Perspectives of HIV agencies on improving HIV prevention, treatment, and care services in the USA.

HIV healthcare services in the USA are made available through a complex funding and delivery system. We present perspectives of HIV agencies on improvements that could lead to an ideal system of HIV prevention, treatment and care. We conducted semi-structured interviews with representatives from 21 HIV agencies offering diverse services in Baltimore, MD. Thematic analysis revealed six key themes: (1) Focusing on HIV prevention, (2) Establishing common entry-points for services, (3) Improving information availability, (4) Streamlining funding streams, (5) Removing competitiveness and (6) Building trust. We recommend that in addition to addressing operational issues regarding service delivery and patient care, initiatives to improve HIV service systems should address underlying social issues such as building trust.

Priority setting for health in emerging markets.

The use of health technology assessment research in emerging economies is becoming an increasingly important tool to determine the uses of health spending. As low- and middle-income countries' gross domestic product grows, the funding available for health has increased in tandem. There is growing evidence that comparative effectiveness research and cost-effectiveness can be used to improve health outcomes within a predefined financial space. The use of these evaluation tools, combined with a systematized process of priority setting, can help inform national and global health payers. This review of country institutions for health technology assessment illustrates two points: the efforts underway to use research to inform priorities are widespread and not confined to wealthier countries; and many countries' efforts to create evidence-based policy are incomplete and more country-specific research will be needed. Further evidence shows that there is scope to reduce these gaps and opportunity to support better incorporation of data through better-defined priority-setting processes.

Reflexões sobre diferentes temas: capital e trabalho nos serviços de saúde; o estado, as agências e a saúde; vínculos de trabalho na administração pública brasileira / Reflections on different themes: capital and work in health services; the state, the agencies and health; work links in the Brazilian public administration

INTRODUÇÃO: Esta publicação contempla temas e artigos independentes, elaborados em diferentes momentos, mas sempre procurando formular ideias e proposições em torno de assuntos candentes, à época em que foram elaborados. OBJETIVO: Produto essencialmente do conhecimento e da reflexão dos autores sobre os temas, abordam questões coerentes com o objeto de estudo do ObservaRH/UnB e propõem-se a representar uma contribuição para a Rede de Observatórios da América Latina, para o Ministério da Saúde do Brasil, demais instâncias político administrativas do Sistema Único de Saúde (SUS) e permitir o debate entre os demais estudiosos e interessados nesse campo. Esta edição inaugura as publicações que integram a Série Formulação do ObservaRH/UnB. CONCLUSÃO: Os textos já haviam sido disponibilizados no sítio web do Observatório, mas foi considerada importante a oportunidade de dispor de mais este veículo de comunicação para maximizar as possibilidades de consulta e difusão dos artigos. O ObservaRH/UnB agradece aos autores desses estudos pela contribuição para a reflexão e o debate nos temas abordados.

[The wind prophylaxis. Repressive and sanitary institutions in Argentina's Patagonia, 1880-1940]. / La profilaxis del viento. Instituciones represivas y sanitarias en la Patagonia Argentina, 1880-1940.

This article focuses on the study of some social control technologies and discourses, displayed in Argentina's provinces between 1880 and 1940, with particular reference to the so-called 'Territorios Nacionales' of La Pampa Río Negro and Neuquén, which were submitted to a direct federal authority. THe main purpose is to analyze - within these areas- - the building of repressive and sanitary institutions (i.e., police, prisons, asylums, hospitals) as well as the enforcement of positivists studying and classifying methodologies, intended to identify 'abnormality'. A straight and permanent rule of these "territorios Nacionales' on the federal State could have meant a longer attention to their social and economic development through a direct and intense presence of national, modernizing, positivist institutions. However, a deeper historical study of repressive and sanitary institutions allows to arrive to completely different conclusions. The sources show that these institutions had numerous daily problems, were frequently and severely under-budgeted and were obliged to develop not originally forseen functions and tasks. These situations imply revising not only these institutions' real regulation capacities but also the very existence of a generalized, efficient social control programme in Argentina at the beginning of the 20th century, as many scholars focused on Buenos Aires's study case have already argued.

[Analysis of the cost of public health service items in four centers for disease control and prevention in county level in China].

OBJECTIVE: To analyze the unreasonable part of full cost of the public health service items in county level. METHODS: On basis of typical survey in 2005, 18 questionnaires were released and the response rate was 100%. The whole cost and ladder apportionment of expense methods were employed to account the full cost of items including practice items, items required by government and nationwide items required by government provided by 4 centers for disease control and prevention in county level. RESULTS: It was found that 28.4% - 54.9% nationwide items required by government had not been provided, but 2.8% - 10.2% items being not required by government had been provided. Furthermore the frequency of the items required by government was not up to par from 8 topmost to 2 bottommost on average every year. The efficiency was not high because of lacking in the vehicle for work, and 33.3% - 43.6% shortage of equipments for laboratory, and 18.1% - 45.8% logistic staff and technicians only 2/3 time of the whole year had a full workload. All the above resulted in the bias from the standard cost of items required by government. CONCLUSION: For compensating the cost of items reasonable and accurate by government, a kind standard cost of the items according to the government request should be established.

The Preventive Health and Health Services Block Grant: the Massachusetts experience.

The Preventive Health and Health Services Block Grant funds a variety of disparate programs in health promotion and disease prevention. Many of these programs were funded by categorical grants to the States prior to the creation of this block grant in 1981. This block grant allows States to set priorities among the different programs by shifting their funding allocations. In addition, there is considerable opportunity to use these funds creatively in shaping the content of their programs. The Massachusetts Department of Public Health's experience with this block grant is reviewed, showing the grant's critical importance in the department's statewide disease prevention efforts. In order to maximize public health impact, the department has shifted its funding allocations based on explicit criteria. These criteria represent a model that may have widespread applicability for other State health departments.

Health planners and local public finance--the case for revenue sharing.

Little attention has been paid by health planners or researchers to questions of local public finance. However, a review of the literature concerning general revenue sharing (GRS) funds indicated that about $400 million per year from this source is spent on health services and resources. GRS funds, about $6.4 billion per year, are distributed to more than 39,000 State, county, and city governments. The 1976 amendments to the General Revenue Sharing Act eliminated restrictions on the use of the funds, and they can be employed as matching funds for other Federal monies. An exploratory study of the use of GRS funds for health purposes was conducted in several localities, with particular attention to the health systems agencies. Its results confirmed that there are wide variations among localities in the use of revenue-sharing funds to support health services. Also, not only did the health systems agencies' officials have little impact on the allocation of revenue sharing funds, but only in one locale had an HSA official taken a direct role in the budgetary process. Health planners, who were interviewed during the study, described what they considered their agencies' proper role in local budgetary matters.