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2.
Ciênc. Saúde Colet ; 25(12): 4945-4956, Dec. 2020. tab
Artigo em Português | LILACS, Coleciona SUS, Sec. Est. Saúde SP | ID: biblio-1142715

RESUMO

Resumo A pandemia de Covid-19 revelou a existência de ameaça concreta e imediata à segurança alimentar e nutricional (SAN), em especial de grupos vulnerabilizados. O estudo buscou identificar as estratégias governamentais implementadas no Brasil para prover o Direito Humano à Alimentação Adequada e Saudável em contextos de elevada vulnerabilidade social frente à Covid-19. Foi realizado um estudo transversal, com análise de documentos oficiais publicados entre 20 de março e 30 de julho de 2020 pela União, Distrito Federal, estados e capitais brasileiras, com foco em medidas que assegurem disponibilidade e acesso físico ou financeiro a alimentos. As estratégias implementadas envolvem fundamentalmente distribuição de alimentos e garantia de renda mínima. Foram instituídas: Renda Básica Emergencial (União); Programa de Aquisição de Alimentos (PAA) e auxílio financeiro emergencial (estados); programas de doação emergencial de alimentos (estados e municípios). Medidas existentes foram adaptadas frente à pandemia, como o Programa Nacional de Alimentação Escolar (PNAE), o Programa de Aquisição de Alimentos (PAA) nacional, a distribuição de alimentos e de cestas básicas. Embora importantes, essas estratégias têm alcance limitado e são insuficientes para assegurar a SAN.


Abstract The Covid-19 pandemic revealed a concrete and immediate threat to food and nutrition security (FNS), especially for vulnerable groups. This study aimed to identify government strategies implemented in Brazil to provide the Human Right to Adequate and Healthy Food in high social vulnerability contexts during the Covid-19 pandemic. A cross-sectional study was carried out, with analysis of official documents published between March 20 and July 30, 2020, by the Federal Government, Federal District, Brazilian states, and capitals, focusing on measures to ensure availability and physical or financial access to food. Strategies implemented mainly involve food distribution and minimum income assurance. The following were implemented: Basic Emergency Income (Federal Government); Food Acquisition Program (PAA), and emergency financial aid (states); emergency food donation programs (states and municipalities). Existing measures were adapted to the pandemic, such as the National School Food Program (PNAE), the National Food Acquisition Program (PAA), and the distribution of food and staple food baskets. While essential, these strategies have limited scope and are insufficient to ensure FNS.


Assuntos
Humanos , Infecções por Coronavirus/epidemiologia , Pandemias , Abastecimento de Alimentos/legislação & jurisprudência , Betacoronavirus , Brasil/epidemiologia , Áreas de Pobreza , Estudos Transversais , Regulamentação Governamental , Emergências , Assistência Alimentar/legislação & jurisprudência , Assistência Alimentar/organização & administração , Financiamento Governamental/legislação & jurisprudência , Abastecimento de Alimentos , Abastecimento de Alimentos/economia , Abastecimento de Alimentos/métodos , Dieta Saudável , Renda , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração
3.
Environ Health Prev Med ; 25(1): 17, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517677

RESUMO

BACKGROUND: Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities. METHODS: A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis. RESULTS: NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare. CONCLUSION: The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.


Assuntos
Disparidades em Assistência à Saúde/tendências , Cobertura do Seguro/tendências , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/legislação & jurisprudência , Filipinas , Fatores Socioeconômicos
4.
Cad Saude Publica ; 36(5): e00088920, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32490913

RESUMO

COVID-19 has created enormous challenges for health systems worldwide, with the rapidly growing number of deaths and critical patients with pneumonia requiring ventilatory support. Alternative methods to control the spread of the disease such as social isolation, extreme quarantine measures, and contact tracing have been used around the world. However, these measures may not be totally effective to fight COVID-19, in step with the necessary national preparations to meet the new patient care demands. A wide range of digital technologies can be used to enhance these public health strategies, and the pandemic has sparked increasing use of telehealth. This field has grown considerably in Brazil in recent years. Still, despite the intense proliferation of recommendations and rules, until the current pandemic the country still lacked a fully consolidated regulatory framework. The emergence of COVID-19 marks a key moment in the expansion of applications and use of telehealth for improving the health system's response to the current crisis. The article discusses telehealth's contribution to the fight against COVID-19 and the recent initiatives triggered in Brazil as opportunities for the consolidation of telemedicine and improvement of the Brazilian Unified National Health System. The authors conclude that telehealth offers capabilities for remote screening, care and treatment, and assists monitoring, surveillance, detection, prevention, and mitigation of the impacts on healthcare indirectly related to COVID-19. The initiatives triggered in this process can reshape the future space of telemedicine in health services in the territory.


Assuntos
Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Brasil/epidemiologia , Educação em Saúde/métodos , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Pandemias/legislação & jurisprudência , Consulta Remota/tendências , Telemedicina/legislação & jurisprudência , Telemedicina/métodos
5.
BMC Public Health ; 20(1): 846, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493256

RESUMO

BACKGROUND: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. METHODS: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasi-experiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. RESULTS: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. CONCLUSION: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Cidades , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/legislação & jurisprudência , Feminino , Alemanha/epidemiologia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados não Aleatórios como Assunto
6.
PLoS One ; 15(5): e0233334, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32437376

RESUMO

To update the landscape analysis of vaccine injuries no-fault compensation programmes, we conducted a scoping review and a survey of World Health Organization Member States. We describe the characteristics of existing no-fault compensation systems during 2018 based on six common programme elements. No-fault compensation systems for vaccine injuries have been developed in a few high-income countries for more than 50 years. Twenty-five jurisdictions were identified with no-fault compensation programmes, of which two were recently implemented in a low- and a lower-middle-income country. The no-fault compensation programmes in most jurisdictions are implemented at the central or federal government level and are government funded. Eligibility criteria for vaccine injury compensation vary considerably across the evaluated programmes. Notably, most programmes cover injuries arising from vaccines that are registered in the country and are recommended by authorities for routine use in children, pregnant women, adults (e.g. influenza vaccines) and for special indications. A claim process is initiated once the injured party or their legal representative files for compensation with a special administrative body in most programmes. All no-fault compensation programmes reviewed require standard of proof showing a causal association between vaccination and injury. Once a final decision has been reached, claimants are compensated with either: lump-sums; amounts calculated based on medical care costs and expenses, loss of earnings or earning capacity; or monetary compensation calculated based on pain and suffering, emotional distress, permanent impairment or loss of function; or combination of those. In most jurisdictions, vaccine injury claimants have the right to seek damages either through civil litigation or from a compensation scheme but not both simultaneously. Data from this report provide an empirical basis on which global guidance for implementing such schemes could be developed.


Assuntos
Seguro de Responsabilidade Civil , Vacinas/efeitos adversos , Adulto , Criança , Compensação e Reparação , Feminino , Saúde Global , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Responsabilidade Legal/economia , Masculino , Imperícia/economia , Imperícia/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Gravidez , Inquéritos e Questionários , Vacinação/efeitos adversos , Vacinação/economia , Vacinação/legislação & jurisprudência , Vacinas/economia , Organização Mundial da Saúde
7.
Ciênc. Saúde Colet ; 25(4): 1197-1204, abr. 2020. graf
Artigo em Português | LILACS | ID: biblio-1089520

RESUMO

Resumo Ao longo século XX, as profundas alterações que ocorreram na Medicina apenas podem ser completamente esclarecidas se forem observadas numa perspectiva histórica, pois elas sempre ocorreram em resposta a influências externas, umas científicas e tecnológicas, outras de ordem social. A moderna Medicina Familiar é uma das muitas disciplinas novas que se desenvolveram durante o curso da história da Medicina e aqui debatemos de forma crítica, os últimos 40 anos dos cuidados primários em saúde em Portugal, começando em 1971, mesmo antes da Declaração de Alma-Ata (1978). Ao longo do percurso, em 2005, surge a Reforma dos Cuidados Primários em Saúde em Portugal e as novas unidades de saúde familiar, que até setembro de 2019 atendiam cerca de 94% dos cidadãos portugueses, ou seja, mais de nove milhões e meio de pessoas. No final dessa trajetória, de forma solidária e voluntária, esta Reforma serviu de inspiração para outra, no Brasil, na cidade do Rio de Janeiro, em 2009. Por fim, apresentamos os desafios apontados na Declaração de Astana de 2018, dentre elas, a questão da força de trabalho nos cuidados de saúde primários, como fator essencial para o desempenho e a sustentabilidade dos sistemas de saúde.


Abstract Throughout the twentieth century, the profound changes that have taken place in Medicine can only be wholly explained if observed from a historical perspective, for they have always occurred in response to external influences, some scientific and technological, others of a social nature. Modern Family Medicine is one of the many new disciplines that have developed during medical history, and we critically discuss the last 40 years of primary health care in Portugal, which started in 1971, long before the Alma-Ata Declaration (1978). Along the way, in 2005, the Primary Health Care Reform emerges in Portugal, along with the new family health facilities, which until September 2019, attended about 94 % of Portuguese citizens, i.e., 9,5 million people. At the end of this course, in solidarity and voluntarily, this Reform inspired another one in Brazil, in Rio de Janeiro, in 2009. Finally, we present the challenges pointed out in the 2018 Astana Declaration, among them, the issue of the workforce in primary health care as an essential factor for the performance and sustainability of health systems.


Assuntos
Humanos , Atenção Primária à Saúde/história , Reforma dos Serviços de Saúde/história , Congressos como Assunto/história , Medicina de Família e Comunidade/história , Portugal , Atenção Primária à Saúde/organização & administração , Especialização/história , Brasil , Saúde Global , Cazaquistão , Reforma dos Serviços de Saúde/organização & administração , Centros Comunitários de Saúde/história , Centros Comunitários de Saúde/legislação & jurisprudência , Centros Comunitários de Saúde/organização & administração , Congressos como Assunto/organização & administração , Academias e Institutos/história , Academias e Institutos/organização & administração , Europa (Continente) , Medicina de Família e Comunidade/organização & administração , Programas Nacionais de Saúde/história , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração
8.
Ciênc. Saúde Colet ; 25(4): 1215-1220, abr. 2020.
Artigo em Inglês | LILACS | ID: biblio-1089518

RESUMO

Abstract Since 2012, the Besrour Centre for Global Family Medicine at the College of Family Physician of Canada has brought together its partners from the Americas annually, to reflect on the evolution of Family Medicine on the continent since Alma-Ata, and to look forward to future challenges. Family doctors are but one element of a strong health system. Family Medicine provides key ingredients to respond to population health needs especially as countries move through the epidemiological transition to face larger burdens of chronic disease and multimorbidity. In this paper, we provide a high-level overview of the state of Family Medicine on the continent. We then analyze trends in the education of family physicians to face this changing landscape, including the emphasis on the leader role of future family physicians. Postgraduate programs in Family Medicine in the Americas are placing increasing emphasis on teaching collaborative care in view of creating truly interdisciplinary health teams for the benefit of patients.


Resumo Desde 2012, o Centro Besrour de Medicina Global de Família, na Faculdade de Medicina de Família do Canadá, reúne seus parceiros das Américas anualmente para refletir sobre a evolução da Medicina de Família no continente desde Alma-Ata e para os desafios futuros. Os médicos de família são apenas um elemento de um forte sistema de saúde. A Medicina de Família fornece ingredientes-chave para responder às necessidades de saúde da população, especialmente à medida em que os países passam pela transição epidemiológica para enfrentar um fardo maior de doenças crônicas e de multimorbidade. Neste artigo, fornecemos uma visão geral de alto nível do estado da Medicina de Família no continente. Em seguida, analisamos as tendências na educação dos médicos de família para enfrentar esse cenário em mudança, incluindo a ênfase no papel de líder dos futuros médicos de família. Os programas de pós-graduação em Medicina de Família nas Américas estão enfatizando cada vez mais o ensino do cuidado colaborativo, a fim de criar equipes de saúde verdadeiramente interdisciplinares para o benefício dos pacientes.


Assuntos
Humanos , Atenção Primária à Saúde/organização & administração , Congressos como Assunto , Medicina de Família e Comunidade/educação , Medicina de Família e Comunidade/tendências , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/tendências , América , Brasil , Canadá , Saúde Global , Cazaquistão , Necessidades e Demandas de Serviços de Saúde , Liderança , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração
9.
Ciênc. Saúde Colet ; 25(4): 1361-1374, abr. 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1089507

RESUMO

Resumo O objetivo desse artigo é apresentar um debate sobre a nova política de financiamento para Atenção Primária à Saúde (APS) no Brasil. Para desenvolvimento do método de pagamento foi realizado consulta da literatura nacional e internacional, além do envolvimento de gestores municipais, estaduais e federais da APS. O modelo final proposto é baseado em Capitação ponderada; Pagamento por desempenho; Incentivo para Ações Estratégicas. A capitação é ponderada por vulnerabilidade socioeconômica, aspectos demográficos e ajuste municipal, o pagamento por desempenho composto por um conjunto total de 21 indicadores e incentivos a ações estratégicas foi possível a partir da manutenção de alguns programas específicos. Os resultados das simulações apontaram para um baixo cadastro (90 milhões de brasileiros) para a cobertura estimada atual (148.674.300 milhões de brasileiros). Além disso, demonstraram um incremento imediato de recursos financeiros para 4.200 municípios brasileiros. Observa-se que a proposta do financiamento traz a APS brasileira para o século XXI, aponta para o fortalecimento dos atributos da APS e torna concreto os princípios de universalidade e equidade do Sistema Único de Saúde.


Abstract This paper aims to present a debate on the new Brazilian Primary Health Care (PHC) funding policy. We consulted the national and international literature, and we involved municipal, state, and federal PHC managers to develop the payment method. The proposed final model is based on weighted capitation, payment-for-performance, and incentive for strategic actions. Capitation is weighted by the socioeconomic vulnerability, demographic aspects, and municipal adjustment, the payment-for-performance consists of an entire set of 21 indicators, and incentives for strategic actions were facilitated from the maintenance of some specific programs. The results of the simulations pointed to low registration (90 million Brazilians) for the currently estimated coverage (148,674,300 Brazilians). Moreover, they showed an immediate increase in financial resources for 4,200 Brazilian municipalities. We observed that the funding proposal brings Brazilian PHC into the 21st century, points to the strengthening of PHC attributes, and materializes the principles of universality and equity of the Unified Health System.


Assuntos
Humanos , Atenção Primária à Saúde/economia , Reembolso de Incentivo , Capitação , Financiamento Governamental/legislação & jurisprudência , Programas Nacionais de Saúde/economia , Brasil , Programas Nacionais de Saúde/legislação & jurisprudência
10.
Infez Med ; 28(1): 17-28, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-32172257

RESUMO

The HIV epidemic has not yet ended, and there are ever more challenges: the recent Italian National Plan of Interventions against HIV and AIDS (Piano Nazionale di Interventi Contro HIV e AIDS (PNAIDS) 2017-2019) was hailed for its comprehensiveness. Its likelihood of success across the HIV care continuum was therefore assessed. Awareness interventions are sporadic and continue to miss high risk populations; if effectively implemented, the prescriptive detail in PNAIDS may help address this. Combined prevention needs greater focus and investment. However, there has been recent progress: free anonymous testing is available at multiple settings although improvements to provide access to key vulnerable populations are needed. Clinical management is available to a high standard across the country, with some areas for improvement in ensuring equality of access. Long-term management of people living with HIV is often effective, but discrepancies exist across regions and settings of care. It is recommended to enable implementation of PNAIDS as a matter of urgency, develop integrated awareness and testing interventions for STIs and HIV, make condoms free for high-risk populations, and develop a network of multidisciplinary services for long-term holistic care of people living with HIV.


Assuntos
Infecções por HIV/epidemiologia , Política de Saúde , Programas Nacionais de Saúde , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Testes Anônimos/legislação & jurisprudência , Antirretrovirais/uso terapêutico , Preservativos/provisão & distribução , Diagnóstico Tardio/estatística & dados numéricos , Usuários de Drogas/legislação & jurisprudência , Infecções por HIV/diagnóstico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/prevenção & controle , Sobreviventes de Longo Prazo ao HIV , Acesso aos Serviços de Saúde/legislação & jurisprudência , Transição Epidemiológica , Saúde Holística , Hospitais Especializados , Humanos , Itália/epidemiologia , Assistência de Longa Duração/métodos , Programas Nacionais de Saúde/legislação & jurisprudência , Preconceito/legislação & jurisprudência , Trabalho Sexual/legislação & jurisprudência , Doenças Sexualmente Transmissíveis/diagnóstico , Estereotipagem , Populações Vulneráveis
12.
Rev Saude Publica ; 54: 16, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32022144

RESUMO

This text aimed to analyze characteristics and challenges of the 16th Brazilian National Health Conference based on the conference three thematic axes: Health as a right; Consolidation of the Brazilian Unified Health System (SUS) principles; Adequate and enough funding for SUS. Given the initiatives to dismantle the social security model and the setbacks of social protection policies, to delimitate health in an expanded sense is essential to defend the SUS project. We analyzed the proposal of Universal Health Coverage as an alternative to universal systems. We then presented the restrictions of universal coverage and how the restrictions can threaten the SUS principles. We also discussed insufficient SUS funding and possible worsening in the face of fiscal austerity policies. To strengthen social participation and to monitor the proposals approved at the conference are necessary.


Assuntos
Congressos como Assunto , Política de Saúde , Programas Nacionais de Saúde , Brasil , Assistência à Saúde , Democracia , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/tendências
13.
Cien Saude Colet ; 25(2): 395-405, 2020 Feb.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32022181

RESUMO

This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Programas Nacionais de Saúde/organização & administração , Brasil , Terapias Complementares/organização & administração , Assistência à Saúde/legislação & jurisprudência , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde , Humanos , Medicina Integrativa/organização & administração , Programas Nacionais de Saúde/legislação & jurisprudência
14.
Dtsch Med Wochenschr ; 145(4): 268-270, 2020 02.
Artigo em Alemão | MEDLINE | ID: mdl-32069495

RESUMO

A constitutional expert opinion, which reviews the social and constitutional foundations of tobacco cessation within the framework of statutory health insurance in Germany, comes to the conclusion that the legislator must release the reimbursement of professional tobacco cessation as a curative service by the statutory health insurance - and not only as a subsidy for a psychotherapeutically oriented measure within the framework of prevention.


Assuntos
Programas Nacionais de Saúde , Abandono do Uso de Tabaco/economia , Prova Pericial , Alemanha , Humanos , Reembolso de Seguro de Saúde , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência
15.
Ciênc. Saúde Colet ; 25(2): 395-405, Feb. 2020. tab, graf
Artigo em Português | LILACS | ID: biblio-1055806

RESUMO

Resumo Esta revisão narrativa tem por objetivo analisar a produção científica sobre as Práticas Integrativas e Complementares (PIC) no Sistema Único de Saúde (SUS) visando compreender as potencialidades e fragilidades do processo de implantação da Política Nacional de Práticas Integrativas e Complementares (PNPIC). Após busca nas bases de dados, 25 artigos foram selecionados e os seus resultados analisados criticamente. Da análise do material emergiram cinco temas principais que explicitaram potencialidades e fragilidades de implantação da política: 1) Formação profissional em PIC para o SUS; 2) Estruturação da oferta em PIC, acesso e promoção da saúde; 3) Conhecimento, acesso e aceitação de usuários em relação às PIC; 4) Conhecimento de profissionais e gestores em relação à PNPIC; e 5) Escopo, monitoramento e avaliação da PNPIC. Os resultados se alinham aos relatórios de gestão da PNPIC aprofundando o conhecimento acerca da implantação da política e reforçando a necessidade de empoderamento dos atores do SUS para o enfrentamento de seus desafios.


Abstract This narrative review examines the literature on complementary and integrative practices (CIPs) and their incorporation into Brazil's national health system (Sistema Único de Saúde - SUS) in an attempt to understand the strengths and weaknesses of the implementation of the National Policy on Complementary and Integrative Practices in the SUS (PNPIC, acronym in Portuguese). A search was conducted of the MEDLINE, LILACS, and SciELO databases, resulting in final sample of 25 articles. Our analysis identified five key themes in the literature related to the strengths and weaknesses of policy implementation: 1) Professional training in CIPs in the SUS; 2) structuring the provision of CIPs, access, and health promotion; 3) knowledge, access, and acceptance of service users in relation to CIPs; 4) knowledge of SUS professional staff and managers in relation to the PNPIC; and 5) scope and monitoring and evaluation of the PNPIC. In consonance with the conclusions of the PNPIC management reports, the findings provide a deeper insight into policy implementation problems and reinforce the need to empower the actors involved in this process to tackle these challenges.


Assuntos
Humanos , Assistência à Saúde/organização & administração , Política de Saúde , Programas Nacionais de Saúde , Terapias Complementares/organização & administração , Brasil , Conhecimentos, Atitudes e Prática em Saúde , Assistência à Saúde/legislação & jurisprudência , Medicina Integrativa/organização & administração , Promoção da Saúde/organização & administração , Acesso aos Serviços de Saúde , Programas Nacionais de Saúde/legislação & jurisprudência
16.
Einstein (Sao Paulo) ; 18: eGS5129, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31939526

RESUMO

OBJECTIVE: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. METHODS: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. RESULTS: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. CONCLUSION: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Brasil , Cidades , Custos de Cuidados de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/economia , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Avaliação de Resultados em Cuidados de Saúde , Estudos Retrospectivos , Fatores Socioeconômicos
17.
Cien Saude Colet ; 24(12): 4405-4415, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778491

RESUMO

This paper aims to identify new sources of revenue for the additional allocation of resources to meet the population's health needs fixed in the federal budget expenses, in the context of the Unified Health System (SUS) underfunding process and the negative effects of Constitutional Amendment 95/2016 for this process - verified decrease in the proportion of federal net current revenue destined to SUS. From this perspective, it is necessary to address the problem of underfunding by linking the search for additional resources with new sources of funding with actions and public health services that will be improved, expanded and created, of which criteria are: regarding sources, exclusivity for SUS, non regressive taxing and review of revenue waiver; and, regarding uses, prioritization of primary care as reference of the health care network and appreciation of civil servants in the health area. The result calculated for the sources ranged from R$ 92 billion to R$ 100 billion, higher than the R$ 30.5 billion calculated for uses under the described terms. A documentary research was conducted to collect data from secondary sources, especially in the reports sent to the National Health Council by the Ministry of Health.


Assuntos
Orçamentos/legislação & jurisprudência , Financiamento Governamental/legislação & jurisprudência , Financiamento da Assistência à Saúde , Programas Nacionais de Saúde/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência , Alocação de Recursos/legislação & jurisprudência , Brasil , Financiamento Governamental/economia , Humanos , Programas Nacionais de Saúde/economia , Saúde Pública/economia , Alocação de Recursos/economia , Impostos/economia
18.
Cien Saude Colet ; 24(12): 4509-4518, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778501

RESUMO

Since 2014, Brazil has been experiencing an economic-fiscal-political-institutional crisis. This study evaluates whether the implementation of crisis responses contributed to weaken SUS regional and federative governance. This is an implementation study, and two theoretical categories of public health, the power in Testa and the subject in Campos have been incorporated. It presumes that the implementation shifts power and develops subjects. We analyzed public data from 2014 to 2018, organized into four axes of analysis: a) instruments for implementing crisis response; b) parliament and judicial interference in investments; c) legal frameworks of regionalization; d) federative actors and possible defense coalitions. Results show reduced federal resources, specifically for regional care networks; increased parliament and judicial interference with health resources, due to the evolution of congressional amendments and lawsuits, and changes in SUS regionalization guidelines. There is a shift of power from federative regional arrangements to the central government, parliament, the judiciary, and isolated local services. It is concluded that the response to the crisis weakened the regional federative governance of SUS, aggravating the impacts of the crisis on health.


Assuntos
Política de Saúde , Programas Nacionais de Saúde , Política Pública , Planos Governamentais de Saúde , Brasil , Tomada de Decisões Gerenciais , Recessão Econômica , Política de Saúde/economia , Política de Saúde/legislação & jurisprudência , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Política Organizacional , Política Pública/economia , Política Pública/legislação & jurisprudência , Planos Governamentais de Saúde/economia , Planos Governamentais de Saúde/legislação & jurisprudência
19.
Cien Saude Colet ; 24(12): 4599-4604, 2019 Dec.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31778510

RESUMO

"Crisis" is a phenomenon that is part of global and local policies with social, political, and economic repercussions. It is the context of this paper that aims to reflect on the Brazilian response to the HIV/AIDS epidemic. We examined the realms of this phenomenon, such as the review of the consensus on austerity policies, their impact and the construction of "anti-agendas" that hinder the narrative of human rights, gender, sexuality, and health and hamper HIV/AIDS prevention and care. Such a conservative move can be associated with censorship of specialized materials and the recent change of management in the structure of the Ministry of Health, the extinction of hundreds of participatory councils within the Executive Branch and the new National Policy on Drugs that replaces the guidance "harm reduction" with one of "abstinence". All these phenomena revive an old concern, that is, that the "ideological virus" will outweigh the biological virus, exacerbating the situation of stigma and discrimination. Besides the neoliberal socioeconomic orientation that threatens the Brazilian state, such facts would affect the continuity of institutional responses to HIV/AIDS.


Assuntos
Recessão Econômica , Infecções por HIV/prevenção & controle , Programas Nacionais de Saúde/economia , Alocação de Recursos/economia , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/prevenção & controle , Brasil/epidemiologia , Assistência à Saúde/economia , Infecções por HIV/epidemiologia , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Prevenção Primária/métodos , Alocação de Recursos/legislação & jurisprudência , Direito à Saúde
20.
Isr J Health Policy Res ; 8(1): 80, 2019 11 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722734

RESUMO

BACKGROUND: Undocumented migrants in Israel, mostly originating from HIV endemic countries, are not covered by Israel's universal healthcare coverage. We initiated a Public-Private Partnership (PPP) to handle this public health and humanitarian challenge. The PPP venture included the Ministry of Health (MoH), pharmaceutical companies, pharmacies, and specialized HIV clinics, the Israeli HIV Medical Society (from the Israel Medical Association), and non-governmental organizations. This study describes the national policy process in conceptualizing and implementing access to HIV services for undocumented migrants through a PPP, and analyzes the preliminary results. METHODS: This case study describes the process of creating a temporary Public-Private Partnership to provide HIV care for undocumented migrants based on institutional records of the Department of Tuberculosis and AIDS (DTA) and memories and reflections from partners. This case was analyzed according to the OECD-DAC criteria for development assistance (relevance, effectiveness, efficiency, sustainability and impact). Demographic and serological data of patients referred between 2014 to 2018 were collected to monitor progress. and analyze preliminary medical and biological outcomes. Ethical approval was obtained from the Ministry of Health. RESULTS: Creating a policy to extend HIV care to undocumented migrants was a 15 year process that confronted several challenges within Israeli and international discourse, particularly concerning governmental response to the migration crisis. The use of a PPP model involving numerous stakeholders provided a solid, local feasibility demonstration that extending HIV care as a matter of policy would have positive implications for public health in Israel. During the first 2 years of the program (2014-2015), the MoH funded medical follow-up and the pharmaceutical companies provided antiretroviral treatment (ART) free of charge for only 100 patients at any given time, in addition to ART provided by the MoH for pregnant women. Since 2016, the MoH has fully covered this service and integrated it within the Israeli health system; this constitutes the major success of the PPP program. As of December 2018, the national program has monitored 350 patients and treated 316 (90.3%). The most prevalent disease present upon referral was Tuberculosis. CONCLUSIONS: To our knowledge, this study documents the first example of a successful PPP with government partnership in a high-income country to address undocumented migrants' lack of access to health services in general and HIV care in particular. In light of the intensification of North-South migration, this Israeli case study could be useful for other countries facing similar challenges. It also has lessons within Israel, as the country grapples with other health problems among uninsured communities.


Assuntos
Infecções por HIV/terapia , Acesso aos Serviços de Saúde/organização & administração , Formulação de Políticas , Migrantes/estatística & dados numéricos , Comportamento Cooperativo , Feminino , Infecções por HIV/epidemiologia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Israel/epidemiologia , Masculino , Pessoas sem Cobertura de Seguro de Saúde/legislação & jurisprudência , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/legislação & jurisprudência , Migrantes/legislação & jurisprudência
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