Lineamientos para emisión de certificados de habilitación de establecimientos de atención para la salud, públicos y privados: unidad técnica normativa 2019 / Guidelines for the issuance of certificates of authorization of health care establishments, public and private: normative technical unit 2019

El objetivo del documento es la normalización de los criterios mínimos que deben cumplir los establecimientos de salud para su funcionamiento. Además, es un modelo básico para ser certificado, previo a solicitar la licencia sanitaria. Contiene unos fundamentos legales, así como las definiciones de rigor en torno al tema central. Incluye las indicaciones a seguir, para la solicitud de inspección, previo a la certificación. Incluye el anexo: "Guía de inspección de condiciones de habilitación de establecimientos de atención para la salud" (anexo A). También, "Modelo de certificación de habilitación" (anexo B). "Categorías de establecimientos regulados por DRACES" (anexo C). El anexo D y último, contiene todo el fundamento legal que deben conocer quienes soliciten ser habilitados.

Government roles in regulating medical tourism: evidence from Guatemala.

BACKGROUND: Regulation of the medical tourism and public health sectors overlap in many instances, raising questions of how patient safety, economic growth, and health equity can be protected. The case of Guatemala is used to explore how the regulatory challenges posed by medical tourism should be dealt with in countries seeking to grow this sector. METHODS: We conducted a qualitative case study of the medical tourism sector in Guatemala, through reviews and analyses of policy documents and media reports, key informant interviews (n = 50), and facility site-visits. RESULTS: Key informants were critical of the absence of effective public regulation of the emerging medical tourism sector, noting several regulatory gaps and the importance of filling them. These informants specifically expressed that: 1) The government should regulate medical tourism in Guatemala, thought there was disagreement as to which government sector should do so and how; 2) The government has not at this time regulated the medical tourism sector nor shown great interest in doing so; and 3) International accreditation could be used to augment domestic regulation. CONCLUSIONS: The intersection of domestic and international regulation of medical tourism has been largely unexplored. This case study advances new research in this area. It highlights the need for and dearth of regulatory protections in Guatemala and lessons for other, similarly situated countries. National regulatory models from Israel and Barbados could be adapted to the Guatemalan context. Global governance could help to protect national governments from any competitive disadvantages created by regulation. Underlying the concerns over growth in medical tourism, however, is how it contributes to the ongoing privatization of health care facilities worldwide. This trend risks undermining efforts to reach targets for Universal Health Coverage and exacerbating existing inequities in the global distribution of health and wealth.

Recomendação nº 006, de 25 de agosto de 2016: recomenda ao Ministério da Saúde, CONASS e CONASEMS que seja atualizada a Portaria n.º 3.394, de 30 de dezembro de 2013, especialmente o art. 3º, com vistas a incluir todos os tipos de câncer / Recommendation No. 006, of August 25, 2016: recommends to the Ministry of Health, CONASS and CONASEMS that Ordinance No. 3.394, of December 30, 2013, be updated, especially art. 3, with a view to including all types of cancer

Recomenda ao Ministério da Saúde, CONASS e CONASEMS que: 1. Seja atualizada a Portaria n.º 3.394, de 30 de dezembro de 2013, especialmente o art. 3º, com vistas a incluir todos os tipos de câncer; 2. Os estabelecimentos públicos e privados, para receber os recursos de custeio, informem os procedimentos diagnósticos de todos os tipos de câncer no SISCAN (art. 3º, §3º da Portaria); 3. Seja estabelecido prazo improrrogável de 120 dias para que seja gerado exclusivamente pelo SISCAN o Boletim de Produção Ambulatorial Individualizada (BPA-I) (art. 7º da Portaria); 4. Sejam criados centros regionais de diagnóstico precoce de câncer no SUS garantindo desde exames básicos até os mais avançados, principalmente biópsia; 5. Sejam revisados dos tetos físico e financeiros dos estados e municípios em gestão plena e Distrito Federal do sistema para adequar as necessidades da demanda; 6. Sejam criadas notificações obrigatórias de ocorrência de casos de câncer dentro do sistema de notificação de agravos e doenças não transmissíveis.

Globos de látex de caucho natural: objetos peligros a desterrar de las instituciones de salud / Natural rubber latex balloons: dangerous objects to be banned from health institutions

Los globos de látex de caucho natural y los guantes de examinación del mismo material inflados como globos, que se entregan a los pacientes para aliviar el estrés de la atención sanitaria en las instituciones de salud tanto públicas como privadas, pueden provocar reacciones de hipersensibilidad de tipo I y son una de las causas más comunes de aspiración fatal. La suelta de globos contaminan el ambiente y agravan la extinción de la fauna y de la vida marina. Los pacientes sensibilizados o alérgicos al látex que participan en los festejos donde se utilizan globos de látex corren el riesgo de una reacción anafiláctica, potencialmente fatal. Aconsejarles no concurrir a dichos eventos, implica impedirles el disfrute de las actividades recreativas que es un derecho de la infancia manifestado en la Declaración de los Derechos del Niño. Muchos hospitales de países desarrollados ya cuentan con una política de prohibición de los globos de látex en sus instituciones, que podría replicarse en nuestro medio por las ventajas que conlleva y su muy bajo costo de implementación (AU)

Natural rubber latex balloons and examining gloves of the same material blown up as balloons to entertain patients to alleviate the stress of care at public and private health institutions, may cause reactions of type-1 hypersensitivity and are the most common cause of fatal asphyxia. Balloons that are released up into the air contaminate the environment and aggravate the extinction of fauna and marine life. Patients who are sensitized or allergic to latex and participate in celebrations in which latex balloons are used are at risk of a potentially fatal anaphylactic reaction. To advise them not to participate in these events means to stop them from enjoying recreational activities which is a right manifested in the Declaration of the Rights of the Child. In many hospitals in developed countries a policy of prohibition of latex gloves is already in place. This prohibition may be replicated in our environment considering its advantages and very low cost of implementation (AU)

[Preserving the cultural heritage of health in Brazil: an emerging question]. / Preservação do patrimônio cultural da saúde no Brasil: uma questão emergente.

In a discussion that applies the category "heritage" to goods within the realm of health, the article problematizes the recent recognition and incipient protection of the cultural heritage of health in Brazil. It presents a roster of assets that receive federal protection through Brazil's Instituto do Patrimônio Histórico e Artístico Nacional (IPHAN), including hospitals and health-related buildings as well as inventories conducted in a number of state capitals by the Brazilian Network for Cultural Heritage in Health. This approach suggests that preserving this valuable heritage is a matter of importance for the history of health in Brazil.

Preservação do patrimônio cultural da saúde no Brasil: uma questão emergente / Preserving the cultural heritage of health in Brazil: an emerging question

Resumo O estudo discute a categoria de patrimônio aplicada aos bens relacionados à saúde, problematizando o recente reconhecimento e a incipiente proteção que o patrimônio cultural da saúde vem tendo no país. Para a reflexão, apresenta-se uma relação de bens tombados em nível federal pelo Instituto do Patrimônio Histórico e Artístico Nacional, em que se apresentam alguns hospitais e edificações relacionadas à saúde e os inventários mais recentes promovidos em diversas capitais pela Rede Brasil de Patrimônio Cultural da Saúde. A abordagem coloca em evidência a importância desse patrimônio e da sua preservação para a história da saúde no país.

Abstract In a discussion that applies the category “heritage” to goods within the realm of health, the article problematizes the recent recognition and incipient protection of the cultural heritage of health in Brazil. It presents a roster of assets that receive federal protection through Brazil’s Instituto do Patrimônio Histórico e Artístico Nacional (IPHAN), including hospitals and health-related buildings as well as inventories conducted in a number of state capitals by the Brazilian Network for Cultural Heritage in Health. This approach suggests that preserving this valuable heritage is a matter of importance for the history of health in Brazil.

[Autonomy for financial management in public and private healthcare facilities in Brazil]. / Autonomia financeira em estabelecimentos públicos e privados de saúde no Brasil.

Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.

[Institutional liability and medical research]. / Responsabilidad institucional e investigación médica.

On December 14, 2011 an addition to Article 100 of the General Health Law was published in the Federation Official Journal. The added section VII states that: "It is the responsibility of the Health Care Institution to provide medical care to the subject that is injured, if this is directly related to the investigation, without prejudice to the legally appropriate compensation", thus establishing the institution's liability in an precise way when it authorizes research. This is a relevant situation of Fundamental Rights. We will present the spirit of the ordinary legislator from the Law initiative to its enactment.

Reglamento para la regulación, autorización, acreditación y control de establecimientos para la salud: acuerdo gubernativo No. 376-2007 / Regulation for the regulation, authorization, accreditation and control of health establishments: government agreement No. 376-2007

Tal como su nombre lo indica, el documento describe los requerimientos y condiciones, tanto para certificar establecimientos para la salud, como para su correcta y legal administración. Incluye las definiciones de los términos descritos en el título y su función dentro del reglamento. Además, otros conceptos como: "certificado de calidad", constancia de supervisión", "establecimientos de servicio social", entre otros. Están además, los requisitos para otorgar la licencia sanitaria a cada tipo de establecimientos, también descritos ampliamente en el acuerdo.

Institutional responses to medical mistakes: ethical and legal perspectives.

Health care institutions must decide whether to inform the patient of a medical error. The barriers to disclosure are an aversion to admitting errors, a concern about implicating other practitioners, and a fear of lawsuits and liability. However, admission of medical errors is the ethical thing to do and may be required by law. When examined, the barriers to such disclosures have little merit, and, in fact, lawsuits and liability may actually be reduced by informing the patient of medical errors. Therefore, a health care institution should implement a written policy providing for disclosure of medical errors, using a process such as that outlined in the article.