Responsibility for Funding Refractive Correction in Publicly Funded Health Care Systems: An Ethical Analysis.

Allocating on the basis of need is a distinguishing principle in publicly funded health care systems. Resources ought to be directed to patients, or the health program, where the need is considered greatest. In Sweden support of this principle can be found in health care legislation. Today however some domains of what appear to be health care needs are excluded from the responsibilities of the publicly funded health care system. Corrections of eye disorders known as refractive errors is one such domain. In this article the moral legitimacy of this exception is explored. Individuals with refractive errors need spectacles, contact lenses or refractive surgery to do all kinds of thing, including participating in everyday activities, managing certain jobs, and accomplishing various goals in life. The relief of correctable visual impairments fits well into the category of what we typically consider a health care need. The study of refractive errors does belong to the field of medical science, interventions to correct such errors can be performed by medical means, and the skills of registered health care professionals are required when it comes to correcting refractive error. As visual impairments caused by other conditions than refractive errors are treated and funded within the public health care system in Sweden this is an inconsistency that needs to be addressed.

Variations in demand and provision for publicly funded outpatient musculoskeletal physiotherapy services across Quebec, Canada.

RATIONALE: The prevalence of musculoskeletal disorders is high and expected to increase in the next decade. Persons suffering from musculoskeletal disorders benefit from early physiotherapy services. However, access to publicly funded physiotherapy services has been shown to be compromised by long waiting times and limited availability of resources in many countries around the world. Decisions on resource allocation may create geographic disparities in provision and access to services, which may result in inequity in access. AIMS AND OBJECTIVES: This study aimed to assess variations in demand and provision of publicly funded outpatient physiotherapy services across the province of Quebec, Canada, as well as to assess the demand to provision relationship. METHODS: We conducted a secondary analysis of data retrieved from the 2008 Quebec Health Survey and data obtained from a survey of hospitals in the province of Quebec in 2015. We used geographic information systems analyses and descriptive analyses to assess geographic variations and the relationship between demand and provision. RESULTS: Our results indicate substantial variations in the provision and demand for physiotherapy services in the province of Quebec. The variations in service provision did not follow the variations in demand. Long waiting times and insufficient provision of services were found in many regions. CONCLUSIONS: The variations in provision of physiotherapy services between regions reported in our study did not correspond to the variations in demand. Such geographic variations and demand to provision mismatches may create inequity in access to services, especially for those unable to afford private services.

O sistema único de saúde e a mídia televisiva: análise de um telejornal local em emissora nacional / Brazilian public healthcare system and television media: analisis of a local news report broadcasted by a nationwide network

Introdução: O Sistema Único de Saúde é constantemente mencionado na Mídia brasileira, seja televisiva, escrita ou virtual. Objetivo: Este estudo pretendeu analisar como o sistema público de saúde é abordado pela Mídia televisiva, mais especificamente, no telejornal veiculado por emissora local, no estado do Rio Grande do Norte. Método: Trata-se de pesquisa documental, tendo como base de dados as reportagens veiculadas pelo telejornal da InterTV Cabugi, RNTV Primeira Edição, no período de março a agosto de 2016. Os dados foram sistematizados e, em seguida, foi realizada análise de conteúdo em que organizou-se as reportagens por categorias, para identificar quais os temas predominantes quando se referem ao Sistema Único de Saúde, bem como saber quais atores entrevistados e que destaques foram dados pela emissora. Resultados: Os resultados encontrados são corroborados por outros achados da literatura de que há certo padrão midiático, seja em nível local ou nacional, na abordagem da Saúde Pública, com predominância de reportagens que destacaram situações negativas em hospitais, doenças e a figura do médico, com ênfase na visão curativista e hospitalocêntrica. Conclusão: O poder da mídia em influenciar a sociedade é pouco aproveitado positivamente para valorizar a Política Pública de Saúde como já identificado na literatura pesquisada (AU).

Introducion: Brazilian publicly-funded health care system, the Unified Health System is constantly mentioned in Brazilian media, be it printed, audiovisual or online. Objective: this study aimed to analise the television news coverage regarding SUS, specifically by a local newscast in Rio Grande do Norte State. Methodology: a documentary research was performed using a database of news from RNTV Primeira Edição, a news report broadcasted by InterTV Cabugi, in its editions from March to August 2016. Acquired data were systematized and the news were then sorted in categories for a content analysis in order to identify the main themes regarding SUS, as well as to acknowledge the types that were most often interviewed and the highlights given by the aforementioned TV network. Results: results found corroborate other findings in literature that there is a standard way in wich media, be it local or nationwide, approaches the Public Healthcare System. The news tend to highlight negative situations in hospitals, disease outbreaks and the doctor's image, emphasizing a "hospitalocentric" and "curativist" model of health. Conclusions: the influence and power of media over society is little used to make a good image of Public Healthcare Policies, as already verified in the researched literature (AU).

Socioeconomic status and wait times for pediatric surgery in Canada.

OBJECTIVES: Even in a publicly funded health care system, access to care may be related to socioeconomic status (SES). For children, delays in surgical procedures can have profound functional, social, and psychological effects with lifelong impact. The purpose of this study was to determine whether SES was related to meeting surgical wait time access targets for children. We also assessed the effects of gender, age, and distance to hospital on meeting access targets. METHODS: Patient addresses, referral wait times, and surgical wait times were obtained for 39,287 surgical procedures between 2005 and 2011 at the Hospital for Sick Children. Using census data, we derived household income quintile, distance to hospital, and indices of social and material deprivation. These indices were correlated with the percentage of children meeting clinic referral wait time targets and receiving surgery within the Pediatric Canadian Access Targets for Surgery. RESULTS: Across all SES quintiles, 33% of children exceeded their referral wait time targets, and 28% of children exceeded their surgical wait time targets. Indices of material or social deprivation and age did not correlate with the time from referral to clinic consultation (P = .54, .40, and .58, respectively). Gender was statistically significant (P < .001), but the difference was small (odds ratio = 0.87 for girls). Distance was also statistically significant (P = .005), and these differences translate into clinically meaningful differences in meeting wait time targets. Regarding completion of surgical procedures, material deprivation, distance, and gender did not correlate with longer wait times for surgery (P = .44, .09, .59, respectively). Social deprivation was statistically significant (P = .02) but not clinically significant. Increasing patient age was significantly associated with increased proportion of out-of-window wait times (P < .001). SES did not affect the timeliness of completion of surgery even when the urgency of the surgery (priority level based on diagnosis) was considered. CONCLUSIONS: SES does not predict the timeliness of delivery for pediatric surgical services.