Análisis comparado del marco jurídico sobre Calidad de la Atención y Seguridad del Paciente (CASP) en América Latina, España y la Comunidad Europea

El 5 de octubre del 2007 durante la 27.ª Conferencia Sanitaria Panamericana, se emite la Resolución CSP27/10 sobre Política y Estrategia Regional para la Garantía de la Calidad de la Atención Sanitaria, incluyendo la Seguridad del Paciente (CASP). Esta Resolución se basa en el documento presentado el 17 de julio del mismo año (CSP27/16), que define la calidad de la atención, incluyendo la seguridad del paciente, como la cualidad de la atención sanitaria esencial para la consecución de los objetivos nacionales de salud, la mejora de la salud de la población y el futuro sostenible del sistema de atención en salud.

[Right-to-health litigation in three Latin American countries: a systematic literature review]. / Litigios por derecho a la salud en tres países de América Latina: revisión sistemática de la literatura.

OBJECTIVE: Identify and evaluate studies that analyzed characteristics of right-to-health litigation in Brazil, Colombia, and Costa Rica. METHODS: Studies were evaluated that analyzed characteristics of right-to-health litigation identified through a search of PubMed, LILACS, Cochrane Library, and Scirus (April 2012). Two reviewers evaluated the studies. Variables collected were, among others, grounds for litigation, proportion of lawsuits for benefits covered by the health system, and lawsuits on high-cost technologies. RESULTS: Thirty studies were identified (Brazil 19, Colombia 10, and Costa Rica 1). Judgments were frequently in favor of plaintiffs: Colombia (75%-87%), Costa Rica (89.7%), and Brazil (70%-100%). In Colombia, lawsuits were filed for benefits included in the Compulsory Health Plan (range: 41%-69.9%). In Brazil there was considerable variation in the amount of lawsuits between the Exceptional Circumstance Drug Dispensing Program (13%-31%) and basic medicines in the Unified Health System (approximately 50%). Lawsuits on drugs varied as a percentage of all lawsuits (Colombia 11.9%-35.6%, Costa Rica 30.2%, and Brazil 49.6%). A study in Brazil found a statistically significant difference when comparing lawsuits on exceptional drugs versus all other drugs, by social class; and in another study, according to lawsuits from municipalities with better socioeconomic indicators. A concentration of lawsuits on drug prescribing by a limited group of physicians was reported. Prescribing was not always supported by scientific evidence. Another study found that in half of the cases, the cost of legal proceedings was higher than the cost of the services being claimed. CONCLUSIONS: There are similarities in the grounds, nature, and impact of litigation in the context of the countries studied. The studies included show weaknesses of health systems to ensure access to different services as well as in the introduction of new health technologies.

Litigios por derecho a la salud en tres países de América Latina: revisión sistemática de la literatura / Right-to-health litigation in three Latin American countries: a systematic literature review

OBJETIVO: Identificar y evaluar estudios que analizaron las características de los litigios por derecho a la salud en Brasil, Colombia y Costa Rica. MÉTODOS: Se evaluaron estudios que analizaron las características de los litigios por derecho a la salud identificados mediante una búsqueda en PubMed, LILACS, Biblioteca Cochrane, Scirus (Abril, 2012). Dos revisores evaluaron los estudios. Las variables recabadas fueron, entre otras: causales de litigio, proporción de demandas por beneficios cubiertos por el sistema de salud y demandas por tecnologías de alto costo. RESULTADOS: Se identificaron 30 estudios (Brasil 19, Colombia 10 y Costa Rica 1). La decisión judicial fue frecuentemente favorable para los demandantes: Colombia (75%-87%), Costa Rica (89,7%) y Brasil (70%-100%). En Colombia las demandas se efectuaron por beneficios incluidos en el Plan Obligatorio de Salud (rango 41%-69,9%). En Brasil se presentó una variación importante de demandas entre el Programa de Medicamentos de Dispensación Excepcional (13%-31%) y los medicamentos básicos del Sistema Único de Salud (aproximadamente 50%). En relación al total de demandas, las de medicamentos fueron variables (Colombia 11,9%-35,6%, Costa Rica 30,2% y Brasil 49,6%). Un estudio de Brasil encontró una diferencia estadísticamente significativa al comparar las demandas por medicamentos excepcionales versus los demás, según el estrato social; y en otro estudio según las demandas de municipios con mejores indicadores socioeconómicos. Se reportó una concentración de las demandas en la prescripción de medicamentos por un grupo acotado de médicos. La prescripción no fue siempre sustentada por evidencia científica. Otro estudio halló que en la mitad de los casos el costo del proceso judicial resultó ser superior al costo de los servicios demandados. CONCLUSIONES: Existen similitudes en las causales, naturaleza y repercusiones de la judicialización en el contexto de los países estudiados. Los estudios incluidos muestran las debilidades de los sistemas de salud para garantizar el acceso a los distintos servicios así como para la incorporación de las nuevas tecnologías sanitarias.

OBJECTIVE: Identify and evaluate studies that analyzed characteristics of right-to-health litigation in Brazil, Colombia, and Costa Rica. METHODS: Studies were evaluated that analyzed characteristics of right-to-health litigation identified through a search of PubMed, LILACS, Cochrane Library, and Scirus (April 2012). Two reviewers evaluated the studies. Variables collected were, among others, grounds for litigation, proportion of lawsuits for benefits covered by the health system, and lawsuits on high-cost technologies. RESULTS: Thirty studies were identified (Brazil 19, Colombia 10, and Costa Rica 1). Judgments were frequently in favor of plaintiffs: Colombia (75%-87%), Costa Rica (89.7%), and Brazil (70%-100%). In Colombia, lawsuits were filed for benefits included in the Compulsory Health Plan (range: 41%-69.9%). In Brazil there was considerable variation in the amount of lawsuits between the Exceptional Circumstance Drug Dispensing Program (13%-31%) and basic medicines in the Unified Health System (approximately 50%). Lawsuits on drugs varied as a percentage of all lawsuits (Colombia 11.9%-35.6%, Costa Rica 30.2%, and Brazil 49.6%). A study in Brazil found a statistically significant difference when comparing lawsuits on exceptional drugs versus all other drugs, by social class; and in another study, according to lawsuits from municipalities with better socioeconomic indicators. A concentration of lawsuits on drug prescribing by a limited group of physicians was reported. Prescribing was not always supported by scientific evidence. Another study found that in half of the cases, the cost of legal proceedings was higher than the cost of the services being claimed. CONCLUSIONS: There are similarities in the grounds, nature, and impact of litigation in the context of the countries studied. The studies included show weaknesses of health systems to ensure access to different services as well as in the introduction of new health technologies.

O tratamento do risco em saúde e a nova regulação internacional / Treatment of the risk in health and the new international regulamentation

O artigo tem por objetivo analisar o controle dos riscos internacionais em saúde, com base em critérios de segurança humana e segurança sanitária, e as respostas da comunidade internacional para confrontar esses riscos em um marco de direitos e liberdades individuais. Revisa os instrumentos internacionais recentes: o Convênio Marco da Organização Mundial da Saúde para o Controle do Tabaco e o Regulamento Sanitário Intenacional (2005).

Infecciones hospitalarias. Legislación en América Latina / Hospitable infections. Legislation in Latin America

El presente documento trata de las infecciones hospitalarias, intrahospitalarias o nosocomiales adquiridas en el marco de una internación que constituyen un importante problema de salud pública en el ámbito mundial, tanto para los pacientes, como para sus familias y la comunidad. Se estructura a partir de un análisis temático y, dentro de cada tema, menciona y analiza la legislación de cada país en orden alfabético.

Evolución del concepto etnia/raza y su impacto en la formulación de políticas para la equidad / The evolution of the ethnicity/race concept and its impact on framing policies that promote equity

Acknowledging the differences between individuals based on their unique identity is a basic requirement for achieving equity. A review of international human rights efforts and the recommendations and declarations of global conferences and regional summits as they redirect policy to battle discrimination shows a positive evolution in the concept of ethnicity/race. This is evident in the transition from using "invisible" differences as an equalizing measure to respecting lifestyle diversity and acknowledging that individuals have a right to be valued for their differences. This evolution in the ethnicity/race concept has been pivotal to building multiethnic, multicultural, and multilingual nations in which minority groups are involved in framing equitable health policies and programs. This study covers the time period from 1948 to the present day, identifying four stages in the concept's evolution that coincide with milestones in the political and social relationship between government institutions and ethnic minority groups. The results of these five decades of positive progress is a heightened appreciation for differences, which underlies multiethnic societies and surpasses any one of the tangible benefits received by minority groups. The progress of democratic societies depends heavily on this concept, one that ensure a stronger foundation for future development.

[The evolution of the ethnicity/race concept and its impact on framing policies that promote equity]. / Evolución del concepto etnia/raza y su impacto en la formulación de políticas para la equidad.

Acknowledging the differences between individuals based on their unique identity is a basic requirement for achieving equity. A review of international human rights efforts and the recommendations and declarations of global conferences and regional summits as they redirect policy to battle discrimination shows a positive evolution in the concept of ethnicity/race. This is evident in the transition from using "invisible" differences as an equalizing measure to respecting lifestyle diversity and acknowledging that individuals have a right to be valued for their differences. This evolution in the ethnicity/race concept has been pivotal to building multiethnic, multicultural, and multilingual nations in which minority groups are involved in framing equitable health policies and programs. This study covers the time period from 1948 to the present day, identifying four stages in the concept's evolution that coincide with milestones in the political and social relationship between government institutions and ethnic minority groups. The results of these five decades of positive progress is a heightened appreciation for differences, which underlies multiethnic societies and surpasses any one of the tangible benefits received by minority groups. The progress of democratic societies depends heavily on this concept, one that ensure a stronger foundation for future development.

Infecciones hospitalarias. Legislación en América Latina

[Introducción]. El objetivo principal de este trabajo es presentar la recopilación de la legislación aplicable a la prevención, la vigilancia y el control de las infecciones intrahospitalarias en la Región, con el fin de analizar las tendencias y evaluar el estado de los sistemas de vigilancia sanitaria. Surge como una iniciativa conjunta del Área de Vigilancia Sanitaria y Atención de las Enfermedades y el Área de Fortalecimiento de los Sistemas de Salud de la Organización Panamericana de la Salud/Organización Mundial de la Salud.

Legislación sobre antibióticos en América Latina

Presenta informaciones acerca de la legislación de los antibióticos en América Latina aunque los medios comerciales se chocan con el marco legal para el control de los medicamentos. Documento en formato PDF, requiere Acrobat Reader.

O Regulamento Internacional da Saúde / The International Health Regulations

O artigo situa o regulamento internacional da saúde em um contexto atual sobre a crescente globalização que a saúde, indiretamente, tem muito a beneficiar-se com as alianças comerciais entre os Estados, consequencia do reconhecimento de que a saúde tem importância expressiva sobre a economia. Daí a impostância de um regulamento com aplicação supranacional que alcance todos os envolvidos.

[The law and equity in health]. / Legislación y equidad en salud.

What role does the law play in reducing inequalities in health that are unnecessary, avoidable, and unfair? The question is addressed in this paper, whose purpose is to examine how the legal system, as a regulatory agency of the State, contributes to achieving greater equity in access to and use of health-related goods and services. From the legal viewpoint, health is a public commodity that is critical to human well-being and survival. But in prioritizing health as a human right, the legal system is challenged with finding ways to make health equally accessible to all, while bearing in mind the particular needs of different groups. There are currently important gaps in health legislation in the Region that must be addressed if greater equity in health is to be achieved. Such gaps, along with potential ways to correct them, are discussed throughout the paper.