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5.
Rev Peru Med Exp Salud Publica ; 36(2): 296-303, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31460644

RESUMO

The care of people and their health is a primary function of the family and of society as shown by studies on primitive humans, as well as in pre-Hispanic Peru. The conquest and subsequent centuries of colonization fractured the traditional way of caring for people, replacing social solidarity with charity actions mainly from religious orders that provided hospices later called hospitals. During the colony and until the beginning of the 20th century, the care of the sick continued to be the responsibility of charitable institutions, such as the Charities created after independence. Social rights such as education and health only emerged in the first decades of the last century and were enshrined in the 1933 Constitution. However, both in that Constitution as in those from 1979 and 1993, the right to education was recognized more fully, while the right to heath was limited. The Universal Health Coverage Act of 2009 propounds guaranteeing the right to access quality healthcare services for everybody, as part of the right to health in the broadest sense. The current limitations force us to redefine the right of every citizen to comprehensive care of their health and the State's guidance to guarantee it.


Assuntos
Assistência à Saúde/normas , Acesso aos Serviços de Saúde , Qualidade da Assistência à Saúde , Assistência à Saúde/história , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Peru , Direito à Saúde , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência
6.
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
10.
PLoS One ; 14(6): e0215577, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31251737

RESUMO

Persistent barriers to universal access to medicines are limited social protection in the event of illness, inadequate financing for essential medicines, frequent stock-outs in the public sector, and high prices in the private sector. We argue that greater coherence between human rights law, national medicines policies, and universal health coverage schemes can address these barriers. We present a cross-national content analysis of national medicines policies from 71 countries published between 1990-2016. The World Health Organization's (WHO) 2001 guidelines for developing and implementing a national medicines policy and all 71 national medicines policies were assessed on 12 principles, linking a health systems approach to essential medicines with international human rights law for medicines affordability and financing for vulnerable groups. National medicines policies most frequently contain measures for medicines selection and efficient spending/cost-effectiveness. Four principles (legal right to health; government financing; efficient spending; and financial protection of vulnerable populations) are significantly stronger in national medicines policies published after 2004 than before. Six principles have remained weak or absent: pooling user contributions, international cooperation, and four principles for good governance. Overall, South Africa (1996), Indonesia and South Sudan (2006), Philippines (2011-2016), Malaysia (2012), Somalia (2013), Afghanistan (2014), and Uganda (2015) include the most relevant texts and can be used as models for other settings. We conclude that WHO's 2001 guidelines have guided the content and language of many subsequent national medicines policies. WHO and national policy makers can use these principles and the practical examples identified in our study to further align national medicines policies with human rights law and with Target 3.8 for universal access to essential medicines in the Sustainable Development Goals.


Assuntos
Medicamentos Essenciais/economia , Programas Governamentais/legislação & jurisprudência , Direito à Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Guias como Assunto , Política de Saúde/legislação & jurisprudência , Humanos , Indonésia , Legislação de Medicamentos , Malásia , Filipinas , Somália , África do Sul , Sudão do Sul , Uganda , Populações Vulneráveis , Organização Mundial da Saúde
11.
Curationis ; 42(1): e1-e8, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31038329

RESUMO

BACKGROUND:  The Republic of South Africa (RSA) is shifting towards universal health coverage and a unified health system. This milestone can be achieved through the implementation of National Health Insurance (NHI). To employ NHI, health establishments in the country are compelled to comply with quality standards. The non-compliance with quality standards at primary health care (PHC) clinics within a district in Gauteng, which was verified by quality standards' audit reports, prompted an intervention. No prior research aimed at facilitating managers' compliance with quality standards has been conducted within the context under study. This research gap necessitated an exploration on how managers' compliance to quality standards at PHC clinics within a district in Gauteng could best be facilitated. OBJECTIVES:  To describe recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng. METHOD:  A qualitative, exploratory, descriptive and contextual research design was used in this study. Semi-structured, individual interviews were conducted. RESULTS:  The recommendations to facilitate managers' compliance with quality standards at PHC clinics within a district in Gauteng were described. However, for the purpose of this article, only the recommendations seeking to address challenges with management practices as a reason for non-compliance with quality standards at PHC clinics will be discussed. These recommendations include involvement of PHC clinic managers in decision-making, adequate support from senior management and improvement of internal communication practices. CONCLUSION:  The researcher concludes that the senior management team in the district under study should strive to embrace the described recommendations as a strategy to facilitate managers' compliance to quality standards at PHC clinics.


Assuntos
Instituições de Assistência Ambulatorial/normas , Enfermeiras Administradoras/psicologia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Instituições de Assistência Ambulatorial/organização & administração , Humanos , Entrevistas como Assunto/métodos , Enfermeiras Administradoras/normas , Atenção Primária à Saúde/métodos , Pesquisa Qualitativa , África do Sul , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/tendências
14.
Lancet ; 393(10186): 2168-2174, 2019 May 25.
Artigo em Inglês | MEDLINE | ID: mdl-30981536

RESUMO

The USA is home to more immigrants than any other country-about 46 million, just less than a fifth of the world's immigrants. Immigrant health and access to health care in the USA varies widely by ethnicity, citizenship, and legal status. In recent decades, several policy and regulatory changes have worsened health-care quality and access for immigrant populations. These changes include restrictions on access to public health insurance programmes, rhetoric discouraging the use of social services, aggressive immigration enforcement activities, intimidation within health-care settings, decreased caps on the number of admitted refugees, and rescission of protections from deportation. A receding of ethical norms has created an environment favourable for moral and public health crises, as evident in the separation of children from their parents at the southern US border. Given the polarising immigration rhetoric at the national level, individual states rather than the country as a whole might be better positioned to address the barriers to improved health and health care for immigrants in the USA.


Assuntos
Emigrantes e Imigrantes/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Emigrantes e Imigrantes/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Reforma dos Serviços de Saúde/estatística & dados numéricos , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Humanos , Medicaid/legislação & jurisprudência , Medicaid/estatística & dados numéricos , Estados Unidos , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos
16.
PLoS One ; 14(3): e0210714, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30861004

RESUMO

BACKGROUND: Reducing unplanned rehospitalizations is one of the priorities of health care policies in France and other Western countries. An easy-to-use algorithm for identifying patients at higher risk of rehospitalizations would help clinicians prioritize actions and care concerning discharge transitions. Our objective was to develop a predictive unplanned 30-day all-cause rehospitalization risk score based on the French hospital medico-administrative database. METHODS: This was a retrospective cohort study of all 2015 discharges from acute-care inpatient hospitalizations in a tertiary-care university center comprising four hospitals. The study endpoint was unplanned 30-day all-cause rehospitalization via emergency departments, and we collected sociodemographic, clinical, and hospital characteristics based on hospitalization database computed for reimbursement of fees. We derived a predictive rehospitalization risk score using a split-sample design and multivariate logistic regression, and we compared the discriminative properties with the LACE index risk-score. RESULT: Our analysis included 118,650 hospitalizations, of which 4,127 (3.5%) led to rehospitalizations via emergency departments. Variables independently associated with rehospitalization were age, gender, state-funded medical assistance, as well as disease category and severity, Charlson comorbidity index, hospitalization via emergency departments, length of stay (LOS), and previous hospitalizations 6 months before. The predictive rehospitalization risk score yielded satisfactory discriminant properties (C statistic: 0.74) exceeding the LACE index (0.66). CONCLUSION: Our findings indicate that the possibility of unplanned rehospitalization remains high for some patient characteristics, indicating that targeted interventions could be beneficial for patients at the greatest risk. We developed an easy-to-use predictive rehospitalization risk-score of unplanned 30-day all-cause rehospitalizations with satisfactory discriminant properties. Future works should, however, explore if other data from electronic medical records and other databases could improve the accuracy of our predictive rehospitalization risk score based on medico-administrative data.


Assuntos
Readmissão do Paciente/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Criança , Pré-Escolar , Bases de Dados Factuais , Assistência à Saúde/legislação & jurisprudência , Feminino , França , Política de Saúde , Humanos , Lactente , Recém-Nascido , Tempo de Internação , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Readmissão do Paciente/legislação & jurisprudência , Estudos Retrospectivos , Fatores de Risco , Centros de Atenção Terciária , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Adulto Jovem
17.
PLoS One ; 14(2): e0212328, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30779809

RESUMO

OBJECTIVES: This study aimed to define the problems of the current use of the e-Catalogue and the national formulary (NF)-two elements of medicine pricing and reimbursement policies in Indonesia for achieving universal health coverage (UHC)-by examining the knowledge and attitudes of stakeholders. Specifically, to investigate (1) the perceived challenges involved in the further implementation of the e-Catalogue and the NF, (2) reasons of prescribing medicines not listed in the NF, and (3) possible improvements in the acceptance and use of the e-Catalogue and the NF. METHODS: Semi-structured interviews were conducted with stakeholders (policymakers, healthcare providers, a pharmaceutical industry representative, and experienced patients) to collect the qualitative data. The data was analysed using directed content analysis, following the guidelines of the COnsolidated criteria for REporting Qualitative studies (COREQ) in reporting the findings. RESULTS: Interestingly, 20 of 45 participants decided to withdraw from the interview due to their lack of knowledge of the e-Catalogue and the NF. All 25 stakeholders who fully participated in this research were in favor of the e-Catalogue and the NF. However, interviewees identified a range of challenges. A major challenge was the lack of harmonization between the lists of medicines in the e-Catalogue and the NF. Several system and personal reasons for prescribing medicines not listed in the NF were identified. Important reasons were a lack of incentives for physicians as well as a lack of transparent and evidence-based methods of selection for the medicines to be listed in the NF. CONCLUSIONS: The e-Catalogue and the NF have not been fully utilized for achieving UHC in Indonesia. Some possible improvements suggested were harmonization of medicines listed in the e-Catalogue and the NF, restructuring incentive programs for prescribing NF medicines, and increasing the transparency and evidence-based approach for selection of medicines listed in the e-Catalogue and the NF.


Assuntos
Política de Saúde , Medicamentos sob Prescrição/economia , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência , Adulto , Idoso , Atitude , Feminino , Humanos , Indonésia , Entrevistas como Assunto , Conhecimento , Masculino , Pessoa de Meia-Idade
19.
Value Health Reg Issues ; 18: 78-82, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30641410

RESUMO

OBJECTIVES: To describe the process, challenges, and future direction of health technology assessment (HTA), focusing on the drug selection of the National List of Essential Medicines (NLEM) in Thailand. METHODS: Literature and government documents were reviewed and analyzed by authors with experiences in HTA and drug policy in the country. RESULTS: The structure of HTA and its process in the drug selection of the NLEM were described, followed by the outcomes of the use of HTA. Examples of lowering drug prices, as a result of price negotiation using HTA, were presented. A few examples were also provided to demonstrate how decisions were made from considering factors beyond cost-effectiveness findings. Finally, challenges on various issues including improvement of HTA structure and process were discussed for the future direction of HTA in Thailand. CONCLUSIONS: HTA has been adopted as a tool for the drug selection of the NLEM to help Thailand achieve universal health coverage. Nevertheless, various challenges exist and need to be addressed.


Assuntos
Controle de Medicamentos e Entorpecentes/métodos , Avaliação da Tecnologia Biomédica/métodos , Cobertura Universal do Seguro de Saúde/tendências , Previsões , Humanos , Avaliação da Tecnologia Biomédica/tendências , Tailândia , Cobertura Universal do Seguro de Saúde/legislação & jurisprudência
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