Safeguarding the Right to Health of the Elderly in Rural China: A Legal Analysis.

Older people in rural China enjoy the right to health under Chinese law. However, the problems of economic difficulties, the unbalanced allocation of medical resources between urban and rural areas and the weakening of the traditional function of the family as a provider of old-age care in reality make the elderly in rural areas face a higher risk of health problems. The law is an important tool to mitigate these problems. Although China has made great efforts to legally guarantee the right to health of the rural elderly, it has not yet fully implemented the requirements of Article 12 of the International Covenant on Economic, Social and Cultural Rights, Article 14 of the Madrid Political Declaration and International Plan of Action on Ageing. China needs to further improve the relevant legislation to provide adequate legal support for the exercise of the right to health of the elderly in rural areas.

PENITENTIARY MEDICINE IN THE CONTEXT OF NATIONAL HEALTH CARE REFORM IN UKRAINE.

OBJECTIVE: The aim: Identify the main issues in the penitentiary medicine functioning in the context of National Health Care Reform in Ukraine and determine the state of realization of the right to health care and medical assistance of convicts and detainees. PATIENTS AND METHODS: Materials and methods: This article used a set of general and special methods of scientific cognition. The empirical basis of the research consists of: inter¬national acts and standards in the penitentiary field and health care, statistics of the Ministry of Justice, reports of international organizations, the case law of the European Court of Human Rights (ECHR), scientific publications in databases of systematic reviews MEDLINE, PubMed, reports on the results of monitoring visits to prisons and pre-trial detention centers. CONCLUSION: Conclusions: Penitentiary medicine continues to be a separate departmental system, which does not consider the positive changes in the National Medical Services System. Such a superficial imitation of the method of guaranteeing prisoners' rights to medical care is a kind of cargo cultism of public institutions designed to ensure non-discriminatory conditions for implementing the right to health care for all population segments.

Mobile Health in China: Well Integrated or a New Divide?

The application of mobile health holds promises of achieving greater accessibility in the evolving health care sector. The active engagement of private actors drives its growth, while the challenges that exist between health care privatization and equitable access are a concern. This article selects the private internet hospital in China as a case study. It indicates that a market-oriented regulatory mechanism of private mobile health will contribute little to improving health equity from the perspectives of egalitarians and libertarians. By integrating the capability approach and the right to health, it is claimed that mobile health is a means of accessing health care for everyone, where substantive accessibility should be emphasized. With this view, this article provides policy recommendations that reinforce private sector engagement for mobile health, recognizing liberty, equity, and collective responsibility in the Chinese context.

Universal healthcare coverage, patients' rights, and nurse-patient communication: a critical review of the evidence.

The Sustainable Development Goals adopted by world leaders on September 25, 2015, aimed to end poverty and hunger, promote gender equity, empower women and girls, and ensure human dignity and equality by all human beings in a healthy environment. These development goals were premised on international human rights norms and institutions, thereby acknowledging the relevance of human rights in achieving each goal. Particularly, sustainable development goal 3, whose objective is to achieve universal health coverage, enhance healthy lives, and promote well-being for all, implicitly recognizes the right to health as crucial. Our focus in this paper is to discuss how promoting patients' rights and enhancing effective nurse-patient communication in the healthcare setting is a significant and necessary way to achieve universal health coverage. Through a critical review of the empirical research evidence, we demonstrated that enhancing patients' rights and effect nurse-patient communication will promote people-centered care, improve patients' satisfaction of care outcomes, increase utilization of care services, and empower individuals and families to self-advocate for their health. These steps directly impact primary healthcare strategies and the social determinants of health as core components to achieving universal health coverage. We argue that without paying attention to the human rights dimensions or employing human rights strategies, implementing the other efforts will be inadequate and unsustainable in protecting the poorest and most vulnerable populations in the achievement of goal 3.

Creating universal health care in Ireland: A legal context.

In this paper we establish a working definition of, and develop a legal rationale for, the insertion of a constitutional Right to Health (RTH) protection in the Constitution of Ireland. We propose that a legal framework exists for the judicial enforcement of a right to health in Ireland, as based on parallels drawn between Irish case law and that of RSA, a comparable common law constitutional democracy with a developed jurisprudential approach to its constitutional RTH. When modelled after precedential international provisions, this right strengthens and defends health policy goals (such as universal health care) through a common-law system of governmental accountability. Additionally, national rights to health have observable correlations with improved public health, and it stimulates institutional initiatives. The 1937 Constitution of Ireland includes several personal, social, and economic rights, and a RTH would complement the existing right to primary education as a socio-economic right. We note these considerations were discussed during the legislative proposal made in the 32nd Dáil for a constitutional RTH, which emerged in response to Ireland's ongoing efforts toward health policy reform.

CARGOCULTISM OF PSYCHIATRIC CARE IN CUSTODY.

OBJECTIVE: The aim: To analyze the features of the realization mechanism of the persons' rights who have become ill with a mental illness and are in the detention of adequate (equivalent) medical care. PATIENTS AND METHODS: Materials and methods: A set of general and special methods of scientific knowledge were used. The study's empirical basis consists of international acts and standards in the field of health care, statistics of the United Kingdom, France, the United States, some countries in Eastern Europe and Central Asia, reports of international organizations, the case-law of the European Court of Human Rights. The study also used the personal experience of one of the co-authors as a lawyer for more than 20 years and 4 years as a judge of the Supreme Court. RESULTS: Results: The conducted research gives grounds to state that for the last few decades the problem of receiving psychiatric care in conditions of imprisonment remains relevant. This situation is partly due to the fact that the certain standards' content is subject to clarification, as it is contained in optional international instruments or is given some understanding solely through the practice of the ECHR. Given the implementation of the prisoners' right of access to psychiatric care is entrusted primarily to penitentiary institution's administration, attention should be paid to methodological, material, and staffing of their work while introducing maximum openness of psychiatric care's algorithms to prisoners and facilitating access to legal aid for the mentally ill. CONCLUSION: Conclusions: Creating external attributes of mechanisms to ensure the convicts' right to psychiatric care, the relevant national mechanisms do not take into account the specifics of the detained persons' legal status. Such a superficial imitation of the system of guarantees of the prisoners' rights to medical care is a kind of cargo cultism of public institutions, which is designed to provide non-discriminatory conditions for the realization of the right to health care for all categories of the population.

LEGAL ASPECTS OF USING NATURAL RESOURCES FOR HEALTH AND RECREATIONAL PURPOSES TO ENSURE HUMAN RIGHT TO HEALTH CARE.

OBJECTIVE: The aim: Is to conduct a comparative legal analysis of the use of natural resources for health and recreation purposes in Ukraine, the European Union, and other countries to improve the scientific theoretical basis of the legal regulation for the use, protection, and conservation of such natural resources. PATIENTS AND METHODS: Materials and methods: The national and international legal instruments regulating the rights to health and the right to use natural resources for health and recreational purposes were examined by analyzing practices of foreign states in the field of these legal relations, in particular, the comparative-legal, complex, formal, and logical, structural and functional methods along with analytical and empirical research tools. CONCLUSION: Conclusions: The legislation of Ukraine does not fully disclose the concepts, features, classification of natural healing and recreational resources, and therefore many aspects of their use, protection, and conservation remain uncertain and unsecured provisions of regulations. The article features approaches to improving the current ecological legislation promoting proper legal regulation of using natural resources for health and recreational purposes, thereby creating the necessary conditions to ensure the right to health care.

Determinantes da judicialização da saúde: uma análise bibliográfica / Determinants of health judicialization: a bibliographical analysis / Determinantes de la judicialización de la salud: un análisis bibliográfico

Objetivo: a judicialização da saúde é um fenômeno multifacetado e requer a construção de caminhos que possibilitem a análise de fatores que, isolada ou conjuntamente, influenciam em sua constituição; assim, torna-se necessário identificar quais são os fatores apontados pela literatura científica nacional como causas da judicialização no campo da saúde. Metodologia: foi feita uma revisão integrativa de literatura, fundamentada no estudo exploratório-descritivo e bibliográfico de 101 publicações contidas na base de dados da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, usando cinco descritores compatíveis com a pesquisa, a saber: judicialização e saúde e Brasil; judicialização da saúde e Direito; judicialização e saúde e causas; judicialização e saúde e consequências; e judicialização e direito à saúde. Resultados: dos 101 artigos catalogados, 30 foram selecionados; tal amostra foi organizada em três categorias, a partir de sua temática: 14 artigos discutiam a judicialização da assistência farmacêutica; 10 artigos abordavam a judicialização do direito à saúde; e 6 artigos debatiam sobre a judicialização com ênfase nas práticas de gestão. Conclusão: ainda é incipiente a produção intelectual brasileira para a identificação e sistematização dos determinantes da judicialização. Contudo, foi possível identificar caminhos que permitiram uma leitura preliminar sobre a temática, que foram divididos em três categorias: judicialização da assistência farmacêutica; judicialização do direito à saúde; e judicialização e práticas de gestão

Objective: health judicialization is a multifaceted phenomenon; thus, it is necessary to identify what are the factors that cause this phenomenon in Brazilian scientific literature. Methods: it was conducted an integrative literature review, based on an exploratory-descriptive and bibliographic study of 101 publications available in Capes database. The search used 5 descriptors: judicialization and health and Brazil; health judicialization and law; judicialization and health and causes; judicialization and health and consequences; and judicialization and the right to health. Results: of a corpus of 101 articles, the authors selected 30, which were organized into three categories based on its theme: 14 articles discussed the judicialization of pharmaceutical assistance; 10 articles addressed the judicialization of the right to health; and 6 articles discussed judicialization with emphasis on management practices. Conclusion: Brazilian intellectual production is still incipient to identify and systematize the determinants of health judicialization. However, it was possible to have a preliminary understanding of the main themes, which were divided into three categories: the judicialization of pharmaceutical assistance, the judicialization of the right to health and the judicialization and management practices.

Objetivo: la judicialización de la salud es un fenómeno multifacético y requiere la construcción de caminos que permitan analizar los factores que, individualmente o en conjunto, inciden en su constitución; por tanto, se hace necesario identificar cuáles son los factores señalados por la literatura científica nacional como causas de judicialización en el campo de la salud. Metodología: se realizó una revisión integradora de la literatura, a partir de un estudio exploratorio-descriptivo y bibliográfico de 101 publicaciones contenidas en la base de datos de la Coordinación para el Perfeccionamiento del Personal de Educación Superior, utilizando cinco descriptores compatibles con la investigación, a saber: judicialización y salud. y Brasil; judicialización de la salud y el derecho; judicialización y salud y causas; judicialización y salud y consecuencias; y judicialización y derecho a la salud. Resultados: de los 101 artículos catalogados, se seleccionaron 30; esta muestra se organizó en tres categorías, en función de su temática: 14 artículos discutieron la judicialización de la asistencia farmacéutica; 10 artículos abordaron la judicialización del derecho a la salud; y 06 artículos discutieron la judicialización con énfasis en las prácticas de gestión. Conclusión: la producción intelectual brasileña es aún incipiente para la identificación y sistematización de los determinantes de la judicialización. Sin embargo, fue posible identificar caminos que permitieron una lectura preliminar sobre el tema, que se dividió en tres categorías: la primera, judicialización de la asistencia farmacéutica, seguida de la judicialización del derecho a la salud y finalmente, judicialización y prácticas de gestión.

Buen trato en Centros de Atención Primaria chilena, ¿privilegio o derecho humano? / Kind treatment at Chilean primary health care centers: a privilege or a human right?

Introducción: El derecho a la salud garantiza el acceso a todos los individuos a iguales oportunidades para alcanzar el grado máximo de salud. Objetivo: Describir la vinculación entre derechos humanos irrenunciables y la atención centrada en la persona según usuarios de centros de salud de Atención Primaria y expertos en Atención Primaria de Salud de Chile. Métodos: Estudio cualitativo, descriptivo y prospectivo, desarrollado entre enero y diciembre de 2015, considera análisis de contenido de Krippendorff de 5 grupos focales con 41 usuarios y Delphi electrónico de 3 rondas con 29 expertos chilenos. Criterio de finalización saturación de la información y el Coeficiente de Concordancia. Resultados: Según los usuarios, la percepción de buen trato en la atención de salud implica que esta sea coherente, integrada y que no fragmente los requerimientos de los usuarios, lo que se vincula directamente con el respeto al derecho a la salud. Esto es consistente con lo planteado por los expertos, pero es discordante respecto a la experiencia vivida por los usuarios en los centros de la Atención Primaria de Salud, lo que es parte de prácticas vinculadas a la violencia institucional. Conclusiones: El respeto de los derechos humanos en salud debe posicionarse como un tema de primer orden en la agenda pública de salud, ya que el trato digno es un derecho propio de todas las personas(AU)

Introduction: The right to health care ensures access of all individuals to equal opportunities to achieve an optimal health status. Objective: Describe the relationship between inalienable human rights and patient-centered care according to users of primary health care centers and experts in primary health care in Chile. Methods: A qualitative prospective descriptive study was conducted from January to December 2015 to analyze Krippendorff's alpha content in five focal groups of 41 users and three-round e-Delphi with 29 Chilean experts, as well as the data saturation end criterion and the agreement coefficient. Results: According to users, perception of kind treatment in health care implies that it be consistent and integrated and does not breach users' needs, all of which is directly related to respect for the right to health. This is consistent with the opinions contributed by experts, but not with the experiences undergone by users at primary health care centers, which are examples of practices related to institutional violence. Conclusions: Respect for health human rights should have a first-priority position in the health public agenda, since dignified treatment is a right to be enjoyed by the entire population(AU)

Implementation of the right to health care in the countries of the European Union.

OBJECTIVE: Introduction: The right to health is exercised through a complex system of state and social measures of legal, economic, social, scientific, cultural, educational, organizational, technical, sanitary and hygienic nature, aimed at preserving and improving the health of people , lengthening the life expectancy and working capacity, creating good living and working conditions, providing physical and mental development for children and young people, and preventing and managing illnesses and their treatment. The aim: Investigate the international legal and constitutional legal regulation of the right to health care in the countries of the European Union. PATIENTS AND METHODS: Materials and methods: The article analyzes the Constitution of the European Union, a number of international legal acts and judgments of the European Court of Human Rights. RESULTS: Review: Each country defines the conditions for realizing the right to health care, according to which people should be healthy, the state itself assumes the obligations of the controller and the protection of this right. These provisions should primarily be enshrined in the Basic Laws - the constitutions. The main direction of state policy in reforming social relations is the achievement of European international legal standards in all spheres of public life. These standards fix the principles, guarantees of norms that determine the scope of human rights, in particular the right to health care. CONCLUSION: Conclusions: The main problem of ensuring and realizing the right to health in the European Union, as in many countries, is the financing of this industry, because in general, it is impossible to talk about free medical care in the European Union. There are also problems in the field of investment in health care. The urgent issues of primary health care and public health and the elderly dependence period.

The way the health care system in ukraine looks like: international practices within national realities.

OBJECTIVE: Introduction: Nowadays there is the transformation of the national health care system in Ukraine, the ultimate goal of which is to create a modern, competitive model of medical care of citizens on the basis of forming packages of free medical services. However, the model adopted by Ukraine is in contradiction with national legislation in part of free medical aid guaranteed by the Art. 49 of the Constitution of Ukraine, and fragmentary considers positive international practices. The aim of the paper is to determine the mistakes of the reform of the Ukrainian health care system and to reveal the positive international practices of the organization of health care systems that can be implemented in Ukraine. PATIENTS AND METHODS: Materials and methods: National and international legislation, official web resources of the executive authorities of Ukraine, statistics of the World Health Organization, materials of journalistic and scientific periodicals are the materials for the research of the health care system in Ukraine in comparison with international practices. Research methods are cross-sectoral, complex statistical, comparative, generalization, analysis and synthesis. In order to obtain the results, the authors have conducted a critical analysis of the current norms of the national Ukrainian legislation in the health care sector. RESULTS: Review: The authors of the article have studied the main disadvantages of the national health care system in accordance with the concept of reforming the medical sector. Positive international practices that can be implemented into Ukrainian system for the real improvement of medical human rights in Ukraine have been revealed. CONCLUSION: Conclusions: It has been proved that the ongoing reform of the health care system in Ukraine needs to be reviewed and optimized. It has been offered to consolidate a perspective model of the Ukrainian health care system, its principles and guarantees of immunity at the legislative level.

Medicamentos biosimilares en Colombia: una revisión desde el consumo informado / Biosimilar Medicines in Colombia: An Approach from the Informed Consumption / Medicamentos biossimilares na Colômbia: uma revisão desde o consumo informado

Resumen Introducción: este artículo presenta un análisis sobre medicamentos biosimilares en Colombia con miras a establecer si existe un consumo informado respecto de estos fármacos, teniendo en cuenta la calidad y cantidad de información que circula en relación con su disponibilidad y acceso económico (precios). Desarrollo: el tipo de estudio es cualitativo con un diseño documental a partir de la revisión en bases de datos como Pubmed, Scopus, Scielo, Vlex y Redalyc, bases de información de registros sanitarios de agencias reguladoras de medicamentos (FDA, EMA e Invima) y el Sistema de Información de Vademecum Med Informática. Uno de los biosimilares autorizados en FDA y cuatro de la EMA se encuentran registrados en el Invima; sin embargo, son más los biosimilares no autorizados ni en FDA ni en EMA que se encuentran registrados en el Invima, los cuales aún no aparecen con esta clasificación de biosimilares ni en la agencia reguladora colombiana ni en ningún otro medio oficial o comercial. De los medicamentos biológicos de referencia de estos biosimilares, 12 tienen control de precios y 7 han sido autorizados al menos una vez vía judicial a los usuarios del sistema. Conclusiones: si bien, la reglamentación ha sido de gran avance en relación con el acceso a biosimilares y, en consecuencia, a sus biológicos pioneros, el sistema aún tiene barreras jurídicas, de información, disponibilidad y acceso que dificultan la protección y efectividad del derecho a la salud de la población en términos de un consumo informado de estos.

Abstract Introduction: This article presents an analysis of biosimilar drugs in Colombia, aiming at critically analyzing whether the consumption of biosimilar drugs in Colombia is fully informed or if it rather is characterized for its lack of information. Informed consumption in the sense of taking into account the quality and quantity of the information circulating in relation to the availability and affordability (prices) of biosimilar drugs. Development: This is a qualitative documentary analysis, based on the review of databases such as Pubmed, Scopus, Scielo, Vlex and Redalyc, and sanitary databases of drugs regulatory agencies (FDA, EMA and the Colombian Invima) and the Vademecum Med Informatica. One of the biosimilars authorized by FDA and four of those by EMA were also registered before by the Invima. However, the number of Invima authorized biosimilars is higher than that authorized by FDA and EMA. It is also important to highlight the fact that any biosimilar is not registered as such neither before the Invima nor before any other official or commercial source. Out of the biological reference products with biosimilars, twelve have regulated price and seven have been authorized at least once via court ruling. Conclusions: Although the regulations are progressive in relation to the access to biosimilars and, consequently, to their biological pioneers, the system still has legal, availability and information barriers that undermine the protection and effectiveness of the right to health.

Resumo Introdução: este artigo apresenta uma análise sobre medicamentos biossimilares na Colômbia com vista a estabelecer se existe um consumo informado respeito destes fármacos, tendo em conta a qualidade e quantidade de informação que circula em relação com a sua disponibilidade e acesso econômico (preços). Desenvolvimento: o tipo de estudo é qualitativo com um desenho documental a partir da revisão em bases de dados como Pubmed, Scopus, Scielo, Vlex e Redalyc, bases de informação de registros sanitários de agências reguladoras de medicamentos (FDA, EMA e Invima) e o Sistema de Informação de Vademecum Med Informática. Um dos biossimilares autorizados em FDA e 4 da EMA, se encontram registrados no Invima, no entanto são mais os biossimilares não autorizados nem na FDA nem na EMA que se encontram registrados no Invima, os quais ainda não aparecem com esta classificação de biossimilares nem na agência reguladora colombiana, nem em nenhum outro meio oficial ou comercial. Dos medicamentos biológicos de referência destes biossimilares, 12 têm controle de preços e 7 têm sido autorizados pelo menos uma vez via judicial aos usuários do sistema. Conclusões: se bem a regulamentação tem sido de grande avanço em relação com o acesso a biossimilares e, consequentemente, a seus biológicos pioneiros, o sistema ainda tem barreiras jurídicas, de informação, disponibilidade e acesso que dificultam a proteção e efetividade do direito à saúde da população em termos de um consumo informado dos mesmos.

[International experience in the legal regulation of the circulation of medicines through the prism of the law of the world trade organization].

OBJECTIVE: Introduction: The development of international legal cooperation in the field of health has largely been driven by the trade interests of states. The aim: The article analyzes the legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. PATIENTS AND METHODS: Materials and methods: Using the historical legal method has allowed to analyze the genesis of legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. The dialectical method is widely used, in particular, when it comes to the issue of the ratio of market regulation of medicines circulation and public health protection, the formal logic method, in particular, in formulating the general principles, principles and methods of legal regulation in the field of medicines, as well as the systemic method, in particular, in defining the institutional component of legal regulation in the field of medicines. RESULTS: Review: The activities of the WTO include several areas related to health protection: international control over infectious diseases, international legal regulation of food safety (food security), tobacco control, environmental protection, international legal aspects of access and treatment of medicinal and pharmaceutical products, international legal regulation of medical services provision. CONCLUSION: Conclusions: It is proved that the right to health is a right to access to medicines. However, for many developing countries, it is problematic to obtain patents for the production of necessary medicines or to pay a license fee, which creates a barrier to the realization of the right to health.

O papel do Ministério Público na autocomposição de conflitos sanitários transindividuais / The role of the Public Attorney's Office on the auto composition of transindividual sanitary conflicts / El rol del Ministerio Público en la autocomposición de conflictos sanitarios transindividuales

objetivo: analisou-se o papel do Ministério Público na autocomposição bilateral de conflitos sanitários transindividuais, envolvendo políticas públicas de saúde, notadamente se pode atuar como mediador, tendo em vista sua condição de parte, legitimado extraordinário pela substituição processual. Metodologia: tratou-se de estudo exploratório, de base qualitativa, desenvolvido a partir de fontes documentais primárias e bibliográficas, interpretadas e valoradas com os recursos da análise de conteúdo. Resultados: os resultados apurados indicaram que a adequada resolução de conflitos sanitários transindividuais, envolvendo direito à saúde e políticas públicas de saúde, perpassa por um sistema multiportas de acesso à Justiça, com primazia para a autocomposição bilateral, através da negociação, da mediação e da conciliação, de modo que o sistema de jurisdição somente seja acionado como último recurso. Emergiu, também, a legitimidade do Ministério Público para atuar nesse sistema, desempenhando distintos papéis na seara judicial e extrajudicial, tendo a observância ao ordenamento jurídico como linha condutora de sua atuação. Conclusão: na autocomposição bilateral de conflitos sanitários transindividuais, o Ministério Público atua como autêntico negociador colaborativo.

objective: the role of the Public Attorney's Office on the bilateral auto composition of transindividual sanitary conflicts was analyzed, involving public policies of health, notably if it can act as a mediator bearing in mind its condition as a part, extraordinary legitimated by process substitution. Methodology: It was made in the way of an exploratory study, of qualitative basis, developed from primary and bibliographic documental resources on, interpreted and appraised with the resources of contain analysis. Results: the results ascertained indicated that the suitable resolution of the trans individual sanitary conflicts, involving the right to health and public health policies, overarches a multiple doors system, of access to justice with primacy to the bilateral auto composition, through the negotiation, the mediation and the conciliation in the way that the jurisdiction system is only activated as the final resource. So, is also emerged, the legitimacy of the Public Attorney's Office to act in that system, performing distinct roles in the judicial and extrajudicial field having the compliance to the legal order as the conducting line of its acting. Conclusion: On the bilateral auto composition of the transindividual sanitary conflicts, the Public Attorney's Office acts as an authentic collaborative negotiator.

Objetivo: Se hizo un análisis del rol del Ministerio Público en la autocomposición bilateral de conflictos sanitarios transindividuales, envolviendo políticas públicas de salud, notablemente se puede actuar como mediador, teniendo en vista su condición de parte, legitimado extraordinario por la sustitución procesual. Metodología: Se ha tratado de estudio exploratorio, de base cualitativa, desarrollado a partir de fuentes documentales primarias y bibliográficas, interpretadas y valoradas con recursos de análisis de contenido. Resultados: los resultados apurados han indicado que la adecuada resolución de conflictos sanitarios transindviduales, envolviendo derecho a la salud, recorre por un sistema múltiples puertas de acceso a la justicia, con primacía para la autocomposición bilateral, a través de la negociación, de la mediación y de la conciliación, de modo que el sistema de jurisdicción solamente sea accionado como último recurso. Ha emergido, también, la legitimidad del Ministerio Público para actuar en ese sistema, desempeñando distintos roles en el campo judicial y extrajudicial, teniendo la observancia al ordenamiento jurídico como línea conductora de su actuación. Conclusión: en la autocomposición bilateral de conflictos sanitarios transindividuales, el Ministerio Público actúa como auténtico negociador colaborativo.

Concepción de la participación social en salud: propuesta de resignificación / Proposal for the Reconceptualization of Social Participation in Health / Concepção da Participação social em saúde: Proposta de ressignificação

Resumen Introducción: El artículo presenta la reflexión sobre la concepción de la participación social en salud, que propone la autora a partir de sus prácticas para ampliar la comprensión de dicho concepto y realizar el análisis de la Política Distrital de Participación Social en Salud. Desarrollo: La temática de participación se abordó a través del análisis del contexto de la participación social en Colombia: el lugar de enunciación de la participación y su resignificación para la acción colectiva en salud; a partir de ellos se propone avanzar en el contenido de la participación como derecho y práctica social. Conclusiones: La política distrital vincula el concepto de participación con las nociones de poder y los derechos humanos; incluye el concepto de ciudadanía social en salud que instala un sujeto de poder y de derechos que va más allá de ser receptor de información o usuario de los servicios de salud. Se parte de la concepción de participación que subyace a la Ley 100, en la cual se evidencia una postura de participación decisoria; sin embargo, el peso de todos los mecanismos se enmarca en la representación y no en la decisión. En lo conceptual, se plantea el logro del bienestar humano y el desarrollo social, es decir, una visión de salud más allá de la enfermedad. No obstante, todos los mecanismos se centran en los servicios de atención que potencializan la idea de que la salud se restringe a la atención a la enfermedad, a un servicio y no a un derecho. En tal sentido se propone una reflexión para resignificar la participación social en salud desde tres conceptos: habitar, hablar e integrar en la perspectiva de desmarcar la participación de la lógica instrumental del sistema de salud.

Abstract Introduction: This article reflects on a conception of social participation in health proposed by the author on the basis of her practice, intended to increase an understanding of this concept in order to analyze the capital city's Policy for Social Participation in Health. Development: The concept of participation is addressed through an analysis of the context of social participation in Colombia and its practice in the country, and its reconceptualization to favor collective action on health, on the basis of which it is proposed to promote the practice of social participation as a right. Conclusions : City policy links the concept of participation with notions of power and human rights. It entails the concept of citizenship with respect to health, producing subjects that go beyond being recipients of information and users of health services. It is embedded in the conception of participation underlying Law 100, including participation in decision making. Nevertheless, the mechanisms of implementation are based on representation, rather than participation in the decisions produced. Conceptually, the goal is to achieve human well-being and social development, a broad vision of health beyond the absence of disease. Policy mechanisms focus on providing care, though, promoting the concept of health in the context of disease, and on receiving services rather than enjoying a right. We propose a perspective that entails unshackling participation from the instrumental logic of the health care system and reframing social participation in health.

Resumo Introdução: O artigo apresenta a reflexão sobre a concepção de participação social em saúde, que propõe a autora a partir das suas práticas, para ampliar a compreensão de dito conceito e desde ali, realizar a análise da Política Distrital de Participação Social em Saúde. Desenvolvimento: A temática de participação abordou-se através da análise do contexto da participação social na Colômbia, o lugar de enunciação da participação social e a sua ressignificação para a ação coletiva em saúde, a partir dos quais se propõe avançar no conteúdo da participação como direito e prática social. Conclusões: A Política Distrital vincula o conceito de participação com as noções de poder e os direitos humanos. Inclui o conceito de cidadania social em saúde, que instala um sujeito de poder e de direitos que vai mais para além de ser receptor de informação ou usuário dos serviços de saúde. Parte-se da concepção de participação que subjaze à Lei 100, na qual se evidencia uma postura de participação decisória, no entanto, o peso de todos os mecanismos, enquadra-se na representação e não na decisão. No conceitual apresenta-se o logro do bem-estar humano e o desenvolvimento social, é dizer uma visão de saúde ampla mais para além da doença, mas todos os mecanismos se centram nos serviços de atenção que potencializam a ideia de que a saúde é doença, um serviço e não um direito. Em tal sentido propõe-se uma reflexão para ressignificar a participação social em saúde desde três conceitos: habitar, falar e integrar na perspectiva de desmarcar a participação da lógica instrumental do sistema de Saúde.

El litigio estructural en salud: un estudio comparado con base en casos de Sudáfrica, Argentina, India y Colombia / Estructural litigation in health: a comparative study based on cases from South Africa, Argentina, India and Colombia

La creciente judicialización del derecho a la salud ha llevado a indagar por las condiciones que propician que la intervención de los tribunales constitucionales en la materia sea exitosa. OBJETIVO:identificar los factores asociados con el éxito del litigio estructural en salud, particularmente cuando involucra órdenes generales y complejas. METODOLOGÍA:Para ello se recurre a cuatro procesos judiciales adelantados en Sudáfrica, Argentina, India y Colombia en los que la garantía de la salud ha sido mediada, de una u otra forma, por el poder judicial. Los casos son analizados a partir del método comparativo propuesto por Charles Ragin, en el cual las variables independientes o explicativas son los factores que determinan la mayor probabilidad de éxito del caso. RESULTADOS:la investigación adopta el punto de vista según el cual el litigio estructural en salud es exitoso si produce cuatro de los efectos explicados por César Rodríguez y Diana Rodríguez: efecto de desbloqueo, efecto de Políticas Públicas, efecto social y efecto deliberativo. La comparación de estos procesos de judicialización de la salud en distintos contextos, permite arribar a aprendizajes para la garantía de este derecho en Colombia.

The rise of health legalization has led to explore the conditions that produce a successful intervention of constitutional courts in this field. OBJECTIVE:the purpose of this research is to identify factors associated with the success of the structural litigation in health, particularly when it involves general and complex orders. METHODOLOGY:this topic was analized in four judicial proceedings in South Africa, Argentina, India and Colombia where health guarantee has been mediated, in one way or another, by the judiciary. The cases are discussed using the comparative method proposed by Charles Ragin, in which the independent or explanatory variables are the factors that determine the highest probability of success of the case. RESULTS:the research adopts the point of view that structural litigation in health is successful if it produces four effects explained by Cesar Rodriguez and Diana Rodriguez: unlocking effect, public policy effect, social impact and deliberative effect. The comparison of these processes in different contexts, allows arriving to new learnings in order to guarantee this right in Colombia.

Cáncer de piel no melanoma: de la patología a la tutela / Nonmelanoma skin cancer: pathology guardianship

El manuscrito hace una revisión sobre cáncer de piel no melanoma desde diferentes aristas del problema: iniciando en aspectos de conceptualización de la patología, pasando por la descripción de los trámites y costos que debe afrontar un paciente que requiere atención al presentar un diagnóstico presuntivo de cáncer de piel no melanoma en el actual Sistema General de Seguridad Social en Salud colombiano. Adicionalmente, se describien las barreras de acceso y negaciones de servicios, acotando el caso con resultados de una Empresa Promotora de Salud con sede en Bogotá y finalizando en la tutela como tabla de salvación para exigir un derecho fundamental, el derecho a la salud. En Colombia un paciente con cáncer de piel no melanoma diariamente batalla no solo contra su enfermedad sino contra una estructura compleja que supera el resorte del sistema de salud y trasciende a los componentes político, social y económico del país. Lo anterior constituye un círculo vicioso que requiere con urgencia de una intervención profunda a diferentes escalas y que supera el alcance de la reforma del sistema de salud colombiano. Para superar las dificultades documentadas en el acceso real, efectivo y de calidad de los colombianos que sufren de cáncer de piel no melanoma a los servicios de salud se requiere de un compromiso decidido y de acciones concretas.

The manuscript is a review of non-melanoma skin cancer (NSC) from different angles of the problem: starting in conceptualizing aspects of the disease through the description of the procedures and the cost that a patient who requires attention when presenting presumptive NSC diagnosis must face in the current General System of Social Security in Colombian Health. Additionally, barriers to access and denial of services are explained by mentioning the results of a case-based EPS in Bogotá which ending in guardianship as a lifeline to demand the fundamental right to health. In Colombia, a patient with NSC daily struggles not only against the disease but also with a complex structure that overcomes the rein of the health system and transcends political, social and economic components of the country. This is considered as a vicious circle which urgently requires a deep intervention at different scales and which exceeds the scope of the reform of the Colombian health . A strong commitment and concrete actions are required to overcome the difficulties documented in the real, effective and quality access of the Colombians who are suffering from NSC to health services.

Trasplante de medula ósea en Brasil: dimensión bioética / Bone marrow transplants in Brazil: the bioethical dimension / Transplantes de medula óssea no Brasil: dimensão bioética

El presente estudio busca analizar la práctica de los trasplantes de médula ósea en Brasil a la luz de la Bioética. Partiendo del presupuesto constitucional brasileño de que la salud es un derecho de todas las personas, analiza el acceso a estos servicios médicos especializados por parte de los ciudadanos socialmente vulnerables. Presenta el panorama legal de este campo del conocimiento científico en el país, mostrando la legislación general relativa a los trasplantes de órganos y tejidos, además de la reglamentación específica relacionada con los trasplantes de médula ósea, incluyendo la logística pública de apoyo al desarrollo del proceso de atención médica. Considerando aspectos relacionados con el uso de células tronco hematopoyéticas y tomando la bioética como referencia, discute la vulnerabilidad de los pacientes de bajas condiciones socio-económicas, la responsabilidad pública del Estado para con esas personas y la necesidad de darles la debida protección, teniendo en cuenta los patrones sociales de desigualdad observados en los países periféricos como Brasil...

This study intends to analyze the practice of bone marrow transplants in Brazil from the perspective of Bioethics. Starting from the constitutional Brazilian tenet that health is a right belonging to every person, it analyzes the question of access to specialized medical services by socially vulnerable citizens. It presents the legal outlook of this field of scientific knowledge in the country, presenting its general legislation dealing with organ and tissue transplants, besides the specific regulations related to bone marrow transplants, including the logistics of public support for the development of the medical care process. Considering aspects related to the use of Hematopoietic stem cells (HSC) and taking Bioethics as reference, it discusses the vulnerability of socioeconomically deprived patients, the government’s public responsibility toward these people, and the need to provide them with the proper protection, keeping in mind the social patterns of inequality observed in peripheral countries such as Brazil...

O presente estudo visa analisar a prática dos transplantes de medula óssea no Brasil à luz da Bioética. Partindo do pressuposto constitucional brasileiro de que a saúde é um direito de todas as pessoas, analisa o acesso a estes serviços médicos especializados por parte dos cidadãos socialmente vulneráveis. Apresenta o panorama legal deste campo do conhecimento científico no país, mostrando a legislação geral relativa aos transplantes de órgãos e tecidos, além da regulamentação específica relacionada com os transplantes de medula óssea, incluindo a logística pública de apoio ao desenvolvimento do processo de atendimento médico. Considerando aspectos relacionados com o uso de células-tronco hematopoiéticas e tomando a bioética como referência, discute a vulnerabilidade dos pacientes de baixas condições socio-econômicas, a responsabilidade pública do Estado para com essas pessoas e a necessidade de lhes dar a devida proteção, levando em conta os padrões sociais de desigualdade observados nos países periféricos como o Brasil...

Judicialização da saúde na garantia do acesso ao medicamento / The judicialisation of health as a means ensuring access to medicines / La Judicialización de la salud como garantía de acceso a medicamentos

Objetivo Visando conhecer o impacto das demandas judiciais sobre a organização dos serviços públicos de saúde, realizou-se uma revisáo sistemática com enfoque na "judicialização da saúde" para fornecimento de medicamentos. Métodos Foram analisados artigos originais publicados no período de 2007 a 2011, na literatura nacional e internacional, resultando no total de 49239 artigos disponíveis nas bases de dados Science Direct e BIREME. Resultados A pesquisa indicou predominância da bibliografia proveniente do Brasil, principalmente do sudeste, bem como de estudo realizado na Colômbia. Discursáo Dentre os pleitos, configuraram-se como principais agravos relatados as doenças crônicas, podendo-se citar: diabetes, hipertensáo, cânceres e artrite reumatóide. Por serem afecções parte de programas específicos do Sistema Único de Saúde, a dificuldade de acesso a esses fármacos e consequente judicialização da saúde demonstrou a fragilidade das políticas públicas existentes. Conclusão Por fim, conclui-se que a via judicial, apesar de ser uma estratégia para garantir o acesso ao medicamento, apresenta inabilidade para lidar com o julgamento das ações e gera, dessa forma, distorções no fluxo dos sistemas públicos.

Objective A systematic review, focusing on the judicialisation of health regarding gaining access to medicines, was aimed at understanding the impact of lawsuits on the organisation of public health services. Method Original articles published between 2007 and 2011 in the pertinent national and international literature were analysed, resulting in 49,239 articles being found in Science Direct and BIREME databases. Results The survey indicated a predominance of literature from Brazil, mainly the southeast, as well as a study from Colombia. Discussion The aforementioned chronic disease-related claims involved diabetes, high blood pressure, cancer and rheumatoid arthritis. Forming part of specific Unified Healthcare System programmes highlighted the difficulty in gaining access to the appropriate medicine and consequent health judicialisation demonstrated the fragility of existing public policy. Conclusion It was concluded that the courts (despite being a strategy for ensuring access to medicine) were unable to deal with the current spate of lawsuits, thereby leading to disruption regarding the flow of public systems.

Objetivo El estudio tiene como objetivo evaluar el impacto de las demandas judiciales sobre la organización de los servicios públicos de salud, mediante la realización de una revisión sistemática centrada en el uso de los tribunales para el suministro de medicamentos. Método Fueron identificados 49239 artículos en las bases de datos Science Direct e BIREME. Resultado El estudio indicó que la mayor parte de la bibliografía es de Brasil, con uno estudio en Colombia. Discusión Aparecen como los principales trastornos de salud relatados a las enfermedades crónicas, se pueden citar: la diabetes, la hipertensión, el cáncer y la artritis reumatoide. Debido a que son parte de los programas específicos de lo sistema de salud, la dificultad de acceso a estos fármacos y la consiguiente judicialización de la salud de manifiesto la fragilidad de las políticas públicas existentes. Conclusiones Por último, está la conclusión de que los tribunales, a pesar de ser una estrategia para garantizar el acceso a la medicina, presenta incapacidad para hacer frente al juicio de las acciones y por lo tanto genera distorsiones en el flujo de los sistemas públicos.

Gobernanza de las organizaciones de salud basados en Atención Primaria de Salud / Governance of primary health-care-based health-care organization

Se desarrolla un marco analítico para explicar las condiciones de efectividad de diferentes estrategias que promueven sistemas integrados de servicios de salud basados en atención primaria de la salud (APS) en América Latina. Con una perspectiva de economía política, se caracterizan diferentes modos de gobernanza (clan, incentivos y jerárquicos) para representar alternativas formas de regulación que promueven innovaciones en organización de la provisión de los servicios. Se presentan condiciones necesarias para garantizar la efectividad de los modos de gobernanza y sus implicancias en términos de puestas en juego. La construcción institucional de un sistema integrado de salud es interpretado como producto de un proceso social, en donde se combinan diferentes modos de gobernanza, que operan con diferentes formas de resolución de los aspectos normativos de regulación de la provisión de los servicios (con el modo jerárquico), de la distribución de recursos (con el modo incentivos) y sobre los valores sociales que legitiman este proceso (con el modo clan).

An analytical framework was developed for explaining the conditions for the effectiveness of different strategies promoting integrated primary health-care (PHC) service-based systems in Latin-America. Different modes of governance (clan, incentives and hierarchy) were characterised from a political economics viewpoint for representing alternative forms of regulation promoting innovation in health-service-providing organisations. The necessary conditions for guaranteeing the modes of governance's effectiveness are presented, as are their implications in terms of posts in play. The institutional construction of an integrated health system is interpreted as being a product of a social process in which different modes of governance are combined, operating with different ways of resolving normative aspects for regulating service provision (with the hierarchical mode), resource distribution (with the incentives mode) and on the social values legitimising such process (with the clan mode).