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Int J Equity Health ; 18(1): 106, 2019 07 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272460


Overcoming continuing polarization regarding judicial enforcement of health rights in Latin America requires clarifying divergent normative and political premises, addressing the lack of reliable empirical data, and establishing the conditions for fruitful inter-sectoral, inter-disciplinary dialogue.

Reforma dos Serviços de Saúde/legislação & jurisprudência , Equidade em Saúde/legislação & jurisprudência , Prioridades em Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , América Latina , Programas Nacionais de Saúde/legislação & jurisprudência , Fatores Socioeconômicos
Rev. bioét. derecho ; (46): 185-202, jul. 2019.
Artigo em Espanhol | IBECS | ID: ibc-184859


La estrategia de rehabilitación basada en la comunidad fue desarrollada para abordar una importante preocupación ética relacionada con la justicia social y la equidad. A continuación, en base una revisión de la literatura existente, se desarrollan cinco temas claves relacionados con la ética de dicha estrategia, destacando el aporte de Clarke, quien contempla argumentación crítica de cinco temas vinculados a la Rehabilitación basada en la comunidad, tales como; asociación de las partes interesadas, respeto a la cultura y experiencia local, equidad en el diseño del programa, empoderamiento comunitario y rendición de cuentas, se discuten dichas temáticas con el fin de comprender mejor el panorama de la rehabilitación, a partir de las sistematizaciones y experiencias en la población chilena

The community-based rehabilitation strategy was developed to address an important ethical concern related to social justice and equity. Then, based on a review of the existing literature, five key issues related to the ethics of this strategy are developed, highlighting the contribution of Clarke, who considers critical argumentation of five issues related to community-based rehabilitation, such as; Partnerships among stakeholders, Respect for culture and local experience, equity in program design, community empowerment and accountability, these topics are discussed in order to better understand the rehabilitation landscape in Chile, based on systematizations and experiences in the Chilean population

L'estratègia de rehabilitació basada en la comunitat va ser desenvolupada per a abordar una important preocupació ètica relacionada amb la justícia social i l'equitat. A continuació, en base una revisió de la literatura existent, es desenvolupen cinc temes claus relacionats amb l'ètica d'aquesta estratègia, destacant l'aportació de Clarke, qui contempla argumentació crítica de cinc temes vinculats a la rehabilitació basada en la comunitat: associació de les parts interessades, respecte a la cultura i experiència local, equitat en el disseny del programa, apoderament comunitari i rendició de comptes, es discuteixen aquestes temàtiques amb la finalitat de comprendre millor el panorama de la rehabilitació, a partir de les sistematitzacions i experiències en la població xilena

Humanos , Preferência do Paciente/legislação & jurisprudência , Pessoas com Deficiência/legislação & jurisprudência , Pessoas com Deficiência/reabilitação , Justiça Social , Defesa das Pessoas com Deficiência/legislação & jurisprudência , Empoderamento para a Saúde/legislação & jurisprudência , Equidade em Saúde/legislação & jurisprudência , Chile
Int J Equity Health ; 18(1): 28, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155000


BACKGROUND: In 2014 the World Health Organization (WHO) launched the "End TB Strategy", setting new ambitious goals for elimination of tuberculosis (TB). In contrast with previous efforts to control TB, the new strategy adopted the protection and promotion of human rights in TB prevention and care as a core pillar. This mandated the development of national programmes that are sensitive to the characteristics of populations and responsive to structural factors that put people at increased risk of exposure to TB, limit access to good quality health services and make people more vulnerable to TB infection. Indigenous people living in the Peruvian Amazon have been identified as a TB vulnerable group by Peruvian health authorities. This article examines the barriers faced by indigenous people and rural settlers from the Peruvian Amazon in obtaining a TB diagnosis and appropriate TB treatment, through the principles of the human rights based approach of accessibility, availability, affordability, adaptability and quality, and thus provides evidence of the utility of such approach in Peru. METHODS: This is a qualitative study. We combined information from policy documents and legal regulations and in-depth interviews with health workers and health authorities. We used Atlas-ti to conduct a thematic analysis and identify interviewees responses to pre-defined topics. RESULTS: Despite having a strong legal framework to protect the right to health of indigenous people and people affected by TB, there are underlying structural factors contributing to delays in detection, diagnosis and TB treatment, which are mostly related to having a health system poorly prepared to provide care for people living in dispersed rural communities. This article shows the limited level of integration of the "End TB Strategy" principles in the Peruvian National TB Programme and identifies the weakness of the health system to improve health care provision for indigenous people and rural settlers from the Peruvian Amazon. CONCLUSIONS: Our study shows the need to go beyond developing a strong legal framework to ensure vulnerable populations such as indigenous people are able to realize their right to health. Governments need to allocate funds, improve training and adapt healthcare provision to the cultural, geographical, and social context of indigenous people.

Equidade em Saúde/legislação & jurisprudência , Direitos Humanos , Tuberculose/prevenção & controle , Populações Vulneráveis , Humanos , Peru , Pesquisa Qualitativa
Int J Equity Health ; 18(1): 39, 2019 06 03.
Artigo em Inglês | MEDLINE | ID: mdl-31155002


BACKGROUND: Health is recognized as a fundamental right in Brazil's constitution. In the absence of a clearly defined benefit packages of healthcare services that are financed under the Unified Health System (Sistema Único de Saúde, SUS), courts have become important in adjudicating coverage decisions. Empirical assessments of equity and the right to health tend to focus on simple measures of access. However, these empirical perspectives belie the significant inequalities and rights violations that arise in the case of more complex health needs such as cancer. To shed light on these issues, this paper focuses on the care pathways for breast and cervical cancer and explores access and quality issues that arise at different points along the care pathway with implications for the realization of the right to health in Brazil. METHOD: A mixed method approach is used. The analysis is primarily based on a quantitative analysis of national representative administrative data principally from the cervical and breast cancer information systems and the hospital cancer registry. To gain more insights into the organization of cancer care, qualitative data was collected from the state of Bahia, through document analysis, direct observation, roundtable discussions with health workers (HWs), and structured interviews with health care administrators. RESULTS: The paper reveals that the volume of completed screening exams is well below the estimated need, and a tendency toward lower breast cancer screening rates in poorer states and for women in the lowest income brackets. Only 26% of breast cancer cases and 29% of cervical cancer cases are diagnosed at an early stage (stage 0 or I), thereby reducing the survival prospects of patients. Waiting times between confirmed diagnosis and treatment are long, despite new legislation that guarantees a maximum of 60 days. The waiting times are significantly longer for patients that follow the recommended patient pathways, and who are diagnosed outside the hospital. CONCLUSION: The study reveals that there are large variations between states and patients, where the poorest states and patients fare worse on key indicators. More broadly, the paper shows the importance of collecting data both on patient characteristics and health system performance and carry out detailed health system analysis for exposing, empirically, rights violations and for identifying how they can be addressed.

Neoplasias da Mama/terapia , Equidade em Saúde/legislação & jurisprudência , Direitos Humanos , Programas Nacionais de Saúde , Neoplasias do Colo do Útero/terapia , Brasil , Feminino , Humanos
Am J Public Health ; 109(8): 1092-1100, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31219723


Public health professionals have long played a vital-albeit underappreciated-role in shaping, not simply using, US Census data, so as to provide the factual evidence required for good governance and health equity. Since its advent in 1790, the US Census has constituted a key political instrument, given the novel mandate of the US Constitution to allocate political representation via a national decennial census. US Census approaches to categorizing and enumerating people and places have profound implications for every branch and level of government and the resources and representation accorded across and within US states. Using a health equity lens to consider how public health has featured in each generation's political battles waged over and with census data, this essay considers three illustrations of public health's engagement with the enduring ramifications of three foundational elements of the US Census: its treatment of slavery, Indigenous populations, and the politics of place. This history underscores how public health has major stakes in the values and vision for governance that produces and uses census data.

Censos/história , Escravização/estatística & dados numéricos , Equidade em Saúde/legislação & jurisprudência , Índios Norte-Americanos/legislação & jurisprudência , Índios Norte-Americanos/estatística & dados numéricos , Saúde da População/estatística & dados numéricos , Saúde Pública/legislação & jurisprudência , História do Século XVIII , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Estados Unidos
PLoS One ; 14(1): e0210528, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30650155


Genetic analyses provide a powerful tool with which to identify the biological components of historical objects. Te Tiriti o Waitangi | The Treaty of Waitangi is New Zealand's founding document, intended to be a partnership between the indigenous Maori and the British Crown. Here we focus on an archived piece of blank parchment that has been proposed to be the missing portion of the lower parchment of the Waitangi Sheet of the Treaty. However, its physical dimensions and characteristics are not consistent with this hypothesis. We perform genetic analyses on the parchment membranes of the Treaty, plus the blank piece of parchment. We find that all three parchments were made from ewes and that the blank parchment is highly likely to be a portion cut from the lower membrane of the Waitangi Sheet because they share identical whole mitochondrial genomes, including an unusual heteroplasmic site. We suggest that the differences in size and characteristics between the two pieces of parchment may have resulted from the Treaty's exposure to water in the early 20th century and the subsequent repair work, light exposure during exhibition or the later conservation treatments in the 1970s and 80s. The blank piece of parchment will be valuable for comparison tests to study the effects of earlier treatments and to monitor the effects of long-term display on the Treaty.

Equidade em Saúde/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Serviços de Saúde do Indígena/legislação & jurisprudência , Cooperação Internacional , Animais , Identificação Biométrica/métodos , DNA Mitocondrial/classificação , DNA Mitocondrial/isolamento & purificação , Feminino , Testes Genéticos/métodos , Genoma Mitocondrial/genética , Humanos , Nova Zelândia , Filogenia , Ovinos/genética , Reino Unido
Rev Epidemiol Sante Publique ; 67 Suppl 1: S13-S18, 2019 Feb.
Artigo em Francês | MEDLINE | ID: mdl-30616880


In recent years, there has been a new institutional set of developments in France aimed at promoting the adoption of partnership-based, cross-sectoral and modulated health policies based on the health status of the population. Nevertheless, because addressing the challenge of health equity depends largely on the mobilization of a large number of protagonists with very heterogeneous initiatives, interests and values, the conduct of such policies potentially opens up a space for confrontation between those who wish to promote it and those who refuse, challenge, circumvent or neutralize the reconfigurations of public action and the work routines it inevitably induces. This company can therefore be marked by tensions and additional constraints for the actors. In this context, it remains largely conditional.

Equidade em Saúde/organização & administração , Promoção da Saúde/organização & administração , Disparidades nos Níveis de Saúde , Colaboração Intersetorial , Equidade em Saúde/legislação & jurisprudência , Equidade em Saúde/normas , Política de Saúde , Promoção da Saúde/legislação & jurisprudência , Promoção da Saúde/normas , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/normas , Humanos , Governo Local , Parcerias Público-Privadas/legislação & jurisprudência , Parcerias Público-Privadas/organização & administração , Parcerias Público-Privadas/normas , Erro Experimental
Med Law Rev ; 27(2): 295-317, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30102359


Human rights discourse on the rights of transgender people has to a large extent focused on access to correction of legal gender and medical preconditions for this change. Jurisdictions across the world are now beginning to free legal gender recognition from medical interventions and examinations. State bodies have, however, done little to realise the rights of transgender people to adequate healthcare. A key issue is whether international law obliges states to ensure access to trans-specific healthcare. This article examines the right to healthcare appropriate to transgender persons' needs. Drawing on in-depth interviews with transgender people living in Norway, it investigates how individuals explain their needs for trans-specific healthcare. It shows that Norwegian healthcare practice uses the diagnosis of 'transsexualism' to determine a person's needs for trans-specific healthcare and as such excludes many from receiving the healthcare they need. The article analyses whether trans-specific healthcare falls within the ambit of the right to health under Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), and the right to necessary healthcare under the Norwegian Patients' Rights Act. It concludes that the Norwegian authorities are obliged to provide equal access to adequate trans-specific healthcare to those who need it.

Equidade em Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Direito à Saúde/legislação & jurisprudência , Pessoas Transgênero/legislação & jurisprudência , Transexualismo/diagnóstico , Feminino , Identidade de Gênero , Equidade em Saúde/normas , Necessidades e Demandas de Serviços de Saúde/normas , Direitos Humanos/legislação & jurisprudência , Direitos Humanos/normas , Humanos , Direito Internacional , Masculino , Noruega , Direito à Saúde/normas , Pessoas Transgênero/psicologia , Transexualismo/psicologia , Transexualismo/terapia
J Ment Health Policy Econ ; 21(3): 91-103, 2018 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-30530870


BACKGROUND: For decades, insurance plans in the United States have applied more restrictive treatment limits and higher cost-sharing burdens for mental health and substance use treatments compared to physical health treatments. The Mental Health Parity and Addiction Equity Act (MHPAEA) required health plans that offer mental health and substance use benefits to offer them at parity with physical health benefits starting in January 2010. AIMS OF THE STUDY: To determine the effect of MHPAEA on out-of-pocket spending and utilization of outpatient specialty behavioral health services. METHODS: The proportion of individuals with at least one outpatient specialty behavioral health visit, the average number of visits among those with any behavioral health visit, and the proportion of behavioral health spending paid out-of-pocket were obtained from the nationally-representative Medical Expenditure Panel Survey (MEPS) for the years 2006 to 2013. Difference-in-differences models were estimated comparing individuals with employer-sponsored insurance to those with Medicaid, Medicare, or who were uninsured. RESULTS: Out-of-pocket share of spending was lowest among Medicaid (2.0%) and highest among the uninsured (22%), followed by the employer group (13%). Individuals in Medicaid had the highest proportion of any behavioral health visit (11%) and the uninsured had the lowest (2.4%). Among those with any behavioral health visits, the average number of visits was similar across groups. Our primary and sensitivity analyses suggest MHPAEA did not lead to changes in utilization or spending on specialty outpatient behavioral visits for individuals with employer-sponsored insurance compared to other groups. DISCUSSION: Potential reasons for MHPAEA's apparent lack of effect are that health plans were already at parity before the law's passage, that many health plans continue to be out of compliance with the law, that concurrent changes in plans' cost-sharing blunted the law's effects, and that other barriers to behavioral health service use continue to limit utilization. While our study cannot provide direct evidence of these mechanisms, we review existing evidence in support of each of them. Our study had several limitations. We cannot test definitively whether the difference-in-differences assumption was violated or fully control for time-varying differences between groups. We attempt to address this by using multiple control groups and presenting evidence of parallel trends before MHPAEA implementation. Second, because our data do not have state identifiers, we cannot control for which states had existing mental health parity laws. Third, a nationally representative analysis may mask substantial heterogeneity for affected subgroups. IMPLICATIONS FOR HEALTH POLICIES: We find no evidence MHPAEA substantially affected behavioral health utilization or out-of-pocket spending. Federal parity legislation alone is likely insufficient to address barriers to behavioral health affordability and access.

Assistência Ambulatorial/economia , Equidade em Saúde/economia , Equidade em Saúde/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Recuperação da Saúde Mental/economia , Planos de Assistência de Saúde para Empregados/economia , Humanos , Medicaid/economia , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Estados Unidos , Revisão da Utilização de Recursos de Saúde/estatística & dados numéricos
Breastfeed Med ; 13(8): 520-523, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335487


Breast milk (human milk) is the recommended standard for nutrition for infants. There are strategies to increase breastfeeding for people of color due in part to health disparities experienced in underrepresented populations.

Aleitamento Materno/etnologia , Equidade em Saúde/economia , Disparidades nos Níveis de Saúde , Leite Humano , Análise Custo-Benefício , Equidade em Saúde/legislação & jurisprudência , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente , Unidades de Terapia Intensiva Neonatal , Bancos de Leite , Educação de Pacientes como Assunto , Patient Protection and Affordable Care Act/economia , Estados Unidos
Int J Equity Health ; 17(1): 117, 2018 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-30103760


BACKGROUND: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. NEW RESEARCH NETWORK: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. CONCLUSION: Further research using this framework has considerable potential to advance effective policies to advance health and equity.

Assistência à Saúde/legislação & jurisprudência , Assistência à Saúde/organização & administração , Equidade em Saúde/legislação & jurisprudência , Equidade em Saúde/organização & administração , Política de Saúde , Expectativa de Vida , Humanos
Rev. bioét. derecho ; (43): 211-223, jul. 2018.
Artigo em Português | IBECS | ID: ibc-176774


Este artigo discute as questões em torno do acesso à saúde dos grupos étnicos denominados quilombolas. Os quilombos contemporâneos são grupos tradicionais com organização política-econômica-histórica-cultural, que ao longo do tempo lutam pela inclusão social por meio das políticas públicas e ações de atenção integral. O Sistema Único de Saúde (SUS) defende que efetivar o direito humano à saúde da população é estabelecer padrões de equidade na política de saúde do país. Nessa perspectiva, a Bioética torna-se um instrumento de inclusão social pautando discussões democráticas acerca dos problemas que reduzem à população ao acesso equitativo e as melhores condições de vida, saúde e bem-viver

Este artículo discute las cuestiones en torno al acceso a la salud de los grupos étnicos denominados quilombolas. Los quilombos contemporáneos son grupos tradicionales con organización político-económica-histórica-cultural, que a lo largo del tiempo luchan por la inclusión social por medio de las políticas públicas y acciones de atención integral. El Sistema Único de Salud (SUS) de Brasil defiende que el derecho humano a la salud de la población es establecer estándares de equidad en la política de salud del país. En esta perspectiva, la Bioética se convierte en un instrumento de inclusión social que guía las discusiones democráticas acerca los problemas para el acceso equitativo y las mejores condiciones de vida, salud y bienestar de la población

This article discusses the issues related to access to healthcare of ethnic groups called quilombolas. Contemporary quilombos are traditional groups with political-economic-historical-cultural organization, which over time struggle for social inclusion through public policies and actions of comprehensive care. The Unified Health System (SUS) states that implementing the human right to health of the population is establishing equity standards in the health policy of the country. In this perspective, Bioethics becomes a social inclusion instrument guiding democratic discussions about the problems that reduce equitable access and better living, health and good living conditions of the population

Aquest article discuteix les qüestions entorn de l'accés a la salut dels grups ètnics anominats quilombolas. Els quilombos contemporanis són grups tradicionals amb una organització polític-econòmica-històrica-cultural pròpia que al llarg del temps lluiten per la inclusió social per mitjà de les polítiques públiques i accions d'atenció integral. El Sistema Únic de Salut de Brasil defensa que el dret humà a la salut de la població exigeix que s’ estableixin estàndards d'equitat en la política de salut del país. Des d’aquesta perspectiva, la Bioètica es converteix en un instrument d'inclusió social que guia les discussions democràtiques sobre els problemes per a l'accés equitatiu i les millors condicions de vida, salut i benestar de la població

Humanos , Populações Vulneráveis/etnologia , Populações Vulneráveis/legislação & jurisprudência , Bioética , Grupos Étnicos/legislação & jurisprudência , Política Pública/legislação & jurisprudência , Equidade em Saúde/ética , Equidade em Saúde/legislação & jurisprudência , Brasil
Cad. Ibero Am. Direito Sanit. (Impr.) ; 7(2): 11-28, abr./jun. 2018. Ilus
Artigo em Português | LILACS | ID: biblio-969868


Objetivo: Analisar os discursos dos atores processuais em processos no Tribunal de Justiça do Distrito Federal e dos Territórios em que tramitam ações em desfavor das políticas públicas de saúde, no período entre os anos de 2012 e 2013, a fim de conhecer os argumentos mais comumente utilizados para o julgamento dessas ações. Metodologia: Realizou-se uma pesquisa descritiva, analítica, de base documental e bibliográfica, utilizando dados secundários. Os dados foram coletados através de uma pesquisa sobre judicialização no Brasil, nos anos de 2012 e 2013. Os dados quantitativos disponibilizados já se encontravam tratados em tabelas e gráficos e os dados qualitativos foram disponibilizados sem o devido tratamento, o que foi realizado a partir do método da Análise Idiossincrática. Resultados: Os três atores analisados autor, réu e juiz, tratam de questões lógicas que ocorrem no sistema e que podem ocorrer discrepâncias. Cada autor tem o seu ponto de vista, experiência e suas particularidades que não devem ser descartadas, podendo assim, haver conflitos visíveis, mas, em tratando de saúde, o ponto em comum é a melhor decisão para o usuário. Os pedidos a serem judicializados não condizem diretamente com as doenças que mais acometem os pacientes. Conclusão: É possível aferir, a partir dos discursos, a imprudência acometida com os pacientes que estão no processo e percebesse que muitas das prestações de serviços procuradas ainda estão em déficit com seu atendimento, sendo que o estado brasileiro ainda não é garantidor universal dos usuários em suas necessidades. (AU)

Objective: To analyze the speeches of the procedural actors in lawsuits in the Court of Justice of the Federal District and Territories in which they prosecute actions in detriment of the public health policies, in the period between 2012 and 2013, in order to know the arguments most commonly used for the judgment of these actions. Methodology: A descriptive, analytical, documentary and bibliographic research was carried out using secondary data. The data were collected through a research on judicialization in Brazil in the years of 2012 and 2013. The quantitative data available were already treated in tables and graphs and the qualitative data were made available without due treatment, which was done from the method of Idiosyncratic Analysis. Results: The three actors analyzed author, defendant and judge, deal with logical issues that occur in the system and that discrepancies may occur. Each author has his or her points of view and experience and their particularities that should not be discarded, so that there may be visible conflicts, but if it comes to health, the common ground, is the best decision for the user. The requests to be judicialized do not directly correspond to the diseases that most affect the patients. Conclusion: It is possible to gauge from the discourses the imprudence with the patients that are in the process and it is perceived that many of the services rendered are still in deficit with their care, being that the Brazilian state is not yet universal guarantor of the users in your needs. (AU)

Objetivo: Analizar los discursos de los actores procesales en procesos ante el Tribunal de Justicia del Distrito Federal y de los Territorios en que tramitan acciones en desfavorable de las políticas públicas de salud, en el período entre los años 2012 y 2013, a fin de conocer los argumentos más comúnmente utilizados para el juicio de estas acciones. Métodos: Se realizó una investigación descriptiva, analítica, de base documental y bibliográfica, utilizando datos secundarios. Los datos fueron recolectados a través de una encuesta sobre judicialización en Brasil, en los años 2012 y 2013. Los datos cuantitativos disponibles ya se encontraban tratados en tablas y gráficos y los datos cualitativos fueron disponibilizados sin el debido tratamiento, lo que fue realizado a partir del día el método del análisis idiosincrásico. Resultados: Los tres actores analizados autor, reo y juez, tratan de cuestiones lógicas que ocurren en el sistema y que pueden ocurrir discrepancias, cada autor tiene sus puntos de vista y experiencia y sus particularidades que no deben ser descartadas, pudiendo así existir conflictos visibles, pero si se trata de la salud, el punto en común, es la mejor decisión para el usuario. Los pedidos a ser judicializados no concaten directamente con las enfermedades que más afectan a los pacientes. Conclusión: Es posible aferir a partir de los discursos la imprudencia acometida con los pacientes que están en el proceso y se percibe que muchas de las prestaciones de servicios buscadas, aún están en déficit con su atención, siendo que el estado brasileño aún no es garante universal de los usuarios en sus necesidades. (AU)

Humanos , Equidade em Saúde/legislação & jurisprudência , Decisões Judiciais , Judicialização da Saúde , Cobertura Universal de Saúde
Psychiatr Serv ; 69(2): 217-223, 2018 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-29137561


OBJECTIVE: The Mental Health Parity and Addiction Equity Act (MHPAEA) was intended to eliminate differences in insurance coverage for mental health and substance use disorder services and medical-surgical care. No studies have examined mental health service use after federal parity implementation among individuals with diagnoses of eating disorders, for whom financial access to care has often been limited. This study examined whether MHPAEA implementation was associated with changes in use of mental health services and spending in this population. METHODS: Using Truven Health MarketScan data from 2007 to 2012, this study examined trends in mental health spending and intensity of use of specific mental health services (inpatient days, total outpatient visits, psychotherapy visits, and medication management visits) among individuals ages 13-64 with a diagnosis of an eating disorder (N=27,594). RESULTS: MHPAEA implementation was associated with a small increase in total mental health spending ($1,271.92; p<.001) and no change in out-of-pocket spending ($112.99; p=.234) in the first year after enforcement of the parity law. The law's implementation was associated with an increased number of outpatient mental health visits among users, corresponding to an additional 5.8 visits on average during the first year (p<.001). This overall increase was driven by an increase in psychotherapy use of 2.9 additional visits annually among users (p<.001). CONCLUSIONS: MHPAEA implementation was associated with increased intensity of outpatient mental health service use among individuals with diagnoses of eating disorders but no increase in out-of-pocket expenditures, suggesting improvements in financial protection.

Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Equidade em Saúde/economia , Gastos em Saúde/tendências , Cobertura do Seguro/legislação & jurisprudência , Serviços de Saúde Mental/economia , Adolescente , Adulto , Assistência Ambulatorial/economia , Feminino , Planos de Assistência de Saúde para Empregados/economia , Equidade em Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
Rev. bioét. derecho ; (40): 33-47, jul. 2017.
Artigo em Espanhol | IBECS | ID: ibc-163455


Tradicionalmente, la solidaridad ha pasado inadvertida en ética de la salud pública. Sin embargo, algunos autores están reivindicando actualmente la necesidad de tener en cuenta a la solidaridad como un principio rector. Dawson y Jennings son unos de esos autores, pero su concepción de la solidaridad presenta al menos tres contradicciones: en ella, se confunde lo descriptivo con lo normativo, el papel motivacional con el papel justificador de una acción, y el lugar que la solidaridad debe ocupar en una teoría de la justicia en salud. Hace falta resolver estas contradicciones para conceptualizar adecuadamente la idea de solidaridad en la ética de la salud pública si queremos que tenga un rol relevante y deje de ser un valor meramente testimonial

Traditionally, solidarity has gone unnoticed in public health ethics. However, some authors are currently demanding the need to take into account solidarity as a guiding principle. Dawson and Jennings are one of those authors, but their concept of solidarity has at least three contradictions: in it, the descriptive with the normative are confused, as the motivational role with the justifier role of an action, and also the place which solidarity must occupy in a theory of justice in health. We need to resolve these contradictions to properly conceptualize the idea of solidarity in public health ethics if we want that it to have a relevant role and no longer a purely testimonial value

Humanos , Saúde Pública/ética , Bioética , Equidade em Saúde/ética , Equidade em Saúde/legislação & jurisprudência , Disparidades nos Níveis de Saúde , Iniquidade Social/ética , Adhatoda , Motivação/ética
Glob Health Promot ; 24(2): 43-51, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28436297


Health impact assessments (HIAs) were first introduced in Sweden in the mid-to-late 1990s, with the aim of placing health issues on the political agenda and helping to reduce health inequalities. In the early 2000s, HIAs entered a second phase and the Swedish Parliament adopted a national public health policy. A national survey conducted in 2001 showed that 10/289 municipalities had begun to use HIA and 55/289 had decided to use HIA or had initiated an adoption process. In a 2013 follow-up study based on a strategic sample of municipalities, 9/36 municipalities reported using HIA and/or similar tools. Corresponding figures for the 21 Swedish regions were 10 regions in 2001 and four in 2013. HIA and similar tools (sustainability analyses, child impact assessments, and others) were applied to the same extent as HIA. Fifteen years after implementation began, HIA is still being used. Regions show a clear decrease in the use of HIA. There are several explanations for this development. One is the political context, and other explanations are shifts in which actors are responsible for HIA and for public health at the local/regional levels.

Equidade em Saúde/legislação & jurisprudência , Avaliação do Impacto na Saúde/tendências , Estudos Transversais , Política de Saúde , Humanos , Formulação de Políticas , Avaliação de Programas e Projetos de Saúde , Política Pública , Inquéritos e Questionários , Suécia