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1.
Recurso na Internet em Português | LIS - Localizador de Informação em Saúde | ID: lis-48401

RESUMO

Página da VideoSaúde em homenagem aos 80 anos de Sergio Arouca que reuniu em uma playlist no seu Canal no YouTube alguns registros históricos do médico sanitarista disponíveis em seu acervo. Ao todo são seis vídeos com depoimentos, palestras e pronunciamentos do professor, pesquisador e também do Arouca político, que foi deputado federal pelo Rio de Janeiro por dois mandatos (1991-1995 e 1995-1999) e candidato à vice-presidência da República em 1989


Assuntos
Mídia Audiovisual , Biografia , Reforma dos Serviços de Saúde
2.
BMC Health Serv Res ; 21(1): 768, 2021 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-34344362

RESUMO

BACKGROUND: Residents' preference for primary health care (PHC) determined their utilization of PHC. This study aimed to assess the determinants of PHC service preference among the residents and the trend in PHC service preference over time in China. METHODS: We employed the nationally representative longitudinal data from 2012 to 2018 based on the China Family Panel Studies. The analysis framework was guided by the Andersen model of health service utilization. We included a total of 12,508 individuals who have been successfully followed up in the surveys of 2012, 2014, 2016, and 2018 without any missing data. Logistic regressions were performed to analyze potential predictors of PHC preference behavior. RESULTS: The results indicated that individuals' socio-economic circumstances and their health status factors were statistically significant determinants of PHC preference. Notably, over time, the residents' likelihood of choosing PHC service represented a decreasing trend. Compare to 2012, the likelihood of PHC service preference decreased by 18.6% (OR, 0.814; 95% CI, 0.764-0.867) in 2014, 30.0% (OR, 0.700; 95% CI, 0.657-0.745) in 2016, and 34.9% (OR, 0.651; 95% CI, 0.611-0.694) in 2018. The decrease was significantly associated with the changes in residents' health status. CONCLUSIONS: The residents' likelihood of choosing PHC service represented a decreasing trend, which was contrary to the objective of China's National Health Reform in 2009. We recommend that policymakers adjust the primary service items in PHC facilities and strengthen the coordination of service between PHC institutions and higher-level hospitals.


Assuntos
Reforma dos Serviços de Saúde , Atenção Primária à Saúde , China , Estudos de Coortes , Serviços de Saúde , Humanos
3.
Artigo em Inglês | MEDLINE | ID: mdl-34360330

RESUMO

The effects of public hospital reforms on spatial and temporal patterns of health-seeking behavior have received little attention due to small sample sizes and low spatiotemporal resolution of survey data. Without such information, however, health planners might be unable to adjust interventions in a timely manner, and they devise less-effective interventions. Recently, massive electronic trip records have been widely used to infer people's health-seeking trips. With health-seeking trips inferred from smart card data, this paper mainly answers two questions: (i) how do public hospital reforms affect the hospital choices of patients? (ii) What are the spatial differences of the effects of public hospital reforms? To achieve these goals, tertiary hospital preferences, hospital bypass, and the efficiency of the health-seeking behaviors of patients, before and after Beijing's public hospital reform in 2017, were compared. The results demonstrate that the effects of this reform on the hospital choices of patients were spatially different. In subdistricts with (or near) hospitals, the reform exerted the opposite impact on tertiary hospital preference compared with core and periphery areas. However, the reform had no significant effect on the tertiary hospital preference and hospital bypass in subdistricts without (or far away from) hospitals. Regarding the efficiency of the health-seeking behaviors of patients, the reform positively affected patient travel time, time of stay at hospitals, and arrival time. This study presents a time-efficient method to evaluate the effects of the recent public hospital reform in Beijing on a fine scale.


Assuntos
Cartões Inteligentes de Saúde , Reforma dos Serviços de Saúde , Hospitais Públicos , Humanos
7.
BMJ Open ; 11(8): e048449, 2021 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-34433597

RESUMO

INTRODUCTION: In the past three decades, China has made great strides in the prevention and treatment of tuberculosis (TB). However, the TB burden remains high. In 2019, China accounted for 8.4% of global incident cases of TB, the third highest in the world, with a higher prevalence in rural areas. The Healthy China 2030 highlights the gate-keeping role of primary healthcare (PHC). However, the impact of PHC reforms on the future TB burden is unclear. We propose to use mathematical models to project and evaluate the impacts of different gate-keeping policies. METHODS AND ANALYSIS: We will develop a deterministic, population-level, compartmental model to capture the dynamics of TB transmission within adult rural population. The model will incorporate seven main TB statuses, and each compartment will be subdivided by service providers. The parameters involving preference for healthcare seeking will be collected using discrete choice experiment (DCE) method. We will solve the deterministic model numerically over a 20-year (2021-2040) timeframe and predict the TB prevalence, incidence and cumulative new infections under the status quo or various policy scenarios. We will also conduct an analysis following standard protocols to calculate the average cost-effectiveness for each policy scenario relative to the status quo. A numerical calibration analysis against the available published TB prevalence data will be performed using a Bayesian approach. ETHICS AND DISSEMINATION: Most of the data or parameters in the model will be obtained based on secondary data (eg, published literature and an open-access data set). The DCE survey has been reviewed and approved by the Ethics Committee of the School of Public Health, Sun Yat-sen University. The approval number is SYSU [2019]140. Results of the study will be disseminated through peer-reviewed journals, media and conference presentations.


Assuntos
Tuberculose , Adulto , Teorema de Bayes , China/epidemiologia , Reforma dos Serviços de Saúde , Humanos , Modelos Teóricos , Atenção Primária à Saúde , Tuberculose/epidemiologia , Tuberculose/prevenção & controle
8.
Orv Hetil ; 162(32): 1283-1296, 2021 08 08.
Artigo em Húngaro | MEDLINE | ID: mdl-34370687

RESUMO

Összefoglaló. Bevezetés: Az öngyilkosság régóta jelentos probléma hazánkban. Célkituzés: Az elmúlt 20 év során elkövetett, befejezett öngyilkosságok elemzése három idointervallumban (2000-2006, 2006-2010, 2010-2019) nemek, korcsoportok, az elkövetési mód, a családi állapot és a munkanélküliség szempontjából. További célunk volt a pszichiátriai ellátást negatívan érinto, 2007. évi egészségügyi reform suicid halálozással való összefüggéseinek vizsgálata. Módszer: A suicid halálozást a Központi Statisztikai Hivatal adatainak felhasználásával elemeztük. Az évenkénti suicid rátát 100 000 lakosra adtuk meg. Az adatok statisztikai feldolgozásához az Excel 2011-es, az SPSS 23-as és az amerikai NIH Jointpoint programjának 4.8.0.1-as verzióját használtuk. Eredmények: 2000 és 2019 között 51,4%-kal csökkent a suicid halálozás (nok: 15,57 vs. 7,69/100 000 fo; férfiak: 51,5 vs. 24,73/100 000 fo, összlakosság: 32,61 vs. 15,85/100 000 fo). A legnagyobb mértékben a férfiak és a középkorúak körében csökkent a mortalitási ráta, a legkevésbé a fiatal, egyedülálló noknél. A leggyakoribb elkövetési mód változatlanul az akasztás (58,4%). A 20 évig tartó rátacsökkenés 2006 után több évre megtorpant, és egészen 2010-ig nagyjából konstans maradt (24,43 vs. 24,88/100 000 fo). Azt feltételezzük, hogy ennek hátterében jelentos részben a pszichiátriai ellátórendszert negatívan érinto, 2007-ben bevezetett egészségügyi reform állt. Ez a megtörés kimutatható volt szinte minden korcsoportnál, a leggyakoribb elkövetési módoknál, és egyaránt érintette a hajadonokat/notleneket, a házasokat, az özvegyeket és az elváltakat. Csak 2010 után kezdodött újra a suicid mortalitás szignifikáns csökkenése. Az utolsó 10 év alatt 36,3%-kal csökkent a suicid mortalitás (24,88 vs. 15,85/100 000 fo), ami kiemelkedo eredmény az európai országok körében. Következtetés: Egy elhibázott, a pszichiátriai ellátórendszert sújtó egészségügyi reform következményeként az addig egyenletesen csökkeno suicid halálozás üteme 2006 után megtört, és néhány évig stagnált. Több évig tartott, mire bizonyos mértékig rendezodött a pszichiátriai ellátórendszer, és ennek köszönhetoen 2010 után ismét folyamatosan és szignifikánsan csökkent a suicid mortalitás. Orv Hetil. 2021; 162(32): 1283-1296. INTRODUCTION: In Hungary, suicide has been a major public health issue for a long time. OBJECTIVE: Our objective was to examine data on completed suicide cases in Hungary from a 20-year period divided into three intervals (2000-2006; 2006-2010; 2010-2019) grouped by sex, age, methods of commitment, marital and employment statuses. An auxiliary aim was to assess the associations between the healthcare reform in 2007 (with unfavourable impacts on the psychiatric care system) and suicide mortality. METHOD: Data on suicide were provided by the Hungarian Central Statistical Office. In all cases, the yearly suicide rates were given for 100 000 inhabitants. For statistical calculations, we used Excel 2011, SPSS v. 23 and NIH Joinpoint Regression Program v. 4.8.0.1. RESULTS: Between 2000 and 2019, there was a 51.4% reduction in the suicide mortality (females: 15.57 vs. 7.69/100 000; males: 51.5 vs. 24.73/100 000; total population: 32.61 vs. 15.85/100 000). The greatest declines occurred among males and middle-aged. At the same time, the rate of young single females declined only slightly. The most common method of commitment remained hanging (58.4%). During the 20-year-long period investigated, there was a temporary halt between 2006 (24.43/100 000) and 2010 (24.88/100 000) in the otherwise steadily declining trend of the rate. One of the major underlying causes of this plateau is presumed to be the healthcare reform commenced in 2007 with negative impacts on psychiatric services. This plateau was observable in almost all subpopulations irrespective of their age, marital status and the suicide method they used. The decline of the rate restarted only after 2010. In the last 10 years, suicide mortality has decreased by 36.3% (from 24.88 to 15.85/100 000) in Hungary, which is a very good result in a European comparison. CONCLUSION: Due to an unsound health reform threatening the psychiatric care, the previously experienced declining trend of the suicide rate halted in 2006 and has remained almost unchanged for a few years during which psychiatric services could be restored in some degree. From 2010, as a consequence of this restoration, the marked decline of the suicide rate restarted and has been remained stable. Orv Hetil. 2021; 162(32): 1283-1296.


Assuntos
Suicídio Consumado , Suicídio , Causalidade , Feminino , Reforma dos Serviços de Saúde , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade
9.
Front Public Health ; 9: 701201, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34277559

RESUMO

This study analyzed performance of public hospitals and regional differences in performance following reform of medical service prices in Guangdong province, China. From three cities in four regions, we randomly selected a total of 12 traditional Chinese medicine hospitals and 12 general tertiary hospitals. Six questionnaires were completed by the hospitals, using 2014-2018 internal data. Principal components analysis was used to compare performances of the hospitals and regions following price reform. The extent to which medical service prices were adjusted varied considerable for different procedures in the same region and for the same category of procedures among regions. After reform, compensation for medical services in public hospitals reached the target of 80%, except in the Western region. However, annual growth of costs to patients was generally above 4%; the burden on patients was not alleviated by fee control. Reforms were more effective for comprehensive than Chinese traditional medicine hospitals. Performance scores of general hospitals in the Pearl River Delta, Eastern, Western, and Northern regions were 1.24, 1.16, -0.22, and -1.01, respectively. This is consistent with ranking by level of economic development of each region. The government should implement a regional medical service pricing mechanism. Additionally, comprehensive and traditional Chinese medicine hospitals should each have appropriate pricing policies. Future policies should focus on controlling costs incurred by patients.


Assuntos
Reforma dos Serviços de Saúde , Hospitais Públicos , China , Custos e Análise de Custo , Humanos , Políticas
10.
JAMA ; 326(2): 188-189, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34255011
11.
JAMA ; 326(2): 188, 2021 07 13.
Artigo em Inglês | MEDLINE | ID: mdl-34255013
12.
BMC Health Serv Res ; 21(1): 628, 2021 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-34193124

RESUMO

INTRODUCTION: Between 2010 and 2018, Greece implemented an Economic Adjustment Programme and underwent a series of extensive reforms, including in the health sector. We conducted a scoping review to examine whether the Primary Health Care reforms during that period assisted the country in moving towards Universal Health Coverage. METHODS: We performed a review of the literature on the following databases: Scopus, PubMed, Epistemonikos, Web of Science, and Google Scholar, including published research articles and grey literature. Findings were synthesised thematically, using the World Health Organization Universal Health Coverage dimensions: population coverage, service coverage, and financial protection. RESULTS: Forty-four documents were included in this review. Out of these, thirty-eight were research-based (thirty-three qualitative, two quantitative, and three mixed design studies), two grey literature, and four legislative bills. The evidence suggests that despite the systemic interventions addressing longstanding distortions, population coverage, service coverage and financial protection have not significantly improved. CONCLUSIONS: This review suggests that Primary Health Care reforms in Greece have not managed to substantially improve Universal Health Coverage, although some positive steps towards that direction have taken place with the establishment of community-based multidisciplinary health teams. Before further interventions are implemented, an evidence-based monitoring and evaluation mechanism is necessary in order to clearly evaluate their effectiveness and progress.


Assuntos
Reforma dos Serviços de Saúde , Cobertura Universal do Seguro de Saúde , Grécia , Humanos
13.
BMC Health Serv Res ; 21(1): 658, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225708

RESUMO

BACKGROUND: Low and middle income countries has recently implemented various reforms toward Universal Health Coverage (UHC). This study aims to assess the impact of Family Physician Plan (FPP) and Health Transformation Plan (HTP) on hospitalization rate in Iran. METHODS: We conducted an Interrupted Time Series (ITS) design. The data was monthly hospitalization of Mazandaran province over a period of 7 years. Segmented regression analysis was applied in R version 3.6.1. RESULTS: A decreasing trend by - 0.056 for every month was found after implementation of Family Physician Plan, but this was not significant. Significant level change was appeared at the beginning of Health Transformation Plan and average of hospitalization rate increased by 1.04 (P < 0.001). Also hospitalization trend increased significantly nearly 0.09 every month in period after Health Transformation Plan (P < 0.001). CONCLUSIONS: Family physician created a decreasing trend for hospitalization in urban area of Mazandaran province in Iran. HTP with lower user fee in governmental public hospitals and clinics as well as fee-for-service mechanisms, stimulated both level and trend changes in hospital admissions. Some integrated health policy is required to optimize the implementation of diverse simultaneous reforms in low and middle-income countries.


Assuntos
Reforma dos Serviços de Saúde , Médicos de Família , Hospitalização , Humanos , Análise de Séries Temporais Interrompida , Irã (Geográfico)/epidemiologia
14.
Soc Sci Med ; 283: 114210, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34274783

RESUMO

To reduce the heavy reliance of public hospitals on drug sales and use of advanced technologies and to contain the escalating medical expenditures, Beijing implemented two rounds of comprehensive public hospital reform in 2017 and 2019, respectively. The first round focused on separating drug sales from hospital revenue (reform1), and the second round extended to include zero markup on medical consumables and price adjustments for medical services (reform2). To estimate how these two rounds of reform have affected public hospitals' revenue structures, we used observational data of medical revenues from 2016 to 2019 covering 354 healthcare facilities. A Panel-interrupted time-series (PITS) model was used to analyze the effects. The results suggest that the reforms have changed the structure of public hospitals' revenues. The proportion of drug sales in hospital revenues fell from 43.96% in 2016 (pre-reform) to 34.08% in 2019 (post-reform); the proportions of medical consumables decreased by 0.73% after reform 2; and the proportion of medical consultation service fees increased from 15.16% in 2016 to 24.51% in 2019. PITS analysis showed that the proportion of drug sales dropped by 5.46% in the month of reform 1, and it dropped by 0.20% per month on average after reform 2(p < 0.001). The proportion of medical consumables decreased by 0.04% per month on average after reform 2 (p < 0.001). The proportion of medical consultation service increased by 7.13% in the month of reform 1, and it increased by 0.14% per month on average after reform 2(p < 0.001). Similar trends were seen in hospital revenue structures from both inpatient services and from outpatient and accident and emergency services. Thus, Beijing's reforms successfully contained rising medical expenditures and optimized hospitals' revenue structures. These reforms can provide a reference for further public hospital reforms in China and other countries with similar systems.


Assuntos
Custos de Medicamentos , Reforma dos Serviços de Saúde , Pequim , China , Gastos em Saúde , Hospitais Públicos , Humanos
16.
Lima; Perú. Ministerio de Salud; 1ra ed; 20210700. 53 p. ilus.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1282190

RESUMO

El documento contiene: Antecedentes, evolución y perspectivas de la políticas de salud en el Perú, el Acuerdo Nacional y la salud, breve recuento en materia de rectoría y gasto público, un quinquenio de cambios mundiales: la Agenda 2030 y los Objetivos de Desarrollo Sostenible, la pandemia de COVID-19 en las Américas, aportes para la transformación de la salud en un contexto de crisis, El camino de la cobertura universal.


Assuntos
Reforma dos Serviços de Saúde , Infecções por Coronavirus , Impactos na Saúde , Cobertura Universal do Seguro de Saúde , Gestão em Saúde , Pandemias , Desenvolvimento Sustentável , Despesas Públicas , Política de Saúde
17.
Lima; Perú. Ministerio de Salud; 1ra ed; 20210700. 98 p. ilus.
Monografia em Espanhol | MINSAPERÚ | ID: biblio-1282191

RESUMO

El documento contiene: La Política Nacional Multisectorial de Salud al 2030: Perú, País Saludable, El Modelo de Cuidado Integral de Salud por Curso de Vida, Evolución de la rectoría del sector salud: 2016-2021, Redes Integradas de Salud ­ RIS, Financiamiento en salud, Cobertura Universal de Salud - Seguro Integral de Salud, Gestión de riesgos, Derechos en salud: SUSALUD, Trabajando por más salud, Recursos humanos en salud, Agenda Digital del Sector Salud 2020-2025, Medicamentos, Actualización del Plan Esencial de Aseguramiento en Salud PEAS 2021 - DS 023-2021-SA.


Assuntos
Gestão de Riscos , Preparações Farmacêuticas , Reforma dos Serviços de Saúde , Assistência Integral à Saúde , Impactos na Saúde , Desenvolvimento Institucional , Agenda de Prioridades em Saúde , Recursos Humanos , Financiamento da Assistência à Saúde , Cobertura Universal de Saúde , Mão de Obra em Saúde , Política de Saúde , Seguro , Gestão em Saúde
19.
Front Public Health ; 9: 504998, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34136446

RESUMO

Background: In 2010, Sweden opened up for establishment of privately owned primary health care providers, as part of a national Free Choice in Primary Health Care reform. The reform has been highly debated, and evidence on its effects is scarce. The present study therefore sought to evaluate whether the reform have impacted on primary health care service performance. Methods: This ecological register-based study used a natural experimental approach through an interrupted time series design. Data comprised the total adult population of the 21 counties of Sweden 2001-2009 (pre-intervention period) and 2010-2016 (post-intervention period). Hospitalizations and emergency department visits for ambulatory care sensitive conditions (ACSC) were used as indicators of primary health care performance. Segmented regression analysis was used to assess the effects of the reform, in Sweden as a whole, as well as compared between counties grouped by (i) change in private provision pre- to post reform; (ii) the timing of the implementation; and (iii) sustained presence of private providers both pre- and post-reform. Results: The results suggest that, following the introduction of the reform in Sweden as a whole, the trends in total hospitalizations rates were slowed down by 1.0% albeit acute emergency visits increased 1.1% more rapidly after the introduction of the reform. However, we found no evidence of more beneficial effects in counties where the reform had been implemented more ambitiously, specifically those with a larger increase in private primary care providers, or where the reform was introduced early and thus had longer time effects to emerge. Lastly, counties with a sustained high presence of private primary care providers displayed the least favorable development when it comes to ACSC. Conclusion: Taken together, the present study does not support that the Swedish Free Choice reform has improved performance of the primary care delivery system in Sweden, and suggests that high degree of private provision may involve worse performance and higher care burden for specialized health care. Further evaluations of the consequences of the reform are dire needed to provide a comprehensive picture of its intended and unintended impact on health care provision, delivery and results.


Assuntos
Reforma dos Serviços de Saúde , Privatização , Adulto , Assistência Ambulatorial , Humanos , Atenção Primária à Saúde , Suécia
20.
Artigo em Inglês | MEDLINE | ID: mdl-34070687

RESUMO

With the deepening of health insurance reform in China, the integration of social health insurance schemes was put on the agenda. This paper aims to illustrate the achievements and the gaps in integration by demonstrating the trends in benefits available from the three social health insurance schemes, as well as the influencing factors. Data were drawn from the three waves of the China Health and Nutrition Survey (2009, 2011, 2015) undertaken since health reforms commenced. χ2, Kruskal-Wallis test, and the Two-Part model were employed in the analysis. The overall reimbursement rate of the Urban Employee Basic Medical Insurance (UEBMI) is higher than that of Urban Resident Basic Medical Insurance (URBMI) or the New Rural Cooperative Medical Scheme (NRCMS) (p < 0.001), but the gap has narrowed since health reform began in 2009. Both the outpatient and inpatient reimbursement amounts have increased through the URBMI and NRCMS. Illness severity, higher institutional level, and inpatient service were associated with significant increases in the amount of reimbursement received across the three survey waves. The health reform improved benefits covered by the URBMI and NRCMS, but gaps with the UEBMI still exist. The government should consider more the release of health benefits and how to lead toward healthcare equity.


Assuntos
Reforma dos Serviços de Saúde , Seguro Saúde , China , Humanos , População Rural , Previdência Social , População Urbana
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