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2.
Expert Rev Pharmacoecon Outcomes Res ; 19(6): 749-753, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31825682

RESUMO

Background: Agreements between payers and pharmaceutical/medical device companies are widely implemented to address financial and clinical uncertainties. We analyzed the main characteristics of these agreements in Israel from 2011-2018.Research design and methods: We reviewed all agreements implemented during the study period. Information regarding the type of agreement, therapeutic indications, its time frame and the total budget involved are presented.Results: A total of 56 agreements were signed since 2011, of which 53 (95%) were financial-based and 50 (89%) referred to pharmaceuticals. The annual number of agreements increased from one in 2011 to 21 in 2018. The main therapeutic areas covered were: oncology (41%), hepatitis C (16%), neurology (11%), respiratory (9%), and cardiovascular (7%). The proportion of the annual budget allocated subject to these agreements increased accordingly from 3% in 2011 to 73% in 2018. The majority (63%) of the agreements were signed for 5 years, 9% were shorter-term and 20% have no time-limit. In 14 (44%) of the financial-based agreements implemented through 2017, the actual utilization exceeded the pre-specified threshold and the companies reimbursed the health-plans accordingly.Conclusions: The number of agreements and the allocated budget subject to these agreements increased substantially in recent years. Most agreements are financial-based that, in many cases, shifted the short-term financial risk from health-plans to the industry.


Assuntos
Indústria Farmacêutica/organização & administração , Acesso aos Serviços de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Participação no Risco Financeiro/organização & administração , Orçamentos , Indústria Farmacêutica/economia , Serviços de Saúde/economia , Humanos , Israel , Programas Nacionais de Saúde/economia , Mecanismo de Reembolso/economia , Participação no Risco Financeiro/economia , Incerteza
3.
BMC Health Serv Res ; 19(1): 811, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699091

RESUMO

BACKGROUND: The number of people living with chronic health conditions is increasing in Australia. The Chronic Disease Management program was introduced to Medicare Benefits Schedule (MBS) to provide a more structured approach to managing patients with chronic conditions and complex care needs. The program supports General Practitioners (GP)s claiming for up to one general practice management plan (GPMP) and one team care arrangement (TCA) every year and the patient claiming for up to five private allied health visits. We describe the profile of participants who claimed for GPMPs and/or TCAs in Central and Eastern Sydney (CES) and explore if GPMPs and/or TCAs are associated with fewer emergency hospitalisations (EH)s or potentially preventable hospitalisations (PPH)s over the following 5 years. METHODS: This research used the CES Primary and Community Health Cohort/Linkage Resource (CES-P&CH) based on the 45 and Up Study to identify a community-dwelling population in the CES region. There were 30,645 participants recruited within the CES area at baseline. The CES-P&CH includes 45 and Up Study questionnaire data linked to MBS data for the period 2006-2014. It also includes data from the Admitted Patient Data Collection, Emergency Department Data Collection and Deaths Registry linked by the NSW Centre for Health Record Linkage. RESULTS: Within a two-year health service utilisation baseline period 22% (5771) of CES participants had at least one claim for a GPMP and/or TCA. Having at least one claim for a GPMP and/or TCA was closely related to the socio-demographic and health needs of participants with higher EHs and PPHs in the 5 years that followed. However, after controlling for confounding factors such as socio-demographic need, health risk, health status and health care utilization no significant difference was found between having claimed for a GPMP and/or TCA during the two-year health service utilisation baseline period and EHs or PPHs in the subsequent 5 years. CONCLUSIONS: The use of GPMPs and/or TCAs in the CES area appears well-targeted towards those with chronic and complex care needs. There was no evidence to suggest that the use of GPMPs and /or TCAs has prevented hospitalisations in the CES region.


Assuntos
Doença Crônica/terapia , Medicina Geral/organização & administração , Hospitalização/estatística & dados numéricos , Equipe de Assistência ao Paciente/organização & administração , Idoso , Idoso de 80 Anos ou mais , Austrália , Estudos de Coortes , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/organização & administração
4.
S Afr Med J ; 109(10): 771-783, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635576

RESUMO

BACKGROUND: The proposed National Health Insurance (NHI) system aims to re-engineer primary healthcare (PHC) provision in South Africa, with strategic purchasing of services from both private and public sector providers by the NHI Fund. Currently, while access to the private sector is primarily restricted to high-income insured earners, an important proportion of the low-income segment is choosing to utilise private PHC providers over public sector clinics. In recent years, a number of private providers in SA have established innovative models of PHC delivery that aim to expand access beyond the insured population and provide affordable access to good-quality PHC services. OBJECTIVES: To describe the current landscape of private PHC clinic models targeting low-income, uninsured earners and the role they might play during the transition to NHI. METHODS: Key informant interviews were conducted with representatives of a sample of private PHC provider organisations providing services to low-income, uninsured earners with clinics - beyond the traditional private sector general practitioner model. Organisations were asked to describe their service delivery model, the population it serves, the PHC services offered and the financing model. Written responses were captured in Excel and coded manually, and the results were thematically analysed. RESULTS: Of the eight organisations identified, most have actively engaged strategies to ensure the provision of affordable quality care. Within these strategies, scale is an important pivot in spreading fixed costs across more paying patients as well as task shifting to lower cadres of healthcare workers. Access to government medicines and laboratory tests is an important factor in achieving lower costs per patient. Together, these strategies support the sustainability of these models. CONCLUSIONS: We have provided an exploratory analysis of private PHC service delivery models serving the low-income, uninsured patient population, establishing factors that increase the efficiency of such service delivery, and delineating combinations of strategies that could make these models successful both during the transition to NHI and during full-scale NHI implementation. A clear regulatory framework would act as a catalyst for further innovation and facilitate contracting. These existing models can enhance and complement government provision and could be scaled up to meet the needs of expanding PHC under NHI. Understanding these models and the space and parameters in which they operate is important.


Assuntos
Assistência à Saúde/organização & administração , Pessoas sem Cobertura de Seguro de Saúde , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/normas , Clínicos Gerais/organização & administração , Acesso aos Serviços de Saúde , Humanos , Renda , Programas Nacionais de Saúde/economia , Pobreza , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/normas , Setor Privado/economia , Setor Público/economia , Qualidade da Assistência à Saúde , África do Sul
6.
Cien Saude Colet ; 24(10): 3713-3716, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31577001

RESUMO

In the year of the XVI National Health Conference (CNS), thirty-three years into the VIII CNS, this manifesto resumes the theme of relationships between democracy and health and warns Brazilian society about the impending risks that threaten the Unified Health System (SUS), defending our universal system as an effective instrument of health production and citizenship building.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Programas Nacionais de Saúde/organização & administração , Brasil , Humanos
7.
Cien Saude Colet ; 24(10): 3793-3803, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31577010

RESUMO

Although administrators unanimously agree that the Brazilian Unified Health System (SUS) is underfunded, it is also unanimous that there are problems in the efficiency of expenditures management. From this perspective, this study assessed the health technical efficiency in the seven cities of the Rota dos Bandeirantes health region of the state of São Paulo, Brazil, from 2009 to 2012, through the Health Technical Efficiency Index. This index includes structure and results indicators, mainly from the goals and indicators agreement system, and it is collected from the database of the SUS Informatics Department. It was identified that only one city reached high health technical efficiency, while the other cities presented low efficiency. It was concluded that cities with higher income available and higher per capita expenditures achieved the best health indicator results and, therefore, better health technical efficiency indexes. However, some cities, even though small in structure, obtained better results than neighboring cities, which shows structure management efficiency. Thus, the resource represented an essential condition for efficiency, however not sufficient.


Assuntos
Gastos em Saúde , Indicadores Básicos de Saúde , Programas Nacionais de Saúde/organização & administração , Brasil , Cidades , Financiamento da Assistência à Saúde , Humanos , Programas Nacionais de Saúde/economia
8.
Cien Saude Colet ; 24(10): 3947-3956, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31577024

RESUMO

This study aims to compare the differences between clinical practice guidelines (CPGs) of the Ministry of Health (MoH) and those of other Brazilian health institutions. A systematic review of Brazilian CPGs was carried out. CPGs with recommendations for the pharmacological treatment of non-communicable disease (NCDs) were included. CPG methodological quality and transparency was independently assessed by 2 reviewers using the AGREE II. CPGs were rated as high, moderate, and low quality (ranging from A to C). Twenty-six CPGs were assessed for quality. MoH CPGs were published more recently, and were of better quality than the others: 6/6 (100%) were rated as Moderate-A. Although CPGs presented a wide range of methodological quality and transparency, MoH CPGs presented better consistency in the preparation method. To avoid confusion and to improve the quality of care within finite resources in Brazil, and to avoid potential bias, conflicts of interest, national CPGs used within SUS should be developed by Conitec with partners who have no conflict of interest.


Assuntos
Assistência à Saúde/normas , Doenças não Transmissíveis/tratamento farmacológico , Guias de Prática Clínica como Assunto , Brasil , Humanos , Programas Nacionais de Saúde/organização & administração , Qualidade da Assistência à Saúde
9.
Cien Saude Colet ; 24(9): 3457-3462, 2019 Sep 09.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31508763

RESUMO

On May 20, 2019, one day after the world's celebration of the Family Physician's Day, the Ministry of Health published Decree N. 9,795 of May 17, 2019, which changed the organization chart of this federal body. For the first time in the country's history, a specific Secretariat responsible for Primary Health Care and the Family Health Strategy (ESF) was created. The ESF celebrated its 25th anniversary in 2019. The new Primary Health Care Secretariat (SAPS) has three departments: the already existing Department of Strategic Programmatic Actions (DAPES), a Department of Family Health (DESF) and a new Department of Health Promotion (DPS). The Secretariat has, among its competencies, commitments that seek to meet structural challenges, even in the face of a budget constraint scenario that has been observed since 2014. Among the commitments are: (i) increasing the population's access to family health units , (ii) definition of a new funding model based on health and efficiency results, (iii) definition of a new model for the provision and training of physicians for remote areas, (iv) strengthening of clinic and teamwork, v) expansion of the computerization of units and electronic medical records.


Assuntos
Saúde da Família , Programas Nacionais de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Brasil , Orçamentos , Acesso aos Serviços de Saúde , Humanos , Programas Nacionais de Saúde/economia , Equipe de Assistência ao Paciente/organização & administração , Médicos de Família/organização & administração , Atenção Primária à Saúde/economia
10.
BMC Health Serv Res ; 19(1): 670, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533710

RESUMO

BACKGROUND: Health systems reform is inevitable due to the never-ending changing nature of societal health needs and policy dynamism. Today, the Health Transformation Plan (HTP) remains the major tool to facilitate the achievements of universal health coverage (UHC) in Iran. It was initially implemented in hospital-based setting and later expanded to primary health care (PHC). This study aimed to analyze the HTP at the PHC level in Iran. METHODS: Qualitative data were collected through document analysis, round-table discussion, and semi-structured interviews with stakeholders at the micro, meso and macro levels of the health system. A tailored version of Walt & Gilson's policy triangle model incorporating the stages heuristic model was used to guide data analysis. RESULTS: The HTP emerged through a political process. Although the initiative aimed to facilitate the achievements of UHC by improving the entire health system of Iran, little attention was given to PHC especially during the first phases of policy development - a gap that occurred because politicians were in a great haste to fulfil a campaign promise. CONCLUSIONS: Health reforms targeting UHC and the health-related Sustainable Development Goals require the political will to improve PHC through engagements of all stakeholders of the health system, plus improved fiscal capacity of the country and financial commitments to implement evidence-informed initiatives.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Planejamento em Saúde/organização & administração , Política de Saúde , Formulação de Políticas , Atenção Primária à Saúde/organização & administração , Programas Governamentais , Humanos , Irã (Geográfico) , Programas Nacionais de Saúde/organização & administração , Política , Cobertura Universal do Seguro de Saúde/organização & administração
11.
Artigo em Inglês | MEDLINE | ID: mdl-31540517

RESUMO

China has established the universal medical insurance system and individual out of pocket costs have decreased, however, the average healthcare expenditure of the Chinese population and the expenses of the whole society have increased substantially. One major challenge which impedes the progress of attaining sustainable development of the social healthcare system in China is that the number of hospital admissions is disproportionate. Superior hospitals are overcrowded, whereas subordinate hospitals are experiencing low admissions. In this paper, we apply the game theory model to coordinate the healthcare supply chain network, which is composed of the government, medical insurance fund, superior hospitals, subordinate hospitals and patients. Especially by taking the reference price effect into account, this paper analyzes different medical insurance reimbursement strategies and their influence on patient choice and the healthcare supply chain network. The result shows that the reference price effect increases the leverage of medical insurance, guides patients' choice, optimizes the allocation of medical resources and reduces the medical expends. In comparison to a decentralized decision- making strategy, a centralized decision- making strategy can stimulate both superior hospital and subordinate hospital's cooperative intentions which benefits the social healthcare system.


Assuntos
Assistência à Saúde/organização & administração , Órgãos Governamentais/organização & administração , Administração Hospitalar , Programas Nacionais de Saúde/organização & administração , China/epidemiologia , Assistência à Saúde/economia , Teoria do Jogo , Órgãos Governamentais/economia , Humanos , Reembolso de Seguro de Saúde , Programas Nacionais de Saúde/economia , Preferência do Paciente
13.
Healthc Q ; 22(2): 13-14, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556373

RESUMO

The papers that follow are part of an honest, reasonable and serious attempt to build on an existing consensus at the basis of medicare, which guarantees that all Canadians can get medical attention when sick and hospital care when very sick (or injured). Without any exception, reform proposals that run counter to these principles are doomed to failure. However, it becomes harder and harder to ensure that costly and complex healthcare services can be "readily and timely" accessed without a radical shift in approaches. To say things otherwise, to keep what we cherish, we must embrace change, in the form of collaboration, measurement and evidence.


Assuntos
Programas Nacionais de Saúde/organização & administração , Canadá , Reforma dos Serviços de Saúde , Humanos , Assistência Centrada no Paciente/organização & administração , Opinião Pública , Valores Sociais
14.
Healthc Q ; 22(2): 15-19, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556374

RESUMO

Repeated Health Care in Canada (HCIC) surveys over the past two decades have consistently reported that the adult public and clinical and administrative health professionals consider medicare to be successful in terms of quality of care, despite a growing concern that timely access to care remains challenging. These key stakeholders have also recently signalled that major change strategies are likely necessary for continuing success. In the 2018 survey, both the public and professionals ranked highest the creation of a national comprehensive pharmacare plan, entirely funded by the federal government, or with federal funding for those not currently covered by existing pharmaceutical plans. The majority of the public and health professionals in 2018 were also remarkably concordant regarding preferred leadership for designing, instituting and managing a national pharmacare program. The public's priority, supported by 50% of the adult population, was shared leadership involving governments, medical academia and the pharmaceutical/biotech industries, followed by government leadership at 33%. Among professionals, preference for shared leadership averaged 60% and governmental leadership averaged 33%. Based on these data, restriction of pharmacare's leadership exclusively to any single stakeholder raises concern of a critical lack of support for success. A coalition of governments, research hospitals/health authorities and the pharmaceutical/biotech industry - the highest-ranked candidates as potential leaders - would likely provide the best chance to garner the majority of public support and enhance the chances of success in the short and long terms. In summary, the addition of universal pharmacare to medicare's existing healthcare portfolios is an attractive strategy to advance Canadian healthcare and outcomes. The federal government has taken the initial step. Recruitment of additional leaders sharing aspiration, inspiration and experience to optimize pharmacare's development and measure its outcomes is needed. Things can be better.


Assuntos
Seguro de Serviços Farmacêuticos , Programas Nacionais de Saúde/organização & administração , Opinião Pública , Canadá , Pessoal de Saúde/psicologia , Humanos , Liderança
15.
Healthc Q ; 22(2): 21-26, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31556375

RESUMO

Pharmacare, a recently proposed addition to Canada's universal medicare program, has become a prominent topic in the public discourse, but funding and leadership have not been established. Repeated Health Care in Canada (HCIC) surveys of the adult public and a broad spectrum of health professionals reveal very strong support for a national system that is easy to access and covers all prescribed pharmaceuticals. Although the practical details of universal pharmacare remain to be established, there is strong support among the public and professionals as well as increasing federal government interest in moving forward and ultimately implementing pharmacare. At the same time, HCIC surveys indicate that a high percentage of patients do not take their medications as directed, both for acute and chronic illnesses. The data suggest that pharmacare's success will be severely challenged by this. Of the four major challenges preventing usual care from being the best care - suboptimal access, non-diagnosis, non-prescription and non-adherence - risk from some form of non-adherence is often ranked first by care professionals. The most commonly reported reasons for non-adherence in clinical settings are patients' forgetfulness and how they feel in the moment on any given day. Costs of therapy, lack of understanding or poor knowledge transfer between prescribers and patients regarding therapeutic risks and benefits are rarely cited causes for poor adherence. These findings from the 2018 HCIC survey are not new. They are very consistent with measurements in the 2016 and other previous HCIC surveys. They do, however, raise practical challenges for the creation and ongoing management of universal pharmacare. Specifically, a patient-centred care component designed to improve non-adherence to prescribed therapies is needed. Ideally, it should include a measurement and feedback component on adherence that shares data with and between patients, health professionals and payers. Things can be better.


Assuntos
Seguro de Serviços Farmacêuticos , Adesão à Medicação/estatística & dados numéricos , Adulto , Canadá , Doença Crônica/tratamento farmacológico , Humanos , Adesão à Medicação/psicologia , Programas Nacionais de Saúde/organização & administração , Assistência Centrada no Paciente
16.
Otolaryngol Pol ; 73(4): 1-7, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31474621

RESUMO

INTRODUCTION: Thanks to the Polish Universal Neonatal Hearing Screening Program (PUNHSP), all newborns in Poland undergo a free, screening hearing examination. Between 2006 and 2015, the average number of tested children per year was 373,477. According to the analysis of The Central Database (CDB), only 55.8% of the children attended the detailed hearing examinations at the second level of the Program. AIM: The aim of this study is to analyse the dates concerning the attendance of the children at the diagnostic level of PUNHSP in different regions of Poland. MATERIALS AND METHODS: To conduct an analysis of this fact and find out the reasons for low attendance at the second level in 2015, a telephone survey questionnaire was developed for parents who had not registered their babies for further consultation - 3,239 randomly selected parents. RESULTS: The analysis revealed that the number of children examined at the second diagnostic level of the program is in fact much higher than the results of The Central Database show. The actual number is 83.6% as opposed to 55.8%. As a result of the telephone questionnaire some inaccuracies in the input data to the CDB were detected. The main errors in gathering the information for the CDB were incorrect OAE test result and no examination performed. C onclusion: In Poland the worst results (i.e. questionnaire results compared to CDB) for the attendance at the diagnostic level were shown in Pomorskie, Lubelskie, Mazowieckie and Podlaskie regions. In many cases there was a large discrepancy between the reality and the information in the CDB. The improvement of clarity concerning the CDB application is important in order to minimise the possibility of malformation in the CDB.


Assuntos
Bem-Estar da Criança/estatística & dados numéricos , Testes Auditivos/estatística & dados numéricos , Triagem Neonatal/métodos , Encaminhamento e Consulta/estatística & dados numéricos , Criança , Feminino , Seguimentos , Testes Auditivos/métodos , Humanos , Lactente , Recém-Nascido , Masculino , Programas Nacionais de Saúde/organização & administração , Polônia , Fatores de Risco
17.
Health Policy Plan ; 34(7): 499-507, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31369667

RESUMO

The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Único de Saúde: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants.


Assuntos
Pessoal de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Mães , Infecção por Zika virus/terapia , Adulto , Brasil , Pré-Escolar , Anticoncepção , Feminino , Acesso aos Serviços de Saúde/economia , Humanos , Lactente , Recém-Nascido , Masculino , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/normas , Gravidez , Cuidado Pré-Natal , Pesquisa Qualitativa , Fatores Socioeconômicos , Infecção por Zika virus/reabilitação
20.
Health Res Policy Syst ; 17(1): 81, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438972

RESUMO

BACKGROUND: There is widespread and growing interest in designing and implementing social health insurance schemes (SHIS) across many low- and middle-income countries as a means to improve financial protection and achieve universal health coverage. SHIS recently gained traction in Nigeria, but evidence regarding optimal design features of SHIS is sparse and there is lack of a simple and standardised checklist that scheme designers, implementers and researchers could use to assess, guide and inform the design of SHIS. This paper seeks to develop a checklist based on concepts as well as theoretical and empirical evidence that can inform and guide scheme designers and implementers on design options to maximise the effectiveness of the scheme. METHODS: We conducted a review of literature exploring the relevant concepts for the development of a framework and checklist to identify the key factors or variables required to inform the design of SHIS. The checklist details critical considerations/questions to address and options for design. The developed checklist was then used to examine conditions for readiness and appropriateness of SHIS design in two states in Nigeria (Kaduna and Niger). RESULTS: This paper describes the development of a SHIS checklist. The findings also demonstrate that the newly developed checklist, consisting of six design domains, can be used by scheme designers and policy-makers as a simple and effective tool to assess and inform SHIS design features across Nigeria to maximise the chances of the effectiveness of the schemes. CONCLUSION: In conclusion, given that the development of SHIS in the Nigerian states is still in its early stages, applying the SHIS design checklist can serve as a first step to ensuring a feasible and sustainable insurance scheme. The introduction of SHIS, if properly designed and implemented, can be a significant first step towards improving the accessibility, equity and efficiency of healthcare in Nigeria.


Assuntos
Lista de Checagem , Seguro Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Gastos em Saúde , Humanos , Seguro Saúde/economia , Programas Nacionais de Saúde/economia , Nigéria , Mecanismo de Reembolso , Fatores Socioeconômicos , Cobertura Universal do Seguro de Saúde/economia
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