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Science ; 384(6695): 495, 2024 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-38696555
BMC Prim Care ; 25(1): 142, 2024 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-38678172


PURPOSE: Annually, the French Ministry of Health funds clinical research projects based on a national call for projects. Since 2013, the Ministry has prioritized funding of primary care. Projects selected for funding are made public without distinguishing the specific area of research. The objective of this study was to identify and describe the evolution of the primary care research projects funded by the Ministry of Health between 2013 and 2019. METHOD: We reviewed all of the 1796 medical research projects funded between 2013 and 2019 and categorized projects as primary care projects by using a list of specific keywords. This list was established through two approaches: (1) selected by an expert committee, the RECaP primary care working group, and (2) using an automated textual analysis of published articles in the field. The keywords were used to screen the titles of the medical research projects funded. The abstracts (at www. CLINICALTRIALS: gov ) or details (from project leaders) were then analyzed by two independent reviewers to determine true primary care projects. RESULTS: Finally, 49 primary care projects were identified, representing 2.7% of all medical research projects funded, without any significant change over the period. These projects were predominantly interventional (69%), with a median number of patients expected per project of 902. CONCLUSION: Despite the prioritization of primary care research in 2013 by the French ministry of health, the number and proportion of projects funded remains low, with no significant change over the years. TRIAL REGISTRATION: Not applicable.

Pesquisa Biomédica , Financiamento Governamental , Atenção Primária à Saúde , França , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/organização & administração , Humanos , Pesquisa Biomédica/economia , Financiamento Governamental/economia , Financiamento Governamental/tendências
Cien Saude Colet ; 29(4): e01502023, 2024 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-38655951


The present study aimed to analyze how these changes, both at the national and state levels, could affect the conditions of the implementation of obesity prevention and control (OCP) actions in primary health care (PHC) in the Rio de Janeiro State from 2014 to 2021. This study was based on policy analysis methods that emphasize the understanding of the implementation contexts, as well as the induction mechanisms and government incentives for the development of actions and integration of two projects that analyzed the OPC actions in PHC in the 92 municipalities of RJS between 2014 and 2018 (PPSUS-RJS) and between 2019 and 2021 (PEO-RJS). The results indicate that, by 2016, it was possible to observe the positive impacts of the structuring of PHC and the federal induction mechanisms in RJS. However, inflections in the expansion and funding of PHC contributed to the weakening of units, teams, and strategies, and led to retraction of resources for both state and municipal actions. Between 2016-2018, RJS's political and financial scenario deteriorated due to national crises, and the positive counterpoints since then were the induction mechanisms and federal resources that remained, in addition to the technical areas of the RJS-HD and state co-financing resources.

O estudo analisou como as inflexões político-econômicas de financiamento e de estruturação do Sistema Único de Saúde podem ter afetado as condições de implementação de ações de prevenção e controle da obesidade (PCO) na atenção primária à saúde (APS) no estado do Rio de Janeiro (ERJ) entre 2014 e 2021. Fundamentou-se em referenciais de análise de políticas, considerando contexto de implementação, antecedentes históricos, mecanismos de indução e incentivos governamentais para o desenvolvimento das ações de PCO. Baseou-se em dois projetos realizados nos 92 municípios do ERJ entre 2014 e 2018 (PPSUS-ERJ) e 2019-2021 (PEO-ERJ), pautados em análise documental, entrevistas e grupos focais com profissionais e gestores da APS. Até 2016, percebe-se os impactos positivos da estruturação da APS e dos mecanismos de indução federais. No entanto, as inflexões na expansão e no financiamento da APS contribuíram para o enfraquecimento de unidades, equipes e estratégias, além de uma retração de recursos para as ações estaduais e municipais. Entre 2016-2018, a crise política e financeira do ERJ foi potencializada pelas crises nacionais, e os contrapontos positivos desde então foram os mecanismos de indução e recursos federais que permaneceram, além das áreas técnicas da SES-ERJ e do cofinanciamento estadual.

Política de Saúde , Motivação , Obesidade , Atenção Primária à Saúde , Brasil , Humanos , Obesidade/prevenção & controle , Atenção Primária à Saúde/economia , Financiamento Governamental
Soc Sci Med ; 348: 116844, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38615613


This study investigated the impact of local government spending on mental health in England between 2013 and 2019. Guided by the "Health in All Policies" vision, which encourages the integration of health in all decision-making areas, we explored how healthcare and multiple nonmedical budgeting decisions related to population mental health. We used random curve general cross-lagged modelling to dynamically partition effects into the short-run (from t to t + 1) and long-run (from t to t + 2) impacts, account for unobserved area-level heterogeneity and reverse causality from health outcomes to financial investments, and comprehensive modelling of budget items as an interconnected system. Our findings revealed that spending in adult social care, healthcare, and law & order predicted long-term mental health gains (0.004-0.081 SDs increase for each additional 10% in expenditure). However, these sectors exhibited negative short-term impulses (0.012-0.077 SDs decrease for each additional 10% in expenditure), markedly offsetting the long-term gains. In turn, infrastructural and environmental spending related to short-run mental health gains (0.005-0.031 SDs increase for each additional 10% in expenditure), while the long-run effects were predominantly negative (0.005-0.028 SDs decrease for each additional 10% in expenditure). The frequent occurrence of short-run and long-run negative links suggested that government resources may not be effectively reaching the areas that are most in need. In the short-term, negative effects could also imply temporary disruptions to service delivery largely uncompensated by later mental health improvements. Nonetheless, some non-health spending policies, such as law & order and infrastructure, can be related to long-lasting positive mental health impacts.

Gastos em Saúde , Governo Local , Humanos , Inglaterra , Gastos em Saúde/estatística & dados numéricos , Saúde Mental , Serviços de Saúde Mental/economia , Financiamento Governamental/estatística & dados numéricos
J Health Care Poor Underserved ; 35(1): 375-384, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38661876


The Indian Health Service (IHS) faces severe workforce shortages due to underfunding and underdevelopment of clinical training programs. Unlike other direct federal health care systems that have implemented clinical training paradigms as central parts of their success, the IHS has no formalized process for developing such programs internally or in partnership with academic institutions. While the Indian Health Care Improvement Act (IHCIA) authorizes mechanisms by which the IHS can support overall workforce development, a critical portion of the act (U.S. Code 1616p) intended for developing clinical training programs within the agency remains unfunded. Here, we review the funding challenges of the IHCIA, as well as its authorized and funded workforce development programs that have only partially addressed workforce shortages. We propose that through additional funding to 1616p, the IHS could implement clinical training programs needed to prepare a larger workforce more capable of meeting the needs of American Indian/Alaska Native communities.

United States Indian Health Service , Humanos , Estados Unidos , United States Indian Health Service/organização & administração , Mão de Obra em Saúde , Indígenas Norte-Americanos , Desenvolvimento de Pessoal/organização & administração , Financiamento Governamental , Melhoria de Qualidade/organização & administração , Pessoal de Saúde/educação
Cad Saude Publica ; 40(3): e00007323, 2024.
Artigo em Português | MEDLINE | ID: mdl-38656068


This study aims to analyze the effects of the expansion of the federal transfer of parliamentary amendments for municipal financing of primary health care (PHC) in the Brazilian Unified National Health System (SUS), from 2015 to 2020. A longitudinal study was conducted using secondary data on transfers of parliamentary amendments from the Brazilian Ministry of Health and expenditure of municipalities' own resources on public health actions and services and PHC. The effect of the transfer of parliamentary amendments on municipal financing was verified in a stratified way by population size of the municipalities, using generalized estimating equation models. The transfer of parliamentary amendments for PHC showed a large discrepancy in per capita values among municipalities of different population sizes. No correlation with municipal spending on public health actions and services was observed in municipalities with more than 10,000 inhabitants, and the association with spending on PHC (p < 0.050) was inverse in all municipalities. Therefore, the increase in the transfer of parliamentary amendments by the Brazilian Ministry of Health favored a reduction in the allocation of municipal revenues to PHC, which may have been directed to other spending purposes in the SUS. These changes seem to represent priorities established for municipal budget expenditure, which have repercussions on local conditions for guaranteeing stable funding for PHC in Brazil.

O objetivo deste artigo é analisar os efeitos da ampliação do repasse federal de emendas parlamentares no financiamento municipal da atenção primária à saúde (APS) do Sistema Único de Saúde (SUS), no período de 2015 a 2020. Foi realizado estudo longitudinal com dados secundários de transferências por emendas parlamentares do Ministério da Saúde e de despesas com recursos próprios dos municípios, aplicadas em ações e serviços públicos de saúde e na APS. O efeito do repasse de emendas parlamentares no financiamento municipal foi verificado de forma estratificada por porte populacional dos municípios, por meio de modelos de equações de estimativas generalizadas. O repasse de emendas parlamentares para a APS apresentou grande discrepância de valores per capita entre os municípios de diferentes portes populacionais. Observou-se inexistência de correlação com a despesa municipal em ações e serviços públicos de saúde nos municípios com mais de 10 mil habitantes e associação inversa com a despesa em APS (p < 0,050) em todos os grupos. Conclui-se que o aumento do repasse de emendas parlamentares pelo Ministério da Saúde favoreceu a redução da alocação de receitas municipais com APS, que podem ter sido direcionados para outras finalidades de gasto no SUS. Tais mudanças parecem refletir prioridades estabelecidas para a despesa orçamentária dos municípios, que repercutem sobre as condições locais para a garantia da estabilidade do financiamento da APS no Brasil.

El artículo tiene como objetivo analizar los efectos de la ampliación de la transferencia de recursos federal de enmiendas parlamentarias sobre el financiamiento municipal de la atención primaria de salud (APS) en el Sistema Único de Salud brasileño (SUS), en el período del 2015 al 2020. Se realizó un estudio longitudinal con datos secundarios de transferencias de recursos por enmiendas parlamentarias del Ministerio de Salud y de gastos con recursos propios de los municipios, aplicados a acciones y servicios públicos de salud y a la APS. El efecto de la transferencia de recursos de enmiendas parlamentarias sobre el financiamiento municipal se verificó de forma estratificada por tamaño de población de los municipios, utilizando modelos de ecuaciones de estimaciones generalizadas. La transferencia de recursos de enmiendas parlamentarias para la APS mostró una gran discrepancia en los valores per cápita entre municipios de diferente tamaño poblacional. No hubo correlación con el gasto municipal en acciones y servicios públicos de salud en aquellos con más de 10.000 habitantes y asociación inversa con el gasto en APS (p < 0,050) en todos los grupos de municipios. Se concluye que el aumento en la transferencia de recursos de enmiendas parlamentarias por parte del Ministerio de Salud favoreció la reducción de la asignación de ingresos municipales a la APS, que pueden haber sido dirigidos a otros fines de gasto en el SUS. Tales cambios parecen reflejar prioridades establecidas para el gasto presupuestario municipal, que repercuten en las condiciones locales para garantizar la estabilidad del financiamiento de la APS en Brasil.

Financiamento Governamental , Gastos em Saúde , Programas Nacionais de Saúde , Atenção Primária à Saúde , Brasil , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Estudos Longitudinais , Financiamento Governamental/economia , Financiamento Governamental/legislação & jurisprudência , Gastos em Saúde/estatística & dados numéricos , Financiamento da Assistência à Saúde
Fam Med ; 56(5): 317-320, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38506701


BACKGROUND AND OBJECTIVES: The National Institutes of Health and related federal awards for research training (RT) and research career development (RCD) are designed to prepare applicants for research careers. We compared funding rates for RT and RCD for anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, obstetrics-gynecology, pathology, pediatrics, and psychiatry. METHODS: We estimated the denominator using the number of residency graduates from different specialties from 2001 to 2010 from the Association of American Medical Colleges data. For the numerator, we used published data on federally funded awards by specialty from 2011 to 2020. We also examined the correlation between RCD funding and overall research funding. RESULTS: Family medicine had the lowest rate per graduating resident for RT (0.01%) and RCD (0.77%) awards among 10 specialties and was lower than the mean/median for the other nine specialties, ranging from 2.15%/1.19% and 9.83%/8.74%. We found a strong correlation between rates of RCD awards and mean federal funding per active physician, which was statistically significant (ρ=0.77, P=.0098). CONCLUSIONS: Comparatively low rates for family medicine awards for RT and RCD plausibly contribute to poor federal funding for family medicine research, underscoring the need to bolster the research career pathway in family medicine.

Pesquisa Biomédica , Medicina de Família e Comunidade , Internato e Residência , Humanos , Medicina de Família e Comunidade/educação , Estados Unidos , Pesquisa Biomédica/economia , National Institutes of Health (U.S.) , Escolha da Profissão , Apoio à Pesquisa como Assunto/estatística & dados numéricos , Financiamento Governamental
Environ Sci Pollut Res Int ; 31(15): 22645-22662, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38409384


This paper constructs a green supply chain with a manufacturer and a retailer. Taking into account the reference price effect of consumers based on the mental accounting theory, we investigate the following government incentive policies: R&D (research and development) subsidy, consumption subsidy, and dual subsidy. For manufacturer-led (M-led) and retailer-led (R-led) supply chains, we evaluate the optimal wholesale price, sales price, green degree of product, and the optimal subsidy of the government aiming to improve the environmental benefit or social welfare. We find that the government goal, power structure and reference price effect impact the design of subsidy mechanisms significantly. First, for M-led supply chain, the government concerned with the environmental benefit goal should only provide R&D subsidy for the manufacturer when the reference price effect is low; otherwise, the government would offer subsidy both for the manufacturer and consumers. However, the government will only offer R&D subsidy when the social welfare goal is adopted. Second, for R-led supply chain, the government aiming to improve the environmental benefit prefers dual subsidy when the reference price effect is low; otherwise, consumption subsidy is preferable. Surprisingly, under the social welfare goal, no subsidy for R-led supply chain tends to be the best option. Intriguingly, embracing the social welfare goal can result in more economic and environmental benefits for M-led supply chain, although the subsidy strategy is less effective than the environmental benefit goal. Our research can provide inspirations and references for designing government subsidy mechanisms in practice.

Comércio , Governo , Custos e Análise de Custo , Financiamento Governamental , Políticas , Comportamento do Consumidor
PLoS One ; 19(2): e0284235, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38354126


Health services, economics, and outcomes research (referred to as health economics research hereinafter) is one of the interdisciplinary sciences that the National Institutes of Health (NIH) supports in order to pursue its overall mission to improve health. In 2015, NIH guidance was published to clarify the type of health economics research that NIH would continue to fund. This analysis aimed to determine if there were changes in the number of health economics applications received and funded by NIH after the release of the guidance. Health economics applications submitted to NIH both before and after publication of the guidance were identified using a machine learning approach with input from subject matter experts. Application and funding trends were examined by fiscal year, method of application (solicited vs. unsolicited), and activity code. This study found that application and funding rates of health economics research were decreasing prior to guidance. Following publication of this guidance, the application and funding rate of health economics applications increased.

Pesquisa Biomédica , Administração Financeira , Estados Unidos , Financiamento Governamental , Economia Médica , National Institutes of Health (U.S.)
Environ Sci Pollut Res Int ; 31(3): 3976-3994, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38093076


Taking the green credit policy in 2012 as a quasi-natural experiment, this paper uses the difference-in-differences method to explore the impact of green credit policy on enterprises' financial asset allocation and the moderating effect of government subsidy. We find that green credit policy significantly promotes the financial asset allocation of heavy-polluting enterprises, which is mainly reflected in short-term liquid financial investment, thus supporting the precautionary motivation of holding financial assets. The mechanism analysis shows that green credit policy promotes the financial asset allocation of heavy-polluting enterprises by reducing the scale of debt financing and increasing the financing cost. Government subsidy can significantly weaken the promoting effect of green credit policy on enterprises' financial asset allocation, and there is heterogeneity due to the regional environmental regulation intensity and financial development level. Further analysis shows that the negative moderating effect of government subsidy on green credit policy and enterprises' financial asset allocation significantly promotes the "shifting form virtual to real" of heavy polluting enterprises by reducing financial asset allocation. This paper discusses the impact of green credit policy on financial asset allocation of heavy-polluting enterprises in China and further clarifies the significant role of government subsidy in the process, so as to provide suggestions for government to control the "shifting from real to virtual" of enterprises. The results also provide an important reference for countries, especially developing countries, to implement green credit policy and government subsidy to achieve sustainable economic development.

Desenvolvimento Econômico , Governo , China , Políticas , Financiamento Governamental
Siglo cero (Madr.) ; 55(1)2024. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-231116


Las políticas sociales buscan relevar a la familia de las personas con discapacidad y dependencia en su papel de cuidadores. Sin embargo, en numerosas ocasiones, estas familias no disponen de todos los recursos necesarios para afrontar estas situaciones de cuidado. El objetivo general del presente trabajo es conocer la percepción sobre los recursos de los que disponen los familiares de personas con discapacidad. Se trata de un estudio cualitativo mediante entrevista estructurada, no experimental ex post facto, de carácter descriptivo y de tipo transversal. La muestra total fueron 27 personas familiares de personas con discapacidad. Para el análisis de las respuestas se empleó el programa JASP y se realizó estadística descriptiva y correlacional. Los resultados indican que el recurso más reconocido y utilizado es el referido a las prestaciones económicas, así como la atención temprana y los colegios de educación especial. Las mujeres son mayoritarias en el cuidado de estas personas, señalando estas mujeres un gasto de energía, por lo que podría ser recomendable mejorar la eficiencia y la eficacia de los programas de respiro familiar. (AU)

Social policies seek to relieve the family of people with disabilities and dependency in their role as caregivers. However, on numerous occasions, these families do not have all the necessary resources to deal with these care situations. The general objective of this study is to find out the perception of the resources available to family members of people with disabilities in Spain. This is a qualitative study using a structured interview, non-experimental ex post facto, descriptive and cross-sectional in nature. The total sample consisted of 27 relatives of people with disabilities. The JASP programme was used to analyse the responses, and descriptive and correlational statistics were performed. The results indicate that the most recognized and used resource is the one referred to economic benefits, as well as early care and special education schools. Women are in the majority in the care of these people, who report an expenditure of energy, so it could be advisable to improve the efficiency and effectiveness of family respite programmes. (AU)

Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Pessoas com Deficiência/psicologia , Ajuda a Famílias com Filhos Dependentes , Estudos sobre Deficiências , Estudos de Avaliação como Assunto , Inquéritos e Questionários , Epidemiologia Descritiva , Estudos Transversais , Financiamento Governamental