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1.
Afr J Prim Health Care Fam Med ; 12(1): e1-e3, 2020 Sep 14.
Artículo en Inglés | MEDLINE | ID: mdl-33054263

RESUMEN

For Africa, the backdrop1 against which COVID-19 emerged is a stark one. Although sub-Saharan Africa accounts for 11% of the world's population, it bears 24% of the global disease burden. The continent is home to 60% of the people with human immunodeficiency virus (HIV), and over 90% of malarial patients. In this region, infectious diseases such as malaria and HIV cause 69% of deaths. As states respond to COVID-19, we need to keep our eyes open to what effective responses are notifying us about our healthcare systems, so that we can craft sustainable interventions as a result and uphold the right to health. This is especially true in the light of the ongoing nature of pandemics on the continent, making urgent the need to maximise the value of our health system and its resources, as we seek lasting transformation.


Asunto(s)
Infecciones por Coronavirus , Accesibilidad a los Servicios de Salud , Pandemias , Neumonía Viral , Pobreza , Privatización , Derecho a la Salud , África del Sur del Sahara/epidemiología , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Infecciones por Coronavirus/virología , Prestación de Atención de Salud/métodos , Infecciones por VIH/epidemiología , Humanos , Malaria/epidemiología , Defensa del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Neumonía Viral/virología
3.
Med Care ; 58(8): 717-721, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32692137

RESUMEN

OBJECTIVE: Compare comorbidity identification in Medicare and Veterans Health Administration (VA) data for the purposes of risk adjustment. DATA SOURCES: Analysis of Medicare and VA datasets for dually-enrolled Veterans receiving care in both settings, fiscal years 2010-2014. STUDY DESIGN: A retrospective analysis of administrative data for a national sample of cancer decedents. DATA EXTRACTION METHODS: Comorbidities were evaluated using Elixhauser and Charlson coding algorithms. PRINCIPAL FINDINGS: Clinical comorbidities were more likely to be recorded in Medicare than in VA datasets. Of 42 comorbidities, 36 (86%) were recorded at a different frequency. For example, congestive heart failure was recorded for 22.0% of patients in Medicare data and for 11.3% of patients in VA data (P<0.001). CONCLUSION: There are large differences in comorbidity assessment across VA and Medicare administrative data for the same patient, posing challenges for risk adjustment.


Asunto(s)
Comorbilidad , Determinación de la Elegibilidad/normas , Medicare/estadística & datos numéricos , Ajuste de Riesgo/métodos , United States Department of Veterans Affairs/estadística & datos numéricos , Anciano , Determinación de la Elegibilidad/métodos , Determinación de la Elegibilidad/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Privatización/estadística & datos numéricos , Estudios Retrospectivos , Ajuste de Riesgo/estadística & datos numéricos , Estados Unidos
4.
Artículo en Inglés | MEDLINE | ID: mdl-32353996

RESUMEN

The aim of this paper is to analyze the changes in accident rates resulting from the privatization of forest operations. Data from the years 1990-2017 were obtained from the Statistical Forestry Yearbooks issued by Statistics Poland, and were analyzed for two periods: the time of intensive privatization (1991-2002) and the post-privatization period (2003-2017). The data from 1990 were treated as a benchmark. There were 14,626 accidents in total, of which 236 (1.61%) were fatal. The non-fatal accident rate in the whole forestry industry showed a decreasing trend in the study period (t = 2.27, p < 0.05). In the case of the fatal accident rate we can observe an upward trend; in the period of intensive privatization the average annual fatality rate was 0.11, and after privatization it was 0.18 (t = -2.68, p < 0.05). In both periods the fatality rate was twice as high in the private forestry sector as in the public sector. The number of working days lost declined in the public sector and increased in the private sector. An accident in the private sector resulted in 20 days' longer absence than one in the public sector. The study confirms that despite economic transition, accident rates in Polish forestry remain a serious issue. The main problem to be addressed is the increase in the fatal accident rate, especially in the private sector.


Asunto(s)
Accidentes , Agricultura Forestal , Sector Privado , Privatización , Accidentes/mortalidad , Humanos , Polonia
5.
Int J Health Serv ; 50(3): 271-275, 2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32380877

RESUMEN

This article analyzes how the neoliberal policies, such as the politics of austerity (with considerable cuts to social policy expenditures including medical care and public health services) and the privatization of health services, imposed by many governments on both sides of the North Atlantic, considerably weakened the capacity of the response to the coronavirus pandemic in Italy, Spain, and the United States.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Política , Política Pública , Betacoronavirus , Prioridades en Salud , Humanos , Italia , Pandemias , Privatización , España , Estados Unidos
6.
N Z Med J ; 133(1512): 76-84, 2020 04 03.
Artículo en Inglés | MEDLINE | ID: mdl-32242181

RESUMEN

Since the 1970s, neoliberalism has been the dominant economic and political philosophy among global institutions and some Western governments. Its three main strategies are: privatisation and competitive markets; reduced public expenditure on social services and infrastructure; and deregulation to enhance economic activity and ensure freedom of 'choice'. Generally, these measures have negatively affected the health and wellbeing of communities. In New Zealand, privatisation and competition led to income inequality and an unequal distribution of the 'determinants of health', a burden borne disproportionately by children, the poor, and by Maori and Pacific people. Limiting health expenditure led to inequalities in access to services with restructuring in the 1990s, subverting the service culture of the health system. Failure to regulate for the protection of citizens has undermined health and safety systems, the security of work and collective approaches to health improvement. There has been some retreat from neoliberalism in New Zealand, but we can do more to focus on 'upstream' health initiatives, to recognise that social investment, including adequate funding of services, returns benefits far in excess of any costs, and to make sure that social and cultural equity goals are achieved.


Asunto(s)
Prestación de Atención de Salud , Política , Bienestar Social , Competencia Económica , Objetivos , Equidad en Salud , Gastos en Salud , Disparidades en el Estado de Salud , Disparidades en Atención de Salud , Humanos , Nueva Zelanda , Privatización , Responsabilidad Social
9.
Soc Sci Med ; 244: 112662, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31726268

RESUMEN

Following three decades of international financial institutions implementing austerity measures in sub-Saharan Africa, many health systems remain chronically underfinanced. During this period, countries like Tanzania have moved from a post-independence vision of a strong social sector providing free care for citizens, to a model of increased privatization of public health facilities, shifting the burden of self-financing to individual health facilities and the constituents they serve. Drawing on longitudinal ethnographic research and document analysis undertaken between 2008 and 2017 within three publicly-funded hospitals in north-central Tanzania, this article examines the actions and perspectives of administrators to explore how novel shifts towards semi-privatization of public facilities are perceived as taken-for-granted solutions to funding shortfalls. Specifically, hospital administrators used "side hustle" strategies of projectification and market-based income generating activities to narrow the gap between inadequate state financing and necessary recurrent expenditures. Examples from publicly-funded hospitals in Tanzania demonstrate that employing side hustles to address funding conundrums derives from perverse incentives: while these strategies are supposed to generate revenues to sustain or bolster services to poor clients, in practice these market-based approaches erode the ability of publicly-funded hospitals to meet their obligations to the poorest. These cases show that neoliberal ideas promoting health financing through public-private initiatives offer little opportunity in practice for strengthening health systems in low income countries, undermining those health systems' ability to achieve the goal of universal health care.


Asunto(s)
Programas de Gobierno/economía , Gastos en Salud , Financiación de la Atención de la Salud , Motivación , Sector Público/economía , Antropología Cultural , Organización de la Financiación/economía , Equidad en Salud , Instituciones de Salud/economía , Hospitales Públicos/economía , Humanos , Estudios de Casos Organizacionales , Política , Privatización/economía , Tanzanía
10.
Cien Saude Colet ; 25(1): 67-78, 2020 Jan.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31859856

RESUMEN

The identification of the current vocational training profile of nursing aides and technicians becomes a central element in understanding the dynamics of their qualification in several states, aiming to expose both the existence of trends for under- and overqualification and the participation of the public sector in the offer and expansion of nursing courses in the country. The article explores three relevant aspects of vocational training based on the results found in the research "Nursing Profile in Brazil (FIOCRUZ/COFEN)": the level of schooling/qualification; the geographical distribution and the governmental participation in the consolidation of the current situation. This is an analytical study based on the interpretation of indicators identified by Pearson's Asymmetry Coefficient. The study uses the database generated by the research, as well as data from MEC/Inep and IBGE. The achieved results establish relations between the characteristics of training, distribution of NA&T in all Brazilian states with the phenomenon of overqualification, besides revealing an apparent separation of the Federal Education Network from the actual demand for nursing technicians in the country.


Asunto(s)
Educación en Enfermería/normas , Asistentes de Enfermería/educación , Brasil , Educación en Enfermería/organización & administración , Educación en Enfermería/estadística & datos numéricos , Privatización
14.
Licere (Online) ; 22(4): 489-518, dez.2019. ilus
Artículo en Portugués | LILACS | ID: biblio-1051191

RESUMEN

Este estudo é uma análise referente às políticas públicas no setor turístico sob a óptica do reflexo do projeto neoliberal no Brasil. Procurou-se na literatura entre os períodos de 1990 a 2018 estudos a respeito da influência neoliberal nas medidas e políticas públicas no país, buscando uma reflexão econômica-sociológica de como esse fenômeno poderia se relacionar com o desenvolvimento do turismo e turismo de aventura. Ademais, houve um conjunto de políticas públicas investigadas que por sua vez trouxeram um maior entendimento a respeito da expansão e desenvolvimento do turismo no Brasil a partir da década de 1990. Através dessa investigação, foi possível constatar uma aproximação relevante entre as políticas públicas para setor turístico e o desenvolvimento expressivo do turismo neste período, inclusive para o turismo de aventura, vertente impulsionada pelas políticas públicas de reflexo neoliberal.


This study is an analysis of public policies in the tourism sector from the perspective of the reflex of the neoliberal project in Brazil. Between 1990 and 2018, literature was searched for studies about the neoliberal influence on public policies and measures in the country, seeking an economic-sociological reflection on how this phenomenon could relate to the development of tourism and adventure tourism. In addition, there was a set of public policies investigated, which in turn brought a greater understanding of the expansion and development of tourism in Brazil since the 1990s. Through this investigation, it was possible to find a relevant approach between public policies for tourism sector and the expressive development of tourism in this period, including adventure tourism, a trend driven by public policies of neoliberal reflex.


Asunto(s)
Política Pública , Factores Socioeconómicos , Privatización , Economía , Turismo
15.
Cien Saude Colet ; 24(12): 4479-4488, 2019 Dec.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31778498

RESUMEN

With the aim of systematizing the health private sector proposals related with the reformulation of the Brazilian health system, as well as contributing to the understanding of its meaning, an essay was carried out, based in documents from the Health Coalition Institute (ICOS) published in the period from 2014 to 2018. The document content analysis was carried out guided by some concepts of Bourdieu, Coutinho and Labra. With the change in the correlation of forces resulting from the 2016 parliamentary coup, the private health sector's proposals gained visibility, which initially seemed to correspond to an update of its historical agenda, but which are progressively changing to suit the new political and economic scenario. From then on, conditions of possibility were created for the protagonism of these entrepreneurs in the field of power in relation to sectoral reform and the formulation of health policies, with consequences related to the disruption of the Brazilian Unified Health System (SUS). The contradictions between the discourse of defense of SUS by the entrepreneurs, and the privatizing concrete proposals may reveal a search for the symbolic profits associated with the defense of the public interests and of the universal.


Asunto(s)
Reforma de la Atención de Salud , Sector de Atención de Salud , Programas Nacionales de Salud/organización & administración , Sector Privado , Privatización , Brasil , Economía , Política de Salud , Humanos , Política , Derecho a la Salud
17.
J Leg Med ; 39(2): 177-211, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31503531

RESUMEN

The federal government subsidizes the research and development of prescription medications. Thus, a captivating critique of expensive medications is that prices are too high because of taxpayer co-financing. This critique is often framed in terms of "paying-twice"-first for the research and second through the above market pricing of resulting products. Reasonable pricing clauses-which place some kind of pricing limitation on the exercise of license or patent rights governing a federally funded medication-are one proposed policy tool for addressing the pay-twice critique. This article provides increased analytical clarity as well as historical context to present-day debates about the privatization of federally funded research and prescription drug pricing. It makes three arguments. First, despite its pervasiveness and intuitive plausibility, the pay-twice critique is subject to differing interpretations which has important implications for the appropriateness of proposed solutions. Second, despite their initial attractiveness, the costs, necessity, and effectiveness of reasonable pricing clauses render the wisdom of this policy tool uncertain. However, third, given continued interest in reasonable pricing clauses, the NIH's previous experience with such a policy offers some useful lessons.


Asunto(s)
Costos de los Medicamentos/legislación & jurisprudencia , Control de Medicamentos y Narcóticos/economía , Control de Medicamentos y Narcóticos/legislación & jurisprudencia , Legislación de Medicamentos/economía , Medicamentos bajo Prescripción/economía , Honorarios por Prescripción de Medicamentos/legislación & jurisprudencia , Costos y Análisis de Costo/economía , Costos y Análisis de Costo/legislación & jurisprudencia , Gobierno Federal , Financiación Gubernamental , National Institutes of Health (U.S.) , Investigación Farmacéutica/economía , Investigación Farmacéutica/legislación & jurisprudencia , Privatización/economía , Privatización/legislación & jurisprudencia , Estados Unidos
18.
Inquiry ; 56: 46958019867612, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31382843

RESUMEN

The Medicare program is quietly becoming privatized through increasing enrollment in Medicare Advantage (MA) plans, even though MA has not lived up to its promise of delivering better care at lower cost. Policymakers must reverse this trend and ensure parity between traditional Medicare and MA rather than encourage it through legislation that only benefits MA. Furthermore, as discussions of expanding health insurance coverage through Medicare intensify, policymakers should explore what version of Medicare they wish to expand.


Asunto(s)
Medicare Part C/tendencias , Medicare/tendencias , Privatización/tendencias , Humanos , Medicare/economía , Medicare/organización & administración , Medicare Part C/economía , Medicare Part C/organización & administración , Estados Unidos
19.
J Am Coll Radiol ; 16(10): 1364-1374, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31427249

RESUMEN

Consolidation in health care has been widely recognized as having significant impact in the United States. A related trend is the corporatization of medical professional practices by companies in capital markets. Several medical subspecialties have been identified as attractive corporatization candidates, including radiology. The purpose of the white paper is to present information about the trend of corporatization in radiology. The real, recognized, and potential influences of capital investors in radiology need to be acknowledged as evolving and important considerations. Many radiologists and practices have already realized significant change as a result of corporatization. Corporatization presents significant practical, financial, ethical, and moral implications for those in and related to radiology.


Asunto(s)
Administración de la Práctica Médica/organización & administración , Privatización/organización & administración , Corporaciones Profesionales/organización & administración , Práctica Profesional/organización & administración , Radiología/organización & administración , Humanos , Estados Unidos
20.
Nat Ecol Evol ; 3(8): 1206-1216, 2019 08.
Artículo en Inglés | MEDLINE | ID: mdl-31332334

RESUMEN

Microbes commonly deploy a risky strategy to acquire nutrients from their environment, involving the production of costly public goods that can be exploited by neighbouring individuals. Why engage in such a strategy when an exploitation-free alternative is readily available whereby public goods are kept private? We address this by examining metabolism of Saccharomyces cerevisiae in its native form and by creating a new three-strain synthetic community deploying different strategies of sucrose metabolism. Public-metabolizers digest resources externally, private-metabolizers internalize resources before digestion, and cheats avoid the metabolic costs of digestion but exploit external products generated by competitors. A combination of mathematical modelling and ecological experiments reveal that private-metabolizers invade and take over an otherwise stable community of public-metabolizers and cheats. However, owing to the reduced growth rate of private-metabolizers and population bottlenecks that are frequently associated with microbial communities, privatizing public goods can become unsustainable, leading to population decline.


Asunto(s)
Evolución Biológica , Privatización , Animales , Ecología
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