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1.
Rev Saude Publica ; 53: 94, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31644724

RESUMO

OBJECTIVE: To evaluate trends in the use of generic and non-generic medicines to treat hypertension and diabetes under the Farmácia Popular Program (FP) and its impact on generic medicines sales volume and market share in the Brazilian pharmaceutical market. METHODS: This longitudinal, retrospective study used interrupted time series design to analyze changes in monthly sales volume and proportion of medicines sales (market share) for oral antidiabetic and antihypertensive medicines for generic versus non-generic products. Analyses were conducted in a combined dataset that aggregate monthly sales volumes from the Farmácia Popular program and from the QuintilesIMS™ (IQVIA) national market sales data from January 2007 to December 2012. The Farmácia Popular program phases analyzed included: a) 2009 reductions in medicines reference prices (AFP-II) and b) 2011 implementation of free medicines program for hypertension and diabetes, the Saúde não tem preço (SNTP - Health has no price). RESULTS: Patterns of use for FP-covered antidiabetic and antihypertensive medicines were similar to their use in the market in general. After one year of the decreases in government subsidies in April 2010, market share of antidiabetic and antihypertensive medicines experienced relative declines of -54.5% and -59.9%, respectively. However, when FP-covered medicines were made free to patients, overall market volume for antidiabetic and antihypertensive generics increased dramatically, with 242.6% and 277.0% relative increases by February 2012, as well as non-generics with relative increase of 209.7% and 279% for antidiabetic and antihypertensive medicines, respectively. CONCLUSIONS: Ministry of Health policies on the amount of patient cost sharing and on the choice of medicines on coverage lists have substantial impacts on overall generic sales volume in retail pharmacies.


Assuntos
Anti-Hipertensivos/uso terapêutico , Comércio/tendências , Serviços Comunitários de Farmácia/tendências , Medicamentos Genéricos/uso terapêutico , Hipoglicemiantes/uso terapêutico , Programas Nacionais de Saúde/tendências , Brasil , Comércio/estatística & dados numéricos , Serviços Comunitários de Farmácia/estatística & dados numéricos , Diabetes Mellitus/tratamento farmacológico , Política de Saúde , Humanos , Hipertensão/tratamento farmacológico , Análise de Séries Temporais Interrompida , Estudos Longitudinais , Programas Nacionais de Saúde/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Farmácias/tendências , Avaliação de Programas e Projetos de Saúde , Valores de Referência , Estudos Retrospectivos , Fatores de Tempo
2.
Rev Saude Publica ; 53: 87, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31576946

RESUMO

OBJECTIVE: To analyze the trend of opinion and satisfaction indicators of the Spanish national health system from 2005 to 2017. METHODS: Ecological study of time series analyzing the trend of eight indicators of opinion and satisfaction on the Spanish national health system and its autonomous communities from 2005 to 2017. The data was obtained from the Ministry of Health, Social Services and Equality and from the Health Barometer. The Prais-Winsten regression method was used. RESULTS: A static tendency was observed in the perception of users on how the health system works (APC = 1.898, 95%CI -0.954 - 4.751) and decreasing opinion on the improvement of primary care (APC = -0.283; 95%CI -0.335 - -0.121), specialized (APC = -0.241, 95%CI -0.74 - -0.109) and hospitalization (APC = -0.171, 95%CI -0.307 - -0.036). Satisfaction with knowledge and follow-up by the family doctor and pediatrician showed an increasing trend (APC = 7.939, 95%CI 3.965 - 11.914). Satisfaction with medical and nursing professionals was static. No large differences were observed in the trends of the indicators studied in the autonomous communities. CONCLUSIONS: A negative trend was observed in the opinion of the Spanish national health system users. Financing, human resources, quality management systems and differences in the autonomous communities may be some of the causes.


Assuntos
Programas Nacionais de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/tendências , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/tendências , Pesquisa sobre Serviços de Saúde , Humanos , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Valores de Referência , Análise de Regressão , Espanha , Fatores de Tempo
5.
Cien Saude Colet ; 24(6): 1997-2008, 2019 Jun 27.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31269153

RESUMO

The analysis of health policy trajectories contributes to disclose the endogenous and exogenous elements that influence the management of health systems. This article aims to describe the trajectory of the Unified Health System of the Federal District (SUS-DF) from 1960 to 2018 and identify the challenges to expand the capacity for protection and health promotion of the population of the Federal District. A documentary analysis of plans, reports, and articles published from 1959 to 2018 and the collection of secondary data were carried out in databases of DATASUS and the Government of the Federal District. RESULTS The SUS-DF trajectory was delineated through care organization actions, health system management and health care personnel training and development. Health indicators such as infant mortality and life expectancy at birth have shown a positive development. There was an increase in health care servicesupply, with an increase in the number of beds, basic health units and professionals, although insufficient, given the population increase. CONCLUSION the actions indicate the growing complexity of health system management, with challenges related to the adaptation of the capacity to respond to the population'shealth needs and reveal internal potentials in the field of health training.


Assuntos
Política de Saúde/tendências , Programas Nacionais de Saúde/tendências , Brasil , Assistência à Saúde/organização & administração , Assistência à Saúde/tendências , Promoção da Saúde/métodos , Humanos , Programas Nacionais de Saúde/organização & administração
7.
Psychiatry Res ; 276: 107-111, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31048180

RESUMO

Electroconvulsive therapy (ECT) as well as the diseases it treats have been associated with stroke and cognitive impairment. We investigate the relationship between ECT and the subsequent development of stroke in patients with different severe mental illnesses. Tapping Taiwan's National Health Insurance Research Database, we identified patients diagnosed with severe mental illnesses who had received ECT between Jan 1, 2002 and Dec 31, 2007. A comparison cohort was constructed of patients who were matched by age, gender, and diagnosis but did not receive ECT. The patients were then followed up for occurrence of subsequent new-onset stroke. We identified 6264 patients had been diagnosed with mental illness and had received ECT. They were matched with 18,664 mentally ill patients who had not. The study cohort had a lower incidence of subsequent stroke than the matched controls, after controlling for age, diabetes, hypertension, coronary heart disease and enrollee sociodemographic category, risk factors for stroke in both study and control cohorts. ECT is associated with reduced risk of subsequent stroke in patients with severe mental illnesses in Taiwan. Therefore, clinicians should not let risk of stroke stop them from suggesting ECT to physically healthy patients who might benefit from this therapy.


Assuntos
Eletroconvulsoterapia/métodos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Vigilância da População , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Adulto , Idoso , Estudos de Coortes , Eletroconvulsoterapia/tendências , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pessoa de Meia-Idade , Programas Nacionais de Saúde/tendências , Estudos Retrospectivos , Fatores de Risco , Comportamento de Redução do Risco , Acidente Vascular Cerebral/psicologia , Taiwan/epidemiologia
8.
Rev Bras Enferm ; 72(2): 367-374, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31017198

RESUMO

AIM: To evaluate quality of the Family Health Strategy (FHS) in the National Program for Improving Access and Quality of Primary Care in the Federal District (FD) from the perspective of users. METHODS: Evaluative research carried out in 25 basic health units of the Federal District through a validated questionnaire assessing the following dimensions: access, gateway, bond, service range, coordination, family focus, community orientation, and health professionals. RESULTS: Service provision, qualification of professionals, quality of professional-user relationship, and continuity of care were the best evaluated dimensions, while family approach, community approach, and access were the worst. Access to the FHS was found to be compromised, besides failing to establish itself as gateway to the FD health system. CONCLUSION: When they can access the local system, FD users do enjoy several services, but access is still a barrier, mainly because the very system is not prepared to meet users' needs/preferences. The dimensions regarding family focus and community orientation are precarious, which reveals the need for reflection on the care model adopted in the Federal District.


Assuntos
Governo Federal , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/tendências , Atenção Primária à Saúde/tendências , Qualidade da Assistência à Saúde/tendências , Inquéritos e Questionários
9.
10.
Value Health ; 22(3): 362-369, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832975

RESUMO

BACKGROUND: Decision makers are facing growing challenges in prioritizing drugs for reimbursement because of soaring drug costs and increasing pressures on financial resources. In addition to cost and effectiveness, payers are using other values to dictate which drugs are prioritized for funding, yet there are limited data on the Canadian public's priorities. OBJECTIVES: To measure the relative societal importance of values considered most relevant in informing drug reimbursement decisions in a representative sample of Canadians. METHODS: An online survey of 2539 Canadians aged 19 years and older was performed in which 13 values used in drug funding prioritization were ranked and then weighted using an analytic hierarchy process. RESULTS: Canadians value safe and efficacious drugs that have certainty of evidence. The values ranked in the top 5 by most of our subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). Values related to patient or disease characteristics such as rarity, socioeconomic status, and health and lifestyle choices held the lowest rankings and weights. CONCLUSIONS: Canadians value, above all, treatment-related factors (eg, efficacy and safety) and disease-related factors (eg, severity and equity). Decision makers are currently using additional justifications to prioritize drugs for reimbursement, such as rarity and unmet need, which were not found to be highly valued by Canadians. Decision makers should integrate the public's values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds.


Assuntos
Tomada de Decisões , Custos de Medicamentos/tendências , Cobertura do Seguro/tendências , Programas Nacionais de Saúde/tendências , Inquéritos e Questionários , Adulto , Canadá/epidemiologia , Tomada de Decisões/fisiologia , Custos de Medicamentos/normas , Feminino , Humanos , Cobertura do Seguro/normas , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/normas , Produção de Droga sem Interesse Comercial/métodos , Produção de Droga sem Interesse Comercial/normas , Inquéritos e Questionários/normas
11.
Saúde debate ; 43(120): 256-268, jan.-mar. 2019. graf
Artigo em Português | LILACS, Repositório RHS | ID: biblio-1004680

RESUMO

RESUMO O acesso à saúde de forma universal e equitativa está preconizado na Constituição Federal de 1988, devendo ser garantida pelo Sistema Único de Saúde (SUS). Dentre os diversos fatores que contribuem para a não efetivação dos princípios do SUS, destacam-se a insuficiência de profissionais e as disparidades regionais na distribuição de recursos humanos, principalmente médicos. Este artigo relata a experiência de avaliação do Programa Mais Médicos (PMM) por uma equipe multidisciplinar composta por 28 pesquisadores, a partir de trabalho de campo em 32 municípios com 20% ou mais da população em extrema pobreza selecionados em todas as regiões do Brasil (áreas remotas, distantes das capitais e comunidades quilombolas rurais), além de análises sobre os 5.570 municípios brasileiros baseadas em bancos de dados do Ministério da Saúde. A pesquisa resultou em vasta produção científica, apontando importantes resultados, como ampliação do acesso à saúde e redução de internações evitáveis. As reflexões aqui trazidas permitem concluir que o PMM contribuiu para a efetivação e consolidação dos princípios e diretrizes do SUS e garantiu acesso à saúde, especialmente para as populações mais pobres, municípios pequenos e regiões remotas e longínquas.


ABSTRACT The universal and equitable access to health is established in the Brazilian Federal Constitution of 1988 and must be guaranteed by the Brazilian Unified Health System - the Sistema Único de Saúde (SUS). The lack of professionals and the large regional differences in the distribution of human resources, mainly physicians, are factors that contribute to the non-fulfillment of the SUS principles. This article reports the experience of evaluation of the More Doctors Program (PMM) by a multidisciplinary team composed of 28 researchers, based on field work in 32 municipalities with 20% or more of the population in extreme poverty selected in all regions of Brazil (remote areas, far from capitals, and rural maroon communities), as well as analyzes of the 5,570 Brazilian municipalities based on the Ministry of Health databases. The research resulted in a vast scientific production, pointing out important results, such as broadening of access to health and reducing of avoidable hospitalizations. The reflections brought here show that the PMM contributed to the implementation and consolidation of the SUS principles and guidelines, and guaranteed access to health, especially for the poorest populations, small municipalities and remote and distant regions.


Assuntos
Humanos , Serviços de Saúde Rural/tendências , Mão de Obra em Saúde/tendências , Atenção Primária à Saúde , Brasil , Programas Nacionais de Saúde/tendências
12.
JMIR Mhealth Uhealth ; 7(1): e3, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30664488

RESUMO

BACKGROUND: Changing population demographics and technology developments have resulted in growing interest in the potential of consumer-facing digital health. In the United Kingdom, a £37 million (US $49 million) national digital health program delivering assisted living lifestyles at scale (dallas) aimed to deploy such technologies at scale. However, little is known about how consumers value such digital health opportunities. OBJECTIVE: This study explored consumers' perspectives on the potential value of digital health technologies, particularly mobile health (mHealth), to promote well-being by examining their willingness-to-pay (WTP) for such health solutions. METHODS: A contingent valuation study involving a UK-wide survey that asked participants to report open-ended absolute and marginal WTP or willingness-to-accept for the gain or loss of a hypothetical mHealth app, Healthy Connections. RESULTS: A UK-representative cohort (n=1697) and a dallas-like (representative of dallas intervention communities) cohort (n=305) were surveyed. Positive absolute and marginal WTP valuations of the app were identified across both cohorts (absolute WTP: UK-representative cohort £196 or US $258 and dallas-like cohort £162 or US $214; marginal WTP: UK-representative cohort £160 or US $211 and dallas-like cohort £151 or US $199). Among both cohorts, there was a high prevalence of zeros for both the absolute WTP (UK-representative cohort: 467/1697, 27.52% and dallas-like cohort: 95/305, 31.15%) and marginal WTP (UK-representative cohort: 487/1697, 28.70% and dallas-like cohort: 99/305, 32.5%). In both cohorts, better general health, previous amount spent on health apps (UK-representative cohort 0.64, 95% CI 0.27 to 1.01; dallas-like cohort: 1.27, 95% CI 0.32 to 2.23), and age had a significant (P>.00) association with WTP (UK-representative cohort: -0.1, 95% CI -0.02 to -0.01; dallas-like cohort: -0.02, 95% CI -0.03 to -0.01), with younger participants willing to pay more for the app. In the UK-representative cohort, as expected, higher WTP was positively associated with income up to £30,000 or US $39,642 (0.21, 95% CI 0.14 to 0.4) and increased spending on existing phone and internet services (0.52, 95% CI 0.30 to 0.74). The amount spent on existing health apps was shown to be a positive indicator of WTP across cohorts, although the effect was marginal (UK-representative cohort 0.01, 95% CI 0.01 to 0.01; dallas-like cohort 0.01, 95% CI 0.01 to 0.02). CONCLUSIONS: This study demonstrates that consumers value mHealth solutions that promote well-being, social connectivity, and health care control, but it is not universally embraced. For mHealth to achieve its potential, apps need to be tailored to user accessibility and health needs, and more understanding of what hinders frequent users of digital technologies and those with long-term conditions is required. This novel application of WTP in a digital health context demonstrates an economic argument for investing in upskilling the population to promote access and expedite uptake and utilization of such digital health and well-being apps.


Assuntos
Telemedicina/métodos , Adulto , Estudos de Coortes , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/tendências , Medicina Estatal/organização & administração , Medicina Estatal/estatística & dados numéricos , Inquéritos e Questionários , Telemedicina/economia , Telemedicina/tendências , Reino Unido
13.
Isr J Health Policy Res ; 8(1): 13, 2019 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-30654847

RESUMO

The Israel Ministry of Health enacted regulations that aim to reduce private expenditure on healthcare services and mitigate social inequality. According to the modified rules, which went into effect in the second half of 2016, patients who undergo surgery in a private hospital and are covered by their healthcare provider's supplemental insurance (SI) make only a basic co-payment.The modified regulations limited the option of self-payment for advanced devices not covered by national health basket, meaning that patients for whom such devices are indicated had to pay privately for the entire procedure. These regulations applied to all medical and surgical devices not covered by national health insurance (NHI).Toric intraocular lenses (IOLs) are a case in point. These advanced lenses are implanted during cataract surgery to correct corneal astigmatism and, in indicated cases, obviate the need for complex eyeglasses postoperatively. Toric IOL implantation has been shown to be highly cost-effective in both economic and quality-of-life terms. Limitations of the use of these advanced IOLs threatened to increase social inequality.In 2017, further adjustments of the regulations were made which enabled supplemental charges for these advanced IOLs, performed through the SI programs of the healthcare medical organizations (HMOs). Allowing additional payment for these lenses at a fixed pre-set price made it possible to apply a supplemental part of the insurance package to the surgery itself. In mid 2018 these IOLs were included without budget in the national health basket, allowing for self-payment for the additional cost in addition to the basic coverage for all patients with NHI.This case study suggests that, in their efforts to enhance health care equity, policymakers may benefit if exercising due caution when limiting the extent to which SI programs can charge co-payments. This is because, when a service or product is not available via the basic NHI benefits package, limiting SI co-payments can sometimes result in a boomerang effect - leading to an increase in inequality rather than the sought-after decrease in inequality.


Assuntos
Equipamentos e Provisões , Política de Saúde , Oftalmologia/economia , Oftalmologia/legislação & jurisprudência , Astigmatismo/cirurgia , Catarata/terapia , Extração de Catarata/economia , Extração de Catarata/métodos , Humanos , Israel , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/tendências , Oftalmologia/instrumentação , Facoemulsificação/economia , Facoemulsificação/métodos
14.
Med Law Rev ; 27(2): 330-338, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30649508

RESUMO

In An NHS Trust and others v Y and another, the Supreme Court was asked to address the question of whether a court order must always be obtained before clinically assisted nutrition and hydration (CANH), which is keeping alive a person with a prolonged disorder of consciousness (PDOC). This case note explores the Court's decision to dispense with the need for such a court order and analyses that important change in approach from the perspective of the right to life protected in Article 2 European Convention on Human Rights (ECHR) as well as in the broader context of end of life decision-making.


Assuntos
Cuidados para Prolongar a Vida/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Apoio Nutricional , Suspensão de Tratamento/legislação & jurisprudência , Transtornos da Consciência/classificação , Humanos , Jurisprudência , Programas Nacionais de Saúde/tendências , Assistência Centrada no Paciente/ética , Assistência Centrada no Paciente/legislação & jurisprudência , Assistência Centrada no Paciente/tendências , Assistência Terminal/ética , Assistência Terminal/legislação & jurisprudência , Assistência Terminal/tendências , Reino Unido , Valor da Vida , Suspensão de Tratamento/tendências
15.
Rev Epidemiol Sante Publique ; 67 Suppl 1: S33-S40, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30639052

RESUMO

BACKGROUND: The state of populations' health is linked to their access to quality healthcare. Best achieving this primary condition - a health, social and humanitarian condition - is an ongoing public policy objective. Although significant effort goes into this, do public policies sufficiently take into account the state of health of the most vulnerable populations? In France, reducing the non-take-up (NTU) of healthcare is a priority in current national health insurance policy. Under the local plans to tackle non-take-up, lack of understanding and exit from the system (PLANIR), national health insurance is currently rolling out a regional and partnership-based intervention framework in order to prevent NTU of healthcare by welfare clients. This social investment is unprecedented, yet the impact of the framework on the most vulnerable populations still seems to be limited. METHOD: The study of this example is based on monitoring of the framework's general implementation. This task was entrusted to the research team co-founded by the author, ODENORE (Observatory for the Non-take-up of Social Rights and Public Services). It is organized in four parts: quantitative monitoring of the detection and addressing of non-take-up situations (n=160,000 questionnaires); analysis of the results through qualitative interviews with beneficiaries and individuals who rejected the framework (n=365 interviews); analysis of the framework's implementation, using qualitative interviews and participant observations at the services in charge of the framework's implementation (n=18 collective interviews across three sites), and an analysis of the partnership through collective interviews with all the actors in the areas involved in the framework (three sites). RESULTS: The analysis shows that the integration of the most vulnerable populations' state of health into a common-law framework for intervention is hindered by three limitations: the framework's neutrality regarding public decisions and non-decisions that exacerbate social and regional health inequalities; its organizational design, which does not take into account the need for long-term medical-psycho-social care; and the absence of regulation capable of bringing together and coordinating the actors working towards healthcare access locally but with different populations. CONCLUSION: The difficulties of integrating the most vulnerable populations into a common-law framework such as the one proposed by the national health insurance do not seem insurmountable-provided, that is, that the regulatory authority (the regional health agencies) are willing and able to make it a strategic organizational objective at local level.


Assuntos
Implementação de Plano de Saúde , Política de Saúde , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Populações Vulneráveis , Tomada de Decisões , Emergências , França/epidemiologia , Implementação de Plano de Saúde/legislação & jurisprudência , Implementação de Plano de Saúde/organização & administração , Implementação de Plano de Saúde/normas , Política de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/organização & administração , Disparidades em Assistência à Saúde/normas , Humanos , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , Direitos do Paciente/legislação & jurisprudência , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/legislação & jurisprudência , Atenção Primária à Saúde/organização & administração , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos
16.
Value Health Reg Issues ; 18: 24-29, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30419447

RESUMO

South Korea is the first Asian country to mandate the submission of pharmacoeconomic data for reimbursement decision making. For a new drug to be listed, it must demonstrate its value in terms of comparative effectiveness and cost effectiveness. The Health Insurance Review and Assessment Service (HIRA) judges the submitted drug's value and decides whether its coverage is appropriate on the basis of the recommendation of the Pharmaceutical Benefit Coverage Assessment Committee. Once the drug has been accepted by HIRA, the National Health Insurance Service and the sponsoring company negotiate the price and expected sales volume. Even if HIRA acknowledges the value of the drug, it cannot be listed if the negotiation fails. In the off-patent market, generic and original branded drugs are treated equally in terms of pricing. Once generics enter the market, both drug prices should be lowered to 53.55% or less of the on-patent price. Since the current system was implemented, concerns have been raised about a decline in the accessibility of new drugs, especially for high-priced drugs used to treat serious diseases. In 2013, several measures had been introduced aimed at improving the accessibility of these drugs. A risk-sharing scheme and an increase in the maximum acceptable cost-effectiveness ratio were subsequently initiated. Although these schemes have been successful in improving access to high-priced drugs, they are often criticized for reducing transparency in pricing. Finding a balance between accessibility and efficiency is still a challenge in Korea.


Assuntos
Controle de Medicamentos e Entorpecentes/métodos , Avaliação da Tecnologia Biomédica/métodos , Tomada de Decisões , Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/tendências , Controle de Medicamentos e Entorpecentes/tendências , Humanos , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/tendências , Mecanismo de Reembolso , República da Coreia , Avaliação da Tecnologia Biomédica/tendências
17.
Med Law Rev ; 27(2): 267-294, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-30272190

RESUMO

This article explores the relationship between obligation and publicly funded healthcare. Taking the National Health Service (NHS) as the focal point of discussion, the article presents a historical analysis of the shifting nature and function of obligation as it relates to this institution. Specifically, and drawing inspiration from recent literature that takes seriously the notion of the tie or bond at the core of obligation, the article explores how the forms of social relation and bonds underpinning a system like the NHS have shifted across time. This is undertaken via an analysis of Aneurin Bevan's vision of the NHS at its foundation, the importance today of the patient (and the individual generally) within publicly funded healthcare, and the role of contract as a contemporary governance mechanism within the NHS. A core feature of the article is its emphasis on the impact that a variety of economic factors-including privatisation, marketisation, and the role of debt and finance capital-are having on previously settled understandings of obligation and the forms of social relation underpinning them associated with the NHS. It is therefore argued that an adequate analysis of obligation in healthcare law and related fields must extend beyond the doctor-patient relationship and that of state-citizen of the classical welfare state in order to incorporate new forms of relation, such as that between creditor and debtor, and new actors, including private healthcare providers and financial institutions.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/ética , Assistência à Saúde/tendências , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/ética , Programas Nacionais de Saúde/tendências , Responsabilidade Social , Contratos , Assistência à Saúde/história , Economia/tendências , Ética nos Negócios , Ética Institucional , Financiamento Governamental/economia , Financiamento Governamental/ética , Financiamento Governamental/história , Financiamento Governamental/tendências , História do Século XX , Humanos , Relações Interprofissionais/ética , Programas Nacionais de Saúde/história , Privatização , Reino Unido
19.
Int J Cardiol ; 278: 46-50, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30553496

RESUMO

BACKGROUND: Dementia and aortic aneurysms share clinical risk factors and molecular signaling pathways. However, the association between dementia and aortic aneurysms has not been examined. The potential effects of open surgical repair (OSR) of aortic aneurysms on future dementia events are unknown. METHODS: We conducted this nationwide population-based, retrospective cohort study using the Taiwanese National Health Insurance Research Database (NHIRD). The cumulative incidence of dementia over a 13-yearfollow-up period was compared among 1)aortic aneurysms and non-aortic aneurysm patients and 2)aortic aneurysm patients who underwent OSR, endovascular aneurysm repair (EVAR) or nonsurgical treatment (NST). RESULTS: This study enrolled 19,921 aortic aneurysms patients and 19,921 matched controls. The aortic aneurysm cohort exhibited a significantly increased incidence of dementia compared with the controls (adjusted hazard ratio (HR)=3.559, p<0.001). Furthermore, 5409 aortic aneurysm patients were treated with surgical intervention, whereas 5409 matched aortic aneurysm patients were not. Aortic aneurysm patients who underwent OSR had a significantly lower incidence of dementia than those who underwent NST (adjusted HR=0.638, 95% confidence interval (CI)=0.411-0.764, p<0.001). Patients who underwent EVAR did not have a lower incidence of dementia than those who underwent NST. CONCLUSION: OSR was associated with a reduced incidence of dementia in patients with aortic aneurysms compared to NST.


Assuntos
Aneurisma Aórtico/epidemiologia , Aneurisma Aórtico/cirurgia , Demência/diagnóstico , Demência/epidemiologia , Programas Nacionais de Saúde/tendências , Idoso , Idoso de 80 Anos ou mais , Aneurisma Aórtico/psicologia , Estudos de Coortes , Demência/psicologia , Feminino , Seguimentos , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taiwan/epidemiologia , Resultado do Tratamento
20.
MMWR Morb Mortal Wkly Rep ; 67(50): 1392-1396, 2018 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-30571674

RESUMO

Ensuring availability of safe blood products through recruitment of voluntary, nonremunerated, blood donors (VNRDs) and prevention of transfusion-transmissible infections (TTIs), including human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and syphilis, is important for public health (1,2). During 2004-2016, the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) provided approximately $468 million in financial support and technical assistance* to 14 sub-Saharan African countries† with high HIV prevalence to strengthen national blood transfusion services (NBTSs)§ and improve blood safety and availability. CDC analyzed these countries' 2014-2016 blood safety surveillance data to update previous reports (1,2) and summarize achievements and programmatic gaps as some NBTSs begin to transition funding and technical support from PEPFAR to local ministries of health (MOHs) (2,3). Despite a 60% increase in blood supply since 2004 and steady declines in HIV prevalence (to <1% among blood donors in seven of the 14 countries), HIV prevalence among blood donors still remains higher than that recommended by the World Health Organization (WHO) (4). PEPFAR support has contributed to significant reductions in HIV prevalence among blood donors in the majority of PEPFAR-supported countries, and linking donors who screen HIV-positive to confirmatory testing and indicated treatment, as well as further reducing TTIs, remains a public health priority (5).


Assuntos
Transfusão de Sangue/tendências , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/tendências , África ao Sul do Saara , Humanos
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