanitario y farmacéutico). El examen estadístico (SPSS 24) incluyó análisis descriptivo e inferencial del gasto sanitario y farmacéutico publico según el período de estudio e ideología, también se realizó un ajuste de regresión para conocer la importancia relativa de las variables predictoras. RESULTADOS: Durante el período de crisis hubo diferencias en el gasto sanitario público por habitante en los distintos tipos de CCAA (pobres/medias/ricas) y según ideología política gobernante (p <0,05). El gasto farmacéutico público pasó de 327 €/hab (pre-crisis) a 366 €/hab en el período final del estudio. Hubo diferencias estadísticamente significativas en el gasto farmacéutico según los distintos tipos de CCAA. De igual forma se encontraron diferencias en el gasto farmacéutico por habitante entre las CCAA regentadas por conservadores y tipo de CCAA a lo largo de todo el período de estudio. CONCLUSIONES: El gasto farmacéutico comunitario por habitante ha disminuido en más del 13% desde 2006 hasta 2017, mientras que el gasto farmacéutico hospitalario se ha incrementado en más del 84%. Las CCAA ricas invierten más en gasto sanitario y las pobres más de medicamentos

OBJECTIVE: The Spanish economic crisis began in 2008 and according to the Ministry of Economy, Industry and Competitiveness it concluded in 2014. During the crisis the main macroeconomic indicators had an adverse evolution and the effects have lasted for more than six years to the present. AIM: To assess the influence on public spending (health and pharmaceutical) that the governing policies have had and the time of crisis suffered. METHODS: Public expenditure per inhabitant (health and pharmaceutical) is compared according to the study period (pre, crisis and post), the political ideology of the ruling party (conservative/ progressive) and each autonomous community in reference to GDP per inhabitant in each of they respect the national average (poor, average or rich) according to the quartiles. The sources of the data have been the National Statistics Institute (GDP and inhabitants of each Autonomous Community and study period) and the Ministry of Health, Social Services and Equality (public health and pharmaceutical expenditure). The statistical procedures (SPSS v24) included descriptive and inferential analysis for public healthcare and pharmaceutical expenditure according to the period of study and ideology. There was also a regression fit to know the relative importance of predictor varibles. RESULTS: During the crisis period there were differences in public health expenditure per inhabitant in the different types of Autonomous Communities (poor / medium / rich) and according to political ideology (p <0.05). Public pharmaceutical expenditure was € 327 / inhab (pre-crisis) to € 366 / inhabitant in the final period of the study. There were statistically significant differences in pharmaceutical expenditure according to the different types of CCAA. Likewise, differences were found in per capita pharmaceutical expenditure between the Autonomous Communities run by conservatives and type of Autonomous Communities throughout the study period. CONCLUSIONS: The community pharmaceutical expenditure per capita has decreased by more than 13% since 2006 until 2017, while the hospital pharmaceutical expenditure has increased by more than 84%. Rich regions invest more in the health care costs and the poor more than drugs

Fiscal austerity and the health sector: the cost of adjustments / Austeridade fiscal e o setor saúde: o preço do ajuste

Abstract Fiscal austerity policies have been used as responses to economic crises and fiscal deficits in both developed and developing countries. While they vary in regard to their content, intensity and implementation, such models recommend reducing public expenses and social investments, retracting the public service and substituting the private sector in lieu of the State to provide certain services tied to social policies. The present article discusses the main effects of the recent economic crisis on public health based on an updated review with consideration for three dimensions: health risks, epidemiological profiles of different populations, and health policies. In Brazil, the combination of economic crisis and fiscal austerity policies is capable of producing a direr situation than those experienced in developed countries. The country is characterized by historically high levels of social inequality, an under-financed health sector, highly prevalent chronic degenerative diseases and persisting preventable infectious diseases. It is imperative to develop alternatives to mitigate the effects of the economic crisis taking into consideration not only the sustainability of public finance but also public well-being.

Resumo Políticas de austeridade fiscal têm sido utilizadas como respostas à crise econômica e deficit fiscal tanto em países desenvolvidos como em desenvolvimento. Embora variem quanto ao conteúdo, intensidade e cronograma de implementação, tais modelos preconizam a redução do gasto público, promovendo também a diminuição do investimento social, a retração da máquina pública e a substituição do Estado pelo setor privado na provisão de determinados serviços vinculados a políticas sociais. Este artigo debate os principais efeitos da crise econômica recente sobre a saúde da população, tendo sido baseado em uma revisão atualizada, considerando-se três dimensões: riscos à saúde, perfil epidemiológico das populações e políticas de saúde. A crise econômica no Brasil, combinada com a política de austeridade fiscal, pode produzir um contexto mais grave do que o vivenciado pelos países desenvolvidos. O país apresenta altos níveis históricos de desigualdade social, subfinanciamento do setor saúde, alta prevalência de doenças crônico-degenerativas e persistência de doenças infeciosas evitáveis. É imperativo que se construam alternativas para se mitigar os efeitos da crise econômica, levando-se em conta não apenas a sustentabilidade das finanças públicas, mas também o bem-estar da população.

Dimensionamento da 'economia política' na 'economia da saúde': para refletir sobre o conceito de sustentabilidade / Dimensioning of 'political economy' in 'health economics': reflecting on the concept of sustainability

RESUMO Este artigo teve como objetivo mapear a produção da economia da saúde no Brasil e seus principais temas, destacando a relevância da economia política, com o intuito de refletir sobre a sustentabilidade do Sistema Único de Saúde. Para tanto, realizou-se uma pesquisa quantitativa exploratória, por meio de coleta de dados nos currículos de pesquisadores doutores em economia da saúde na Plataforma Lattes (CNPq) em 2018. Recuperaram-se os pesquisadores por meio do termo 'economia da saúde' e 'economia política'. Classificaram-se suas produções nas áreas temáticas de 'financiamento', 'política de saúde', 'gestão em saúde', 'análise de custo-efetividade'. Identificaram-se 471 currículos de doutores associados ao termo 'economia da saúde', dos quais 53,9% (254) foram considerados 'economistas da saúde'. Entre os temas mais trabalhados, 42,5% (108) enfatizam a 'análise de custo-efetividade', 20,9% (53) salientam a 'gestão em saúde' e 20,5% (52) ressaltam o 'financiamento'. Dos 254, apenas 11,0% (28) produzem em 'economia política'. A preponderância da produção em 'gestão em saúde' e 'análise de custo-efetividade' sugere que os pesquisadores da economia da saúde estão majoritariamente alinhados ao pensamento neoclássico. Além disso, a produção de conhecimento pelos paradigmas da 'economia política' é rarefeita.

ABSTRACT This article aims to map the production of health economics in Brazil and its main themes, highlighting the relevance of political economy, with the aim of reflecting on the sustainability of the Unified Health System (SUS). For that purpose, a quantitative exploratory research was carried out, through data collection in curricula of health economics researchers at the Plataforma Lattes (CNPq) in 2018. Researchers were retrieved through the term 'health economics' and 'political economy'. Their productions were classified in the thematic areas of 'financing', 'health policy', 'health management', 'cost-effectiveness analysis'. 471 curricula of doctors associated with the term 'health economics' were identified, of which 53.9% (254) were considered 'health economists'. Among the most addressed topics, 42.5% (108) focus on 'cost-effectiveness analysis', 20.9% (53) on 'health management', and 20.5% (52) on 'financing'. Of the 254, only 11.0% (28) show a production in 'political economy'. The preponderance of productions in 'health management' and 'cost-effectiveness analysis' suggests that health economics researchers are mostly aligned with the neoclassical thinking. Moreover, the production of knowledge by the paradigms of 'political economy' is scarce.

A socio-historical approach to policy analysis: the case of the Brazilian Workers' Food Policy / Uma abordagem sócio-histórica à análise de políticas: o caso do Programa de Alimentação do Trabalhador no Brasil / Un enfoque sociohistórico para el análisis de políticas: el caso de la Política Alimentaria de los Trabajadores de Brasil

Abstract: Policy analyses based on traditional or structuralist definitions of the state are important, but they have some limitations for explaining processes related to policymaking, implementation, and results. Bourdieusian sociology links the analysis to objective and subjective dimensions of social practices and can help elucidate these phenomena. This article provides such empirical evidence by analyzing the social genesis of a Brazilian policy that currently serves 18 million workers and was established by the state in 1976 through the Fiscal Incentives Program for Workers' Nutrition (PIFAT/PAT). The study linked the analysis of the trajectory of social agents involved in the policy's formulation to the historical conditions that allowed the policy to exist in the first place. Although the literature treats the policy as a workers' food program (PAT), the current study showed that it actually represented a new model for paying financial subsidies to companies that provided food to their employees, meanwhile upgrading the commercial market for collective meals. The study further showed that the program emerged as an administrative policy, but linked to economic agents. The program became a specific social space in which issues related to workers' nutrition became secondary, but useful for disguising what had been an explicit side of its genesis, namely its essentially fiscal nature.

Resumo: Análises de políticas que partem das concepções clássicas ou estruturalistas do Estado, embora importantes, apresentam algumas limitações na explicação dos processos relacionados com a sua formulação, implementação e resultados. A sociologia Bourdieusiana, ao articular a análise das dimensões objetivas e subjetivas das práticas sociais, pode contribuir para a compreensão desses fenômenos. Este artigo traz evidências empíricas a esse respeito ao analisar a sociogênese de uma política brasileira que atende atualmente a 18 milhões de trabalhadores e que foi instituída pelo Estado em 1976, consubstanciada no Programa de Incentivo Fiscal da Alimentação do Trabalhador (PIFAT/PAT). O trabalho articulou a análise da trajetória dos agentes sociais envolvidos com a sua formulação e o estudo das condições históricas de possibilidade de sua emergência. Embora a literatura a trate como um programa de alimentação do trabalhador (PAT), o presente estudo revelou que, de fato, ela representou um novo modelo de subsídio financeiro às empresas que ofereciam alimentação aos seus empregados, potencializando o mercado de refeições coletivas. Foi ainda constatado que o programa emergiu no interior do campo burocrático, mas em articulação com agentes do campo econômico. Constituiu-se como espaço social específico, em que as questões relacionadas à alimentação se mostraram secundárias, mas úteis na ocultação da face antes explícita em sua gênese: sua natureza essencialmente tributária.

Resumen: Análisis de políticas que parten de concepciones clásicas o estructuralistas del Estado que, pese a que son importantes, presentan algunas limitaciones en la explicación de los procesos relacionados con su formulación, implementación y resultados. La sociología Bourdieusiana, al vincular el análisis de las dimensiones objetivas y subjetivas de las prácticas sociales, puede contribuir a la comprensión de estos fenómenos. Este artículo presenta evidencias empíricas a este respecto, al analizar la sociogénesis de una política brasileña que atiende actualmente a 18 millones de trabajadores, y que fue instituida por el Estado en 1976, consustancial al Programa de Incentivo Fiscal de la Alimentación del Trabajador (PIFAT/PAT). El estudio trata tanto sobre el análisis de la trayectoria de los agentes sociales implicados en su formulación, como sobre el estudio de las condiciones históricas acerca de las posibilidades para su aparición. A pesar de que la literatura lo considere un programa de alimentación del trabajador (PAT), el presente estudio reveló que, de hecho, representó un nuevo modelo de subsidio financiero para las empresas que ofrecían alimentación a sus empleados, potenciando el mercado de comidas colectivas. Se constató incluso que el programa surgió dentro del ámbito burocrático, pero en coordinación con agentes del área económica. Se constituyó como un espacio social específico, donde las cuestiones relacionadas con la alimentación se mostraron secundarias, pero útiles para el ocultar un aspecto antes explícito en su génesis: su naturaleza eminentemente tributaria.

Acerca de la imposición sobre bebidas alcohólicas en España / On alcoholic beverage taxation in Spain

Objetivo: Revisión sistemática de las elasticidades-precio de las bebidas alcohólicas para identificar qué tipo de variables deben tenerse en cuenta antes de proponer cualquier medida de tipo fiscal. Método: Revisión sistemática en EBSCOhost de artículos que incluyen un su resumen las palabras «alcohol» y «elasticidad», así como «alcohol» y «tax», en el título y los resúmenes durante los últimos 20 años en revistas académicas en lengua inglesa. Resultados: Se han encontrado 11 referencias bibliográficas. Si bien las elasticidades s-precio son similares en la mayor parte de los países, existe heterogeneidad según diversas características, como sexo, edad, nivel de consumo y tipo de bebida. Políticas ad-hoc han resultado inefectivas a causa del efecto sustitución y han resultado regresivas al impactar en colectivos con niveles de consumo y renta bajos. Conclusión: Las políticas fiscales deberían aplicarse a todas las bebidas alcohólicas en función del volumen de alcohol, y cualquier medida como un precio mínimo por unidad debe acompañarse de políticas complementarias (AU)

Objective: Review the price elasticity of alcoholic beverages to identify the characteristics we should take into account to make a tax policy proposal. Method: Systematic review of articles in EBSCOhost that include in their abstract and title the words alcohol and elasticity and alcohol and tax, over the last 20 years in academic journals in English. Results: We found 11 references. Although price elasticity is quite similar across countries, it is heterogeneous with regard to gender, age, consumption level and type of beverage. Ad-hoc policies proved ineffective due to the substitution effect, and regressive in their impact on populations with lower levels of income and consumption. Conclusion: Tax policies should be applied to all alcoholic beverages based on their volume of alcohol and all measures, such as the minimum price per unit, should be complemented with other policies (AU)

Estrategias de la OMS para el tratamiento de la tuberculosis resistente / WHO strategies for the management of drug-resistant tuberculosis

No disponible

Impactos probables de la reforma migratoria estadounidense: algunos escenarios para la reumatología mexicana / Probable impacts of United States immigration reform: some scenarios for Mexican rheumatology

No disponible

Efectividad de un programa de alta precoz tras parto normal / Effectiveness of an early discharge program after normal childbirth

Objetivo. Implantar un programa de alta precoz hospitalaria en el parto sin complicaciones para mejorar la efectividad, garantizando la seguridad clínica y la aceptabilidad de los pacientes. Material y métodos. Estudio descriptivo de la efectividad de un programa de alta precoz en el parto sin complicaciones entre febrero de 2012 y septiembre de 2013. Población a estudio: puérperas y recién nacidos con ingreso en el Hospital Universitario de Fuenlabrada, con una duración inferior a 24h, tras parto sin complicaciones que cumplieran los criterios de inclusión definidos. La satisfacción se evaluó mediante una encuesta con escala Likert. La efectividad del programa se monitorizó mediante indicadores de seguridad, productividad, adecuación y continuidad asistencial. Resultados. El 20% de los casos susceptibles de alta precoz del Hospital Universitario de Fuenlabrada completaron el programa. El 94% fueron partos eutócicos. Los 188 casos incluidos —sobre 911 pacientes con parto no complicado— representaron el 6,5% del total de los 2.857 partos atendidos. La estancia media de las pacientes incluidas presentó una disminución del 50% (2,4 a 1,2 días). La continuidad asistencial tras el alta hospitalaria fue seguida por la totalidad de las pacientes. En el 4,8% se reprogramó una consulta de revisión. El 2% de las pacientes reingresaron antes de 96h por problemas no graves. Cuatro recién nacidos (2%) precisaron atención en urgencias (madre o recién nacido) antes de 96h. La evaluación de la satisfacción de las pacientes alcanzó 4,5 sobre 5. Conclusiones. El programa logró una disminución de la estancia media en un 50%, favoreciendo la autonomía de las matronas. Su nivel de aceptación está en línea con intervenciones similares. El despliegue realizado puede ser útil para otras modificaciones de procesos asistenciales (AU)

Objective. To implement a program of early hospital discharge after an uncomplicated birth, in order to improve the effectiveness, as well as ensuring clinical safety and patient acceptability. Material and methods. Descriptive study of the effectiveness of an early discharge program after uncomplicated delivery between February 2012 and September 2013. The populations are post-partum women and newborns admitted to the University Hospital of Fuenlabrada, with a duration of less than 24h after uncomplicated delivery that met the defined inclusion criteria. Satisfaction was assessed using a Likert scale. The effectiveness of the program was monitored by safety indicators, productivity, adaptation, and continuity of care. Results. A total of 20% of cases capable of early discharge from Fuenlabrada University Hospital completed the program. Almost all (94%) were normal deliveries. The 188 cases included were from 911 patients with uncomplicated childbirth, accounting for 6.5% of the 2,857 total births. The mean stay of patients included showed a decrease of 50% (2.4 to 1.2 days). All patients received continuity of care after hospital discharge. The review consultation was reprogrammed for 4.8% of cases, with 2% of patients re-admitted within 96h. with no serious problems. Four newborns (2%) required attention in the emergency department (mother or newborn) before 96h. The assessment of patient satisfaction achieved a score of 4.5 out of 5. Conclusions. The program achieved a decrease in the average stay by 50%, favouring the autonomy of midwives. This acceptance level is in line with similar interventions. The deployment of the program may be useful for other changes in care processes (AU)