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5.
Georgian Med News ; (294): 165-171, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31687971

RESUMO

The article explores the issue of human rights protection in the field of health care by the Constitutional Court of Ukraine. The decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko (1997), the case of paid medical services (1998), the case of free medical care (2002), the case of judicial control over the hospitalization of incapacitated persons into psychiatric institute are analyzed (2016), as well as the new legislation of Ukraine in the light of radical reform in the healthcare sector. Attention is drawn to the principle of friendly attitude to international law, constitutional complaint, legal positions of the Constitutional Court of Ukraine in the above-mentioned cases and the prospect of their application into the development of new legislation of Ukraine in the context of radical reform of the health care system of Ukraine. It is emphasized that the legal positions of the Constitutional Court of Ukraine, with regard of peculiarities of the national legislature, can serve as a source of inspiration for the courts of other countries. The purpose of the article is to specify the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, to determine the prospects of applying the legal positions of the Constitutional Court of Ukraine within the development of new legislation of Ukraine in the light of radical reform of the health care system. The object of the study is the social relations that arise during protection of human rights in the field of health care by the Constitutional Court of Ukraine. The methodological basis of the research are general and special methods of scientific knowledge (formal-logical method, comparative-legal, structural-logical). As a result of the conducted research, the role and place of the Constitutional Court of Ukraine in the system of judicial protection of human and citizen rights, the role of the decisions of the Constitutional Court of Ukraine in the case of K. G. Ustimenko, the case of paid medical services, the case of free medical care, the case of judicial control over hospitalization of incapacitated persons into psychiatric institution in the formation and development of domestic constitutional proceedings are defined. It is emphasized that the introduction of the constitutional complaint concept (institution) contributed to the improvement of the national mechanism of human rights protection in the field of health care. Conflicts of constitutional regulation of the human right to free medical care have been identified, and proposals have been worked out regarding possible ways and methods to eliminate them.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Direitos Humanos , Direitos do Paciente , Instalações de Saúde , Hospitalização , Humanos , Ucrânia
6.
Wiad Lek ; 72(9 cz 2): 1839-1843, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622276

RESUMO

OBJECTIVE: Introduction: It was identified that one of the priorities of medical reform in Ukraine is the establishment of an effective system of legal regulation of professional physician's obligations that meets European standards. However, the legal regulation of relations between actors in the field of health care lags behind the practice of their development. The aim to find out the status of legal regulation of the professional obligations of health workers, to identify the gaps in this regulation, to formulate proposals for improving the legal framework for the issue under investigation. PATIENTS AND METHODS: Materials and methods: Legislation of Ukraine and certain European countries, international declarations and conventions, scientific works, 28 judgments of the European Court of Human Rights, 96 sentences of the practice of the national courts of Ukraine. CONCLUSION: Conclusions: During the study, the stages of determining the professional physician's obligations were singled out, which would optimize the legislative process of regulation of obligations. One of the problems is the incorrect translation of protocols, which is assigned to a medical care institution. It was proposed to solve this problem by introducing a unified system of protocols and standards, the duty of translation and adaptation of which is entrusted to the central body of executive power in the field of health care. It is relevant to consolidate the duty of medical records management at the level of law, which will serve as a guarantee of ensuring the proper performance by the physician of a professional obligation to treat and diagnose a particular patient. In order to avoid cases of judgments, based on the results of the сommission's assessment of the actions of a physician and to eliminate the number of cases of unjustified attraction of physicians to liability, it is necessary to consolidate a clear list of general professional physician's obligations in a single regulatory act.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Médicos/legislação & jurisprudência , Direitos Humanos , Humanos , Papel Profissional , Ucrânia
7.
Georgian Med News ; (292-293): 134-139, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31560679

RESUMO

The objective of the article is to determine the content and correlation of individual and joint interest within medical legal relations in Ukraine. To achieve this objective the authors have applied general scientific and special methods of cognition. The materials of research were statistical data on infectious diseases about the state of vaccinations in Ukraine, judicial practice, and national legislation. It has been concluded that individual and joint interest within medical legal relations are aimed at various objects: individual and public health. These objects are interconnected as general and special, since public health is a combination of individual health. It has been established that public and individual health does not have an economic content, cannot participate in the economic turnover, but have a social value. The prevalence of joint interest over the individual has been grounded. Individual interest within medical legal relations has been defined as the orientation of an individual to protect own health. It has been proved that joint (public) interest within medical legal relations is a set of individual (private) interests of individuals in the health care area. This interest is manifested in the formation of collective immunity, control over the spread of infectious diseases, the creation of conditions for affordable medical care, etc.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Legislação Médica , Saúde Pública/legislação & jurisprudência , Humanos , Ucrânia
8.
Infect Dis Poverty ; 8(1): 81, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31514738

RESUMO

BACKGROUND: Despite great medical advances and scientific progress over the past century, one billion people globally still lack access to basic health care services. In the context of the 2030 Agenda for Sustainable Development social innovation models aim to provide effective solutions that bridge the health care delivery gap, address equity and create social value. This commentary highlights the roles of multilateral organizations and governments in creating an enabling environment where social innovations can more effectively integrate into health systems to maximize their impact on beneficiaries. MAIN TEXT: The integration of social innovations into health systems is essential to ensure their sustainability and the wide dissemination of their impact. Effective partnerships, strong engagement with and endorsement by governments and communities, regulations, trust and sometimes willingness are key factors to enhance system integration, replication and dissemination of the models. Three examples of social innovations selected by the Social Innovation in Health Initiative illustrate the importance of engaging with governments and communities in order to link, integrate and synergize their efforts. Key challenges that they encountered, and lessons learnt are highlighted. Multilateral organizations and governments increasingly engage in promoting and supporting the development, testing and dissemination of social innovations to address the health care delivery gap. They play an important role in creating an enabling environment. This includes promoting the concept of social innovation in health care delivery, spreading social innovation approach and lessons learnt, fostering partnerships and leveraging resources, convening communities, health system actors and various stakeholders to work together across disciplines and sectors, and nurturing capacity in countries. CONCLUSIONS: Multilateral organizations and local and national governments have a critical role to play in creating an enabling environment where social innovations can flourish. In supporting and disseminating social innovation approach, multilateral organizations and governments have a great opportunity to accelerate Universal Health Coverage and the achievement of the Sustainable Development Goals.


Assuntos
Assistência à Saúde/métodos , Difusão de Inovações , Governo , Agências Internacionais/estatística & dados numéricos , Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/estatística & dados numéricos , Humanos
9.
Schmerz ; 33(5): 443-448, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31478141

RESUMO

BACKGROUND: Since March 2017 the law amending narcotics and other legal regulations has made it possible for doctors to prescribe cannabis and cannabis-derived medicines. The introduction of § 31 para 6 of the Social Code Book V (SGB V) allows that patients can be treated with cannabis-derived medicines at the expense of the statutory health insurance if they have a severe illness. COURT DECISIONS: The law requires the approval of a prescription of cannabis for medical purposes by the health insurance before the granting of benefits. Due to denied permission, numerous cases are pending before the social tribunals. The article presents which legal issues are decided and why there is still no case law from the Federal Social Court on the essential questions. OUTLOOK: The possibility of prescribing cannabis as medicine at the expense of the health insurance is an important advance in social law. The § 31 para 6 SGB V should be evaluated as soon as possible. The provisions of SGB V for the reimbursement of off-label treatment should be harmonized with § 31 para 6 SGB V.


Assuntos
Cannabis , Seguro Saúde , Médicos , Prescrições , Assistência à Saúde/legislação & jurisprudência , Alemanha , Humanos , Seguro Saúde/economia , Seguro Saúde/legislação & jurisprudência , Médicos/legislação & jurisprudência , Prescrições/estatística & dados numéricos
10.
Georgian Med News ; (291): 126-130, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31418745

RESUMO

The article examines the issue of public procurement in the healthcare sector through the prism of the Association Agreement with the EU. The emphasis is on the ensuring mutual access to the markets of public procurement of the EU and Ukraine on the basis of planned and consistent approximation of Ukrainian legislation in the field of public procurement to the EU acquis in the field of public procurement. The purpose of this article is to identify the peculiarities of the reform in the field of public procurement in Ukraine, to search for drawbacks in the administrative legislation of Ukraine, which is governing public procurement in the healthcare sector in the context of Ukraine's implementation of the Association Agreement with the EU, and to justify its improvement. The subject of research is the social relations that arise in the implementation of public procurement in the field of health. The methodological basis of the conducted research is the general methods of scientific cognitivism as well as concerning those used in legal science: methods of analysis and synthesis, formal logic, comparative law, statistical methods etc The following main directions of reforming the system of public procurement were established. It has been proved that CPO functioning on the national level of government in the form of a state-owned enterprise under the control of one of the relevant ministries is non-feasibility. The advantages of the ProZorro electronic procurement system and the state of implementation of the provisions of the EU Directives on 2014/23/ EU, 2014/24/ EU, 2014/25/EU, 2014/55/EU into the administrative legislation of Ukraine have been identified. It has been found that in March, 2015 centralized procurement system for medicines and medical products was changed in Ukraine to use the funds of the State Budget of Ukraine for the purchase of medicines and medical products with the involvement of international specialized organizations. On December 21, 2018 the Verkhovna Rada (Supreme Council) of Ukraine put amendments into the Law of Ukraine "On Public Procurement". The attention is paid to the novelties of this Law. It has been found that the legislation of Ukraine has such shortcomings: 1) in Ukraine the issue of clear distribution of functions of the authorities authorized to carry out control in the field of public procurements remains unresolved; 2) the norms of the Law contradict each other; 3) the problems of creating effective mechanisms for the formation of the nomenclature of medicines still remain, as well as their supplies to healthcare institutions.


Assuntos
Assistência à Saúde/legislação & jurisprudência , União Europeia , Setor de Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/economia , Setor de Assistência à Saúde/economia , Humanos , Ucrânia
11.
Georgian Med News ; (291): 130-136, 2019 Jun.
Artigo em Russo | MEDLINE | ID: mdl-31418746

RESUMO

The objective of the article is a comparative and legal study of the models for the organization of public procurements in the healthcare field in the EU and Ukraine. Theoretical and empirical methods of cognition were used to achieve this goal, namely, methods of analysis, synthesis, generalization, as well as comparative and legal method in analyzing the experience of the EU countries in organizing public procurements. The conducted study suggests that the public procurement mechanism in the healthcare sector exists in most states. However, the legal regulation in this area differs significantly in different states. It has been established that a significant part of the states use centralized procurements. The shortcomings of the legal regulation of public procurements in Ukraine have been revealed and the ways to solve them have been offered. The authors have indicated the necessity of using international experience in organizing public procurements in the healthcare sector, in particular, with respect to: centralized procurements with the introduction of procurement groups or consortia (Great Britain, France, Germany, Italy); activities of specially created centralized organizations (Austria, Belgium, Spain, Hungary, Portugal) decentralized procurements (Sweden). In order to improve the legal regulation of public procurements in the healthcare field, the authors have proved the necessity of making amendments to the Law of Ukraine "On Public Procurements".


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/legislação & jurisprudência , União Europeia , Humanos , Ucrânia
12.
Med Care ; 57(9): 710-717, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295167

RESUMO

BACKGROUND: The State Innovation Models (SIM) Initiative invested $254 million in 6 states in Round 1 to accelerate delivery system and payment reforms. OBJECTIVE: The objective of this study was to examine the association of early SIM implementation and diagnosed diabetes prevalence among adults and hospitalization rates among diagnosed adults. RESEARCH DESIGN: Quasi-experimental design compares diagnosed diabetes prevalence and hospitalization rates before SIM (2010-2013) and during early implementation (2014) in 6 SIM states versus 6 comparison states. County-level, difference-in-differences regression models were estimated. SUBJECTS: The annual average of 4.5 million adults aged 20+ diagnosed with diabetes with 1.4 million hospitalizations in 583 counties across 12 states. MEASURES: Diagnosed diabetes prevalence among adults and hospitalization rates per 1000 diagnosed adults. RESULTS: Compared with the pre-SIM period, diagnosed diabetes prevalence increased in SIM counties by 0.65 percentage points (from 10.22% to 10.87%) versus only 0.10 percentage points (from 9.64% to 9.74%) in comparison counties, a difference-in-differences of 0.55 percentage points. The difference-in-differences regression estimates ranged from 0.49 to 0.53 percentage points (P<0.01). Regression results for ambulatory care-sensitive condition and all-cause hospitalization rates were inconsistent across models with difference-in-differences estimates ranging from -5.34 to -0.37 and from -13.16 to 0.92, respectively. CONCLUSIONS: SIM Round 1 was associated with higher diagnosed diabetes prevalence among adults after a year of implementation, likely because of SIM's emphasis on detection and care management. SIM was not associated with lower hospitalization rates among adults diagnosed with diabetes, but the SIM's long-term impact on hospitalizations should be assessed.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Diabetes Mellitus/diagnóstico , Reforma dos Serviços de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/estatística & dados numéricos , Adulto , Idoso , Assistência à Saúde/legislação & jurisprudência , Diabetes Mellitus/epidemiologia , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Ensaios Clínicos Controlados não Aleatórios como Assunto , Inovação Organizacional , Prevalência , Governo Estadual , Estados Unidos/epidemiologia , Adulto Jovem
13.
Cien Saude Colet ; 24(6): 2167-2172, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269175

RESUMO

This paper presents the issue of judicialization of the right to health in Brazil. Data from the National Council of Justice evidence a substantial increase in the number of lawsuits concerning the right to health. We emphasize that the national doctrine exhaustively discusses ways to make the authority more effective, but it does not, as a general rule, discuss the economic aspect of health judicialization. Using the concept of opportunity cost extracted from economics science, it is shown that the judge, by deferring the lawsuit formulated by the plaintiff, automatically forces the Executive Branch to reduce the scope of other policies to generate resources to meet the court order. In specific contexts, this setting ends up favoring individual rights at the expense of the collective rights of SUS users, in violation of the principle of isonomy and efficiency. Finally, the case of the judicialization promoted by the hemophiliac patients in the Federal District is shown as a way of evidencing, at the factual level, the consequences of judicialization in the SUS policies.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Política de Saúde , Direitos Humanos/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Brasil , Assistência à Saúde/economia , Hemofilia A/terapia , Humanos , Programas Nacionais de Saúde/economia
15.
Int J Equity Health ; 18(1): 10, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31154997

RESUMO

BACKGROUND: Equity has been acknowledged as a required principle for the fulfilment of the universal right to health once it seeks to tackle avoidable and unfair inequalities among individuals. In Brazil, a country marked by iniquities, this principle was adopted in the Brazilian National Health System (SUS) organization. But the phenomenon known as judicialization of healthcare, anchored in the argument of universality of the right, has been consolidated as a health policy parallel to the SUS. The analysis of these lawsuits distribution according to their beneficiaries' socio-economic profile can contribute to the verification of the judicialization's potential for reducing inequalities, thus becoming an auxiliary activity in the fulfilment of the universal and egalitarian right to health. This study aimed to assess what socioeconomic factors are associated to municipalities that had larger numbers of beneficiaries from lawsuits in health in the state of Minas Gerais, Brazil, from 1999 to 2009. METHODS: It is a descriptive quantitative study of the residence municipalities of beneficiaries registered in database regarding all deferred lawsuits against the state of Minas Gerais from 1999 to 2009. The verification of cities' socio-economic profile was performed based on information of the Brazilian Institute of Geography and Statistics' 2010 Demographic Census and on indexes derived from it. The variables studied for each municipality were: number of beneficiaries; resident population; Social Vulnerability Index (IVS); and Municipal Human Development Index (IDHm). Descriptive and statistical analysis were used to verify factors associated with a larger number of beneficiaries in a municipality. RESULTS: Out of 853 municipalities in Minas Gerais, 399 were registered as residence of at least one of the 6.906 beneficiaries of studied lawsuits. The residence non-information index was 11,5%. The minimum number of identified beneficiaries living in a municipality was 1 (one) while the maximum was 1920. The binary logistic regression revealed that high and very high IDHm (OR = 3045; IC = 1773-5228), IVS below 0.323 (OR = 2044; IC = 1099- 3800) and population size above 14.661 inhabitants (OR = 6162; IC = 3733-10,171) are statistically associated to a greater number of beneficiaries of lawsuits in health within a municipality. CONCLUSIONS: The judicialization of health care in Minas Gerais, from 1999 to 2009, didn't reach the most vulnerable municipalities. On the contrary, it favored a concentration of health resources in municipalities with better socioeconomic profiles. The register of all beneficiaries' municipalities of residence as well as individual socioeconomic data can contribute to a more conclusive analysis. Nevertheless, in general, the results of this study suggest that the judicial health policy conducted from 1999 to 2009 was not an auxiliary tool for the fulfilment of an equitable right to health in Minas Gerais.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde , Brasil , Cidades , Equidade em Saúde , Política de Saúde , Humanos , Fatores Socioeconômicos
16.
Int J Equity Health ; 18(1): 61, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155005

RESUMO

BACKGROUND: The term "judicialization of health care" describes the use of rights-based litigation to demand access to pharmaceuticals and medical treatments. The judicialization of health care in Latin America has two defining features. Firstly, it has been conducted in an individualized fashion. Secondly, it is highly pharmaceuticalized, since most public expenditure related to health rights litigation is invested in paying for costly medications. Recent studies also suggest that the judicialization of health care is bad for equity since it skews limited health resources away from the poorest citizens and in favor of the more affluent. METHODS: We used a scoping methodology to analyze the study-design and the quality of the data employed by the literature that explicitly assesses the impact of the judicialization of health care on equity in Latin American countries. Articles were selected on the basis of their use of an empirical strategy to determine the effect of the judicialization on equity. We searched Google Scholar, PubMed, Scopus, and Scielo databases. We also went through the studies' bibliographic references, and hand-searched key journals and authors. RESULTS: Half of the studies analyzed find that judicialization has a negative impact on equity, but the other half finds that evidence is inconclusive or that the judicialization of healthcare has a positive effect on equity. The majority of the studies that collect their own data rely on limited samples that are sometimes not representative and mostly not generalizable. Only few studies conduct systematic comparative analysis of different cross-country or within-country cases. None of the studies reviewed aim to establish causation between judicialization and health outcomes. CONCLUSIONS: We conclude that in order to prove or disprove that the judicialization of health care is at odds with equity we first need to overcome the methodological and research-design problems that have beleaguered the available empirical studies. We also conclude that pharmaceuticals' price regulation, state capacity, the behavior of litigants, prescribers and judges, and the economic interests of big-pharma, are variables that have to be incorporated into a rigorous empirical literature capable of assessing the regressive effect of health rights' litigation.


Assuntos
Assistência à Saúde/legislação & jurisprudência , Equidade em Saúde , Humanos , América Latina
17.
Am J Nurs ; 119(7): 46-52, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31232775

RESUMO

: By the 1920s, Lillian Wald's model of care, with nurses working side by side with social workers at the intersection of medicine and society, had become an important component of the U.S. health care system. Over subsequent decades, however, a confluence of historic forces resulted in its marginalization. Today, people are recognizing that medical cures alone, although important, will not reduce the epidemic of diseases of despair or the growing challenges involved in achieving health equity. Wald's approach, extended to a broader range of settings in which nurses work today, could be the missing ingredient.To provide background for the National Academy of Medicine Committee on the Future of Nursing 2020-2030, as it develops its follow-up to the Institute of Medicine's 2010 Future of Nursing: Leading Change, Advancing Health, the Robert Wood Johnson Foundation commissioned a report on nursing's historic role in advancing health. This article summarizes that report, which can be found in its entirety at www.rwjf.org/content/dam/farm/reports/reports/2019/rwjf452706.


Assuntos
Assistência à Saúde/história , Assistência à Saúde/legislação & jurisprudência , História da Enfermagem , Modelos de Enfermagem , História do Século XX , Hospitais , Humanos , Estados Unidos
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