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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
4.
Soins Psychiatr ; 40(324): 18-20, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31623801

RESUMO

"Care is increasingly absent from the pathway of unaccompanied minors". Legal experts of the French ombudsperson work with professionals supporting unaccompanied minors on different levels. They can also have a watchdog role with legislative authorities and judicial bodies. They note in particular increasing difficulty for these youngsters in accessing appropriate care. Interview with Nathalie Lequeux, legal expert and coordinator at the French children's rights centre.


Assuntos
Criança Abandonada , Acesso aos Serviços de Saúde/legislação & jurisprudência , Menores de Idade , Refugiados , Adolescente , Criança , França , Humanos
8.
Lancet ; 394(10195): 345-356, 2019 07 27.
Artigo em Inglês | MEDLINE | ID: mdl-31303318

RESUMO

In 1988, the Brazilian Constitution defined health as a universal right and a state responsibility. Progress towards universal health coverage in Brazil has been achieved through a unified health system (Sistema Único de Saúde [SUS]), created in 1990. With successes and setbacks in the implementation of health programmes and the organisation of its health system, Brazil has achieved nearly universal access to health-care services for the population. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale universal health coverage in a highly unequal country with relatively low resources allocated to health-care services by the government compared with that in middle-income and high-income countries. Analysis of the past 30 years since the inception of the SUS shows that innovations extend beyond the development of new models of care and highlights the importance of establishing political, legal, organisational, and management-related structures, with clearly defined roles for both the federal and local governments in the governance, planning, financing, and provision of health-care services. The expansion of the SUS has allowed Brazil to rapidly address the changing health needs of the population, with dramatic upscaling of health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographical inequalities, insufficient funding, and suboptimal private sector-public sector collaboration. Fiscal policies implemented in 2016 ushered in austerity measures that, alongside the new environmental, educational, and health policies of the Brazilian government, could reverse the hard-earned achievements of the SUS and threaten its sustainability and ability to fulfil its constitutional mandate of providing health care for all.


Assuntos
Acesso aos Serviços de Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Brasil , Programas Governamentais/legislação & jurisprudência , Programas Governamentais/organização & administração , Política de Saúde , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia
9.
BMC Health Serv Res ; 19(1): 342, 2019 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-31164114

RESUMO

BACKGROUND: Since the 2016 presidential election, reports have suggested that President Trump's rhetoric and his administration's proposed policies could be exacerbating barriers to accessing health care for undocumented as well as lawfully present immigrants and their families in the United States. However, very little empirical work has analyzed this possibility or detailed how these reports and rhetoric have altered the health seeking behavior of mixed immigration status families. METHODS: Using a series of focus groups throughout Texas in both English and Spanish, this qualitative study analyzes changes to health access for immigrants. We consulted Community Health Workers to better understand the barriers encountered by their otherwise hard-to-reach undocumented clients and their families as they interface with the health system, revealing key insights about the changing nature of barriers to access under the Trump administration. RESULTS: We identify four key themes about the changing nature of immigrant health access in the United States: growing fear of interacting with health and social services; that social networks are paradoxically limiting health access in the current political climate; that the administration's rhetoric and proposed policies are impeding health seeking behavior; and that children are encountering new barriers to social program participation. CONCLUSIONS: The Trump administration, its proposed immigration policies, and his rhetoric are posing new and significant barriers to health access for immigrants and their families.


Assuntos
Emigração e Imigração/legislação & jurisprudência , Medo , Acesso aos Serviços de Saúde/estatística & dados numéricos , Política , Imigrantes Indocumentados/psicologia , Imigrantes Indocumentados/estatística & dados numéricos , Criança , Feminino , Grupos Focais , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Pesquisa Qualitativa , Texas/epidemiologia
12.
Int J Equity Health ; 18(1): 82, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170993

RESUMO

BACKGROUND: In the context of public expenditure reduction and cuts, in 2012, the Spanish government approved the RDL 16/2012, which significantly affected the core values of the national health system. The measure particularly affected undocumented immigrants over 18 years of age, excluding them from accessing the full range of healthcare services in Spain, except for emergency care. In 2014, Red de Denuncia y Resistencia al RDL 16/2012 (REDER) was created as a public awareness and resistance network to defend universal access to healthcare and to stop its infringement. This study aims to analyse the social impact of REDER as a solidarity movement in response to the exclusion of undocumented immigrants from their universal right to health. METHODS: Qualitative research methodologies were used for the research. Data were collected between November 2017 and December 2017, using eight semi-structured interviews with key informants from the main REDER stakeholders. Additionally, key publications, documents, and presentations of researchers and experts in the field were analysed. For data analysis, a framework extracted from the literature on exclusionary and transformative dimensions of solidarity was used to identify barriers and drivers in REDER's intervention. RESULTS: From its creation to the present, REDER has been able to achieve many of its objectives to defend the right to medical care of groups in irregular situations, contributing to the identification of 4,755 cases of discrimination in healthcare access and helping solve over 90% of these cases by delivering either healthcare assistance or administrative support. REDER has also played an important role in: stimulating social activation and empowering citizens to claim their fundamental rights, organising actions against restrictions on accessibility and creating synergies to restore universal healthcare coverage. CONCLUSIONS: REDER has been shown to be effective in leading the defence of universal healthcare rights, and some achievements in the years following 2012 could be directly attributed to the work done by the network, such as the elimination of legal requirements to obtain health cards or the reduction of the minimum time required to access healthcare. Despite context particularities, the initiatives and main actions of this network may be implemented in other settings that are facing similar limitations to healthcare access, in order to address injustices and promote solidarity.


Assuntos
Redes Comunitárias , Regulamentação Governamental , Acesso aos Serviços de Saúde , Ativismo Político , Discriminação Social , Justiça Social , Imigrantes Indocumentados , Adulto , Idoso , Conscientização , Feminino , Serviços de Saúde , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Medicina Estatal , Cobertura Universal do Seguro de Saúde , Adulto Jovem
13.
Int J Equity Health ; 18(1): 68, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31154999

RESUMO

BACKGROUND: The valuation of medicines as health needs vary depending on the stakeholders involved (users, prescribers, managers, etc.) and their expectations. These factors modulate the role of medicines as a health need and influence access to medicines, and could be useful to explain the rising of Judicialization of access to medicines. AIM: To conduct a comparative analysis of the causes and consequences of judicialization of access to medicines in Argentina, Brazil, Colombia and Chile from the perspective of medicines as health needs. METHODS: A qualitative, cross-country study was carried out in these 4 countries. Semi-structured interviews were conducted with 50 representatives of the different stakeholders involved in the judicialization of access to medicines, including Executive branch, Judiciary, health system managers, patient organizations. The interviews were audio-recorded and transcribed verbatim. Thematic analysis used a framework approach based on the theoretical model for medicines as health needs. FINDINGS: Representatives from Argentina, Brazil and Colombia considered judicialization of access to medicines as a widespread phenomenon in their respective countries. Meanwhile in Chile, the respondents highlighted that most lawsuits related to the right to health were filed against private insurers because of unjustified increases in the insurance premiums. The comparative analysis showed that judicialization of access to medicines emerged in the four countries regardless of the constitutional protection or the health system population coverage. Among the causes were mentioned difficulties in guaranteeing access to covered medicines and the influence of pharmaceutical marketing on needs assessment and prescription behaviours. The interviewees highlighted the pressure to health system managers to fulfil their responsibilities as a positive impact of litigation. In contrast, the funding of medicines without evidence of efficacy or safety was considered a negative impact. Only in Brazil, judicialization has had impact on R&D policies. In Colombia, litigation also encouraged the recognition of the right to health as a fundamental right and the development of policies for controlling medicines prices. CONCLUSION: The results suggest that applying the adopted theoretical model creates the possibility of identifying critical points to guide policy makers to improve the health systems performances and to control lawsuits for access to medicines.


Assuntos
Medicamentos Essenciais/provisão & distribução , Acesso aos Serviços de Saúde/legislação & jurisprudência , Legislação de Medicamentos , Política de Saúde , Humanos , América Latina , Pesquisa Qualitativa
14.
Public Health ; 173: 1-4, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31203136

RESUMO

OBJECTIVE: The short communication is prompted by the debate relating to the effect of pharmaceutical patents on access to affordable medicines, particularly in Africa. A recent amendment made to the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement creates a policy space for the regional alliance of low-income countries for the collective procurement and local production of drugs under compulsory licensing. This article examines the extent to which the regional mechanism can deliver access to pharmaceuticals. The article examines the regional mechanism in the light of the recent regional trade agreements and pharmaceutical plans of some regional economic blocs in Africa as well as the newly signed African Continental Free Trade Agreement (AfCFTA). STUDY DESIGN: This short communication adopts a descriptive approach in linking the regional mechanism in the TRIPS amendment to the regional trade agreements of African countries at the subregional and continental levels. METHODS: To ascertain the extent to which TRIPS Agreements regional model can deliver access to medicines in Africa, the article adopts a desk review approach by examining the relevant provisions of TRIPS Agreement, particularly the newly added Article 31bis, and the provisions of the relevant regional and continental free trade agreements in Africa. RESULTS: The article finds that although the regional model has great prospects in supporting the wider effort to deliver access to medicine, the limitations to its operative utilization may weaken its potency in addressing the urgent public health needs of the continent. CONCLUSION: The article concludes by stressing the inevitability of Africa's integration in tackling the deficiency of access to generic medicines in Africa. It was noted that even though there could be some potential challenges, the regional mechanism is indeed the way to go for low-income countries.


Assuntos
Acesso aos Serviços de Saúde , Propriedade Intelectual , Cooperação Internacional , Preparações Farmacêuticas/provisão & distribução , Saúde Pública , África , Comércio/economia , Comércio/legislação & jurisprudência , Indústria Farmacêutica/economia , Indústria Farmacêutica/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Cooperação Internacional/legislação & jurisprudência , Patentes como Assunto/legislação & jurisprudência , Preparações Farmacêuticas/economia , Políticas , Pobreza
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