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1.
BMC Health Serv Res ; 20(1): 80, 2020 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-32013963

RESUMO

BACKGROUND: Recently, the Executive Branch and Judiciary in Brazil increased spending due to larger numbers of lawsuits that forced the State to provide health goods and services. This phenomenon, known as health judicialization, has created challenges and required the Executive Branch and Judiciary to create institutional strategies such as technical chambers and departments to reduce the social, economic and political distortions caused by this phenomenon. This study aims to evaluate the effects of two institutional strategies deployed by a Brazilian municipality in order to cope with the economic, social and political distortions caused by the phenomenon of health judicialization regarding access to medicines. METHODS: A longitudinal study was carried out in a capital in the Central-West Region of Brazil. A sample of 511 lawsuits was analyzed. The variables were placed into three groups: the sociodemographic characteristics and the plaintiffs' disease, the characteristics of the claimed medical products and the institutional strategies. To analyze the effect of the interventions on the total cost of the medicines in the lawsuits, bivariate and multivariate linear regressions with variance were performed. For the categorical outcomes, Poisson regressions were performed with robust variance, using a significance level of 5%. RESULTS: A reduction in the costs of medicines in the lawsuits and of the requests for medicines within the SUS formulary was verified after the deployment of the Department of Assessment of Nonstandardized Medicines (DAMNP) and the Technical Chamber of Health Assessment (CATS); an increase in processed prescriptions from the Brazilian Universal Health System was observed after the deployment of the CATS; and an increase in medicines outside the SUS formulary without a therapeutic alternative was verified after the CATS. CONCLUSION: The institutional strategies deployed were important tools to reduce the high costs of the medicines in the lawsuits. In addition, they represented a step forward for the State, provided a benefit to society and indicated a potential path for the health and justice systems of other countries that also face problems caused by the judicialization of health.

2.
RECIIS (Online) ; 13(4): 843-853, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047584

RESUMO

Os indicadores de morbidade e de mortalidade materno-infantis são essenciais no contexto da organização da Rede Cegonha, no âmbito do Sistema Único de Saúde (SUS). Esta rede organiza-se para assegurar o acesso, o acolhimento e a resolutividade, por meio de um modelo de atenção voltado para o pré-natal, parto e nascimento, puerpério e sistema logístico. Este artigo apresenta um estudo ecológico desta rede em uma Regional de Saúde, realizado com uso de dados dos Sistemas de Informação de Saúde do Departamento de Informática do SUS. Verificou-se um percentual crescente de gestantes que realizaram sete ou mais consultas pré-natais. No entanto, poucas concluíram a assistência pré-natal, porque não realizaram a consulta de puerpério. Observou-se uma taxa de mortalidade infantil próxima à da meta estipulada pela ONU. Identificou-se um aumento das cesáreas e uma redução de partos normais, além de uma alta mortalidade materna. Esses indicadores apontam para a necessidade de melhoria da qualidade da atenção pré-natal e da assistência ao parto.


Indicators of maternal-child morbidity and mortality are essential in the context of the organization of the Rede Cegonha (Stork Network), within the scope of the Unified Health System (SUS ­ Sistema Único de Saúde). This network is organized to ensure access, protection and successful resolution, through a model of attention focused on prenatal, delivery and childbirth, puerperium (or postpartum period) and logistic system. This article presents an ecological study of this network in a Regional de Saúde (Regional Health Department) that was carried out using data from the SUS Department of Informatics of the Health Information Systems. An increasing percentage of pregnant women who had seven or more prenatal visitscould be observed. However, few pregnant women completed prenatal care because they have not sought for the puerperium consultation. A child mortality rate close to the target set out in the United Nations Sustainable Development Goals was observed. An increase in caesarean sections and a reduction in normal deliveries and at the same time a high maternal mortality were identified. These indicators point to the need to improve the quality of prenatal and delivery care.


Los indicadores de morbilidad y de mortalidad materno-infantil son esenciales en el contexto de la organización de la Rede Cegonha (Red Cigüeña), en el ámbito del Sistema Único de Salud (SUS ­ Sistema Único de Saúde). Esa red se organiza para asegurar el acceso, el acogimiento y la capacidad resolutiva, por medio de un modelo de atención dirigido al prenatal, parto, nacimiento, puerperio y sistema logístico. Este artículo presenta un estudio ecológico de la red en una Regional de Saúde (Dirección Regional de Salud) realizado utilizando datos de los Sistemas de Información de Salud del Departamento de Informática del SUS. Se ha verificado un porcentaje creciente de gestantes que realizaron siete o más consultas de prenatal. Sin embargo, pocas gestantes concluyeron la asistencia prenatal, porque no realizaron la consulta de puerperio. Se observó una tasa de mortalidad infantil próxima a la meta estipulada por la ONU. Se identificó un aumento de las cesáreas y una reducción de partos normales, además de una alta mortalidad materna. Esos indicadores apuntan la necesidad de mejorar la calidad de la atención prenatal y de la asistencia al parto.


Assuntos
Humanos , Mortalidade Infantil , Mortalidade Materna , Indicadores Básicos de Saúde , Saúde da Mulher , Assistência à Saúde , Cuidado Pré-Natal , Sistema Único de Saúde , Saúde da Criança , Parto Humanizado , Serviços de Saúde Materno-Infantil , Estudos Ecológicos , Acolhimento , Acesso aos Serviços de Saúde
3.
BMC Public Health ; 19(1): 212, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30786892

RESUMO

BACKGROUND: Although public policy in Brazil supports access to essential medicines, the health system cannot meet all demand. Increasingly, the population has used legal demands to seek access to medicines, an approach that can undermine equitable access by creating policy inconsistencies (e.g., granting access to medicines outside the SUS formulary). In response, the Executive Branch has signed institutional agreements to create an administrative case for submitting requests for medicines directly to the Executive Branch. The objective of this study was to assess the degree to which the administrative cases for requests are in accordance with public policies and guidelines, e.g., if administrative cases results in fewer decisions to purchase outside the SUS formulary. METHODS: This descriptive study used secondary data from lawsuits filed against the Executive Branch from 2003 to 2015 and from administrative cases granted by the Executive Branch from 2010 to 2015 in the capital of a state located in the central-western region of Brazil. The variables included plaintiffs' sociodemographic characteristics and diseases as well as the characteristics of the medical products sought via the processes. RESULTS: Comparing the requests submitted through lawsuits and the administrative cases revealed differences in the incomes of plaintiffs and the costs of medicines. Both methods for submission recorded requests for medicines for diseases of endocrine and circulatory systems; the only difference was the prevalence of diseases of the genitourinary system in the lawsuits. A higher proportion of lawsuits sought medicines outside the SUS formulary with therapeutic alternatives, while medicines outside the SUS formulary without an alternative were more commonly requested in administrative cases. CONCLUSION: Administrative cases adhere to the public policies and guidelines of the SUS. The administrative cases results in fewer decisions to purchase outside the SUS formulary with alternative, and more decisions to purchase drugs for which there is a formulary alternative. In addition, administrative cases provide greater equity by favoring lower income applicants. However, administrative cases also reveal deficiencies in the State's implementation of existing pharmaceutical policies. The public pressure for effective implementation of existing policies may help expand access to medicines.


Assuntos
Medicamentos Essenciais/provisão & distribução , Programas Governamentais/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Brasil , Humanos , Pobreza , Política Pública , Fatores Socioeconômicos
4.
Ciênc. cuid. saúde ; 15(3): 489-497, Jul.-Set. 2016.
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-974865

RESUMO

RESUMO Trata-se de um estudo de caso interpretativo desenvolvido com o objetivo de descrever as experiências de pessoas que recorreram à via judicial para ter acesso a medicamentos no Sistema Único de Saúde. Os dados foram coletados por meio de entrevista semiestruturada nos domicílios de oito pessoas que recorreram a essa via, residentes em um município localizado no sudoeste do Estado de Goiás. A experiência de acesso ao medicamento foi marcada por barreiras que estão interligadas aos diversos níveis do sistema de saúde; envolvem aspectos organizacionais e assistenciais relacionados à informação, ao acolhimento e à resolutividade. A necessidade do tratamento contínuo da condição crônica e a dificuldade financeira foram os fatores determinantes para que os participantes recorressem à justiça. Observou-se a necessidade de aprimorar o acolhimento e a comunicação entre a equipe de saúde envolvida no acesso ao medicamento e de qualificar os profissionais da saúde para uma compreensão ampliada da assistência farmacêutica no Sistema Único de Saúde.


RESUMEN Se trata de un estudio de caso interpretativo desarrollado con el objetivo de describirlas experiencias de personas que recurrieron a la vía judicial para tener acceso a medicamentos en el Sistema Único de Salud de Brasil. Los datos fueron recolectados por medio de entrevista semiestructurada en los domicilios de ocho personas que recurrieron a esta vía, residentes en un municipio ubicado en el sudoeste del Estado de Goiás. La experiencia de acceso al medicamento fue marcada por obstáculos que están interconectados a los diversos niveles del sistema de salud; involucran aspectos organizacionales y asistenciales relacionados a la información, acogiday resolutividad. La necesidad del tratamiento continuo de la condición crónica yla dificultad financiera fueron los factores determinantes para que los participantes recurrieran a la justicia. Se observól a necesidad de perfeccionar la acogiday comunicación entre el equipo de salud involucrado en el acceso al medicamento y de calificar a los profesionales de la salud para una comprensión ampliada de la asistencia farmacéutica en el Sistema Único de Salud.


ABSTRACT The present study is an interpretative case study developed to describe the experiences of people who have resorted to judicial proceedings to gain access to medications in the Unified Health System. Data were collected through semi-structured interviews in the homes of eight individuals who have used this approach, who lived in a city in the southwest of the State of Goiás. The experience of access to medications was marked by barriers that are interconnected to the different levels of the health system; they involve organizational and assistance aspects related to information, embracement and resolution. The need for continued treatment of chronic conditions and financial difficulties were the determining factors for participants to resort to judicial proceedings. The need to improve embracement and communication among the health teams involved in access to medications, and to qualify health professionals for a broader understanding of pharmaceutical care in the Unified Health System, was observed.


Assuntos
Humanos , Assistência Farmacêutica , Sistema Único de Saúde , Direito à Saúde , Acesso a Medicamentos Essenciais e Tecnologias em Saúde , Acesso aos Serviços de Saúde , Direitos do Paciente
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