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2.
Soc Sci Med ; 278: 113939, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33962321

RESUMO

Many physicians receive a payment for their performance (P4P). This performance is often linked to a health target that triggers a bonus when met. For some patients the target is easily met, while others require a significant amount of care to reach the target (if ever). This study contributes to the literature by providing evidence of how P4P affects allocation of care across patients with low and high responsiveness to treatment compared to a fixed payment, such as capitation and salary, under different degrees of resource constraint. Our evidence is based on a controlled laboratory experiment involving 143 medical students in Denmark in 2019. We find that patients who have the potential to reach the health target, gain care under P4P, whereas patients with no potential to reach it, may receive less care. Redistribution of care between patients under P4P arises when physicians are resource constrained. As many physicians are currently operating under tight resource constraints, policymakers should be careful to avoid unintended inequalities in patients' access to health care when introducing P4P. Risk-adjusting the performance target may potentially solve this issue.


Assuntos
Atenção à Saúde , Reembolso de Incentivo , Instalações de Saúde , Humanos , Alocação de Recursos , Salários e Benefícios
5.
BMJ Open ; 11(4): e045214, 2021 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-33906840

RESUMO

OBJECTIVES: To estimate the gender gap in hourly wages earned by medical specialists in their main jobs after controlling for age, number of hours worked and medical specialty. DESIGN: Observational using governmental administrative and survey data. SETTING: New Zealand public employed medical workforce. PARTICIPANTS: 3510 medical specialists who were employed for wages or a salary in a medical capacity by a New Zealand district health board (DHB) at the time of the March 2013 census, whose census responses on hours worked were complete and can be matched to tax records of earnings to construct hourly earnings. MAIN OUTCOME MEASURES: Hourly earnings in the DHB job calculated from usual weekly hours worked reported in the census and wage or salary earnings paid in the month recorded in administrative tax data. RESULTS: In their DHB employment, female specialists earned on average 12.5% lower hourly wages than their male counterparts of the same age, in the same specialty, who work the same number of hours (95% CI 9.9% to 15.1%). Adding controls for a wide range of personal and work characteristics decreased the estimated gap only slightly to 11.2% (95% CI 8.6% to 13.8%). At most, 4.5 percentage points can be explained by gender differences in experience at the same age. CONCLUSIONS: Male specialists earn a large and statistically significant premium over their female colleagues. Age, specialty and hours of work do not appear to drive these wage gaps. These findings suggest that employment agreements that specify minimum wages for each level of experience, and progression through these levels, are insufficient to eliminate gender wage gaps between similar men and women with the same experience.


Assuntos
Medicina , Especialização , Feminino , Humanos , Renda , Masculino , Nova Zelândia , Salários e Benefícios
6.
Artigo em Russo | MEDLINE | ID: mdl-33901378

RESUMO

In the Russian Federation, for long time legal uncertainty existed regarding relationship between the standards of medical care and clinical guidelines in organizing medical care support. In the actual legislation, there were no official definitions of concept "clinical guidelines". The obligation of of clinical guidelines implementation was limited by expertise of medical care quality. The article analyzes main stages of development and application of clinical guidelines regulation and their relationship with medical care standards as well. The special attention is paid to changes in regulatory legal acts establishing the clinical guidelines status and the new procedure of their development. The mechanisms of medical care quality control are evaluated. The particular attention is paid to the role of clinical guidelines in organization of population medicinal support.


Assuntos
Assistência ao Paciente , Qualidade da Assistência à Saúde , Humanos , Organizações , Federação Russa , Salários e Benefícios
7.
Artigo em Russo | MEDLINE | ID: mdl-33901386

RESUMO

The article considers the main facts of the biography of the field-doctor I. T. Voskoboynikov during his activities in the Kama mills (Izhevsk and Votkinsk ironworks) in the Vyatka Guberniya. The main stages of his service during the end of the XVIII - beginning of the XIX century are defined. The scope of medical duties and contribution to development of the social sphere of the mining department are analyzed. The article highlights the main problems of the regional health system that I. T. Voskoboynikov had to solve in the considering period. Among them were issues of full material support of Izhevsk and Votkinsk hospitals (both economic and medical parts), training and organization of smallpox vaccination. The attention is paid to the interaction of the field-doctor with the factory administration. According to the results of the study it is concluded that I. T. Voskoboynikov was one of the first field-doctors and inspectors of state mining hospitals and he stood at the origins of occupational medicine in two major industrial centers of the region. The research was based on materials from number of central and regional archives.


Assuntos
Médicos , História do Século XIX , História do Século XX , Hospitais , Humanos , Indústrias , Masculino , Mineração , Salários e Benefícios
8.
Pan Afr Med J ; 38: 84, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33889250

RESUMO

Methadone maintenance treatment is reported as cost-effective in treatment of opioid use disorder. Estimated cost of providing methadone varies widely in different regions but there is no data regarding cost of methadone treatment in Kenya. The aim of this study was to estimate the cost of methadone maintenance treatment at a methadone maintenance treatment clinic in Nairobi, Kenya from the perspective of the government, implementing partner and the clients. Data was collected for the period of February 2017 to September 2018 for 700 enrolled clients. The cost of providing methadone treatment was estimated as the sum of salaries, laboratory test, methadone and other commodities costs. The outcome was daily cost of methadone per client. The costs are given in Kenya Shillings (Ksh). The cost of treating one client is approximately Ksh. 149 (US$1.49) per day which amounts to Ksh 4500 (US$ 45) per month. This is from the estimated direct costs such as salaries which accounted for 86.4%, methadone 9.6%, tests and other consumables at 4%. The estimated average dose per patient per day is 60mg.This excludes indirect costs such as capital and set up cost, maintenance cost, training, drug import and distribution and other bills. The findings of this study show that the estimate cost of providing methadone at Nairobi, Kenya is comparable to that in other centers. This can help to inform policy makers on continued provision of methadone treatment in the country.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Metadona/economia , Tratamento de Substituição de Opiáceos/economia , Transtornos Relacionados ao Uso de Opioides/reabilitação , Instituições de Assistência Ambulatorial/economia , Análise Custo-Benefício , Custos de Medicamentos , Humanos , Quênia , Metadona/administração & dosagem , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/economia , Salários e Benefícios/economia
10.
Urol Clin North Am ; 48(2): 187-194, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33795052

RESUMO

The presence of women in genitourinary (GU) specialty training and practice has lagged significantly behind other fields. Current challenges include maternity leave, sexual harassment, and pay disparities. Despite these obstacles, the prevalence of women in GU specialty training has risen rapidly. One consequence of retiring male providers and higher numbers of female graduates will be a notable demographic shift in the percentage of GU care provided by these younger women. It will be essential to anticipate and acknowledge the unique concerns of this workforce, particularly in light of the concomitant aging of the US population and the associated increase in demand for GU care.


Assuntos
Médicas , Urologistas , Adulto , Escolha da Profissão , Mobilidade Ocupacional , Feminino , Humanos , Licença Parental , Gravidez , Salários e Benefícios , Sexismo
11.
Soc Sci Med ; 276: 113822, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33752103

RESUMO

Discrete choice experiments (DCEs) commonly include a monetary attribute. This enables willingness to pay (WTP), a monetary measure of benefit, to be estimated for non-monetary attributes. There has been concern that the inclusion of a cost attribute challenges the credibility of the experiment when valuing publicly funded healthcare systems. However, very little research has explored this issue. Using a UK sample, we allocated participants across two versions of a DCE: one including a cost attribute and the other excluding a cost attribute. The DCE was identical in all other respects. We find no significant difference in response time across the two surveys, monotonicity was higher for the COST DCE and cost was stated as the most commonly ignored attribute in the COST DCE. Whilst the inclusion of a cost attribute did not alter the structure of preferences, it resulted in a lower level of choice consistency. Using an unrestricted latent class model, we find evidence of a credibility effect: respondents with experience of paying for health services and who perceive the choices as realistic are less likely to ignore cost. Further, respondents with a higher response time are less likely to be cost minimisers. Results are robust across different model specifications and choice formats. DCE practitioners should give due consideration to cost credibility when including a cost attribute, ensuring participants engage with the cost attribute. Ways to do this are suggested, including careful motivation of the cost attribute, consideration to the appropriate payment vehicle and careful consideration to the cost attribute when developing and piloting the survey. Failure to do this will result in an invalid willingness to pay estimates and thus policy recommendations.


Assuntos
Comportamento de Escolha , Atenção à Saúde , Instalações de Saúde , Humanos , Preferência do Paciente , Salários e Benefícios , Inquéritos e Questionários
12.
J Expo Sci Environ Epidemiol ; 31(3): 404-411, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33774651

RESUMO

Occupational disease and injuries are the 8th leading cause of death in the United States. Low-wage and minority workers are more likely to work in hazardous industries and are thus at greater risk. Within the small business sector, in particular, the health of low-wage and minority workers is threatened by a multitude of complex and interrelated factors that increase their risk for injuries, death, and even chronic disease. The COVID-19 pandemic has amplified these concerns, as many low-wage and minority workers are essential workers, and many small businesses are reopening with little to no guidance. The article describes work-related health risks and reviews current research on occupational and social ecological approaches to improving the health of minority and low-wage workers primarily employed by small businesses. We propose a conceptual framework that integrates the social ecological model with the hierarchy of controls to address work-related health among low-wage and minority workers specifically in the small business sector. Community-based strategies are recommended to engage small business owners and workers in efforts to address their immediate needs, while building towards sustainable policy change over time. These strategies are of particular importance as small businesses reopen in the ongoing pandemic.


Assuntos
Exposição Ocupacional , Humanos , Pandemias , Salários e Benefícios , Empresa de Pequeno Porte , Estados Unidos/epidemiologia
14.
Cien Saude Colet ; 26(3): 1013-1022, 2021 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-33729355

RESUMO

The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.


Assuntos
/epidemiologia , Atenção à Saúde , Pessoal de Saúde , Pandemias , Atitude Frente a Morte , Brasil/epidemiologia , /transmissão , Atenção à Saúde/economia , Atenção à Saúde/normas , Atenção à Saúde/tendências , Família , Medo , Feminino , Pessoal de Saúde/economia , Pessoal de Saúde/psicologia , Humanos , Programas Nacionais de Saúde , Equipamento de Proteção Individual/provisão & distribuição , Salários e Benefícios/tendências , Fatores Sexuais , Fatores Sociológicos , Local de Trabalho/psicologia , Local de Trabalho/normas
15.
Artigo em Inglês | MEDLINE | ID: mdl-33668892

RESUMO

Long-term care coverage is not integrated into an individual's retirement strategy. It is an additional public health service that is not considered into private pension funds. Nevertheless, this coverage is not sufficient due to the problems of financial sustainability of the public pension systems. However, there are large sums in pension plans dedicated to paying retirement pensions that can be transformed into support for long-term care coverage. This paper develops a mechanism of pension transformation through the different mortality of the beneficiary when becoming a dependent beneficiary. This mechanism allows the beneficiary to convert their pension to LTC support at their own choice, without increasing the cost of the private pension scheme. The proposed model provides consistency in the pension that a retiree receives and adapts it to a retiree's life expectancy: the retiree receives a higher pension when he/she needs it most.


Assuntos
Pensões , Aposentadoria , Feminino , Expectativa de Vida , Masculino , Salários e Benefícios
16.
J Am Vet Med Assoc ; 258(6): 591-600, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33683953

RESUMO

OBJECTIVE: To explore the role of various factors in the wage gap between male and female veterinarians in the United States in 2016 and 2017. SAMPLE: 2,760 veterinarians across the United States. PROCEDURES: Data from the Census of Veterinarians Survey administered by the AVMA Economics Division in 2016 and 2017 were analyzed. The Kolmogorov-Smirnov 2-sample test was used to determine whether a difference existed between male and female income distributions at various levels of experience. Quantile regression was performed separately for male and female respondents to determine the direct effects of individual factors on incomes and compare the effects of practice ownership versus nonownership on income. RESULTS: Income distributions of men and women were unequal at lower experience ranges but equal at higher experience ranges. Income increased for men with each additional year of experience and with practice ownership. For women, practice owners in the lowest income quantile had a negative return to income; overall, their income benefited most from ownership in the form of partnerships. For certain groups, incomes of both genders were lower when they had absences from the workforce. CONCLUSIONS AND CLINICAL RELEVANCE: Findings suggested that the largest source of gender income disparity for veterinarians was attributable to female practice owners earning less than their male counterparts. Indeed, women earned more from specialty certifications than from owning a clinic. To decrease income disparities between genders, ways should be identified to support women-owned practices and promote equal pay.


Assuntos
Médicos Veterinários , Animais , Certificação , Feminino , Humanos , Renda , Masculino , Propriedade , Salários e Benefícios , Estados Unidos
17.
Ciênc. Saúde Colet ; 26(3): 1013-1022, mar. 2021.
Artigo em Português | LILACS | ID: biblio-1153827

RESUMO

Resumo Este texto tem como finalidade discutir o cuidado de trabalhadoras da área da saúde em face da Covid-19, sob a análise sociológica de autoras que o vêm discutindo enquanto um trabalho que é desempenhado, na sua maioria, pelas mulheres das classes populares, é desvalorizado e sofre baixa remuneração. É uma atividade que envolve as construções sociais das emoções e tem utilizado o corpo como um instrumento de trabalho no cuidado com o outro. Além disso, a precarização do trabalho em saúde na sociedade brasileira acirrada nas últimas décadas, como o aumento de contratos temporários, perdas de direitos trabalhistas, a sobrecarga das atividades, condições de trabalho precárias, dentre outros, soma-se com o aumento dos atendimentos médico-hospitalares diante da pandemia da Covid-19. Neste contexto, as trabalhadoras em saúde vivenciam as ausências de equipamentos de proteção individual, medo de contaminação pelo vírus, preocupações com filhos e familiares, vivências diante da morte e do adoecimento de si e de colegas de profissão. Este texto aponta para a necessidade de atenção governamental, bem como para a gestão do trabalho em saúde e dos órgãos de classe profissional, analisando as condições de trabalho que as trabalhadoras em saúde estão vivendo no enfrentamento da pandemia.


Abstract The article aims to discuss the care provided by female healthcare workers in Brazil during the Covid-19 pandemic, based on a sociological analysis by authors who discuss such care as devalued and poorly paid work performed to a large extent by low-income women. The work involves social constructions of emotions and has used the body as a work instrument in care for others. In addition, the increasingly precarious nature of health work in Brazilian society, aggravated in recent decades, with an increase in temporary contracts, loss of labor rights, overload of tasks, and adverse work conditions, among others, adds to the increase in medical and hospital care in the Covid-19 pandemic. In this context, female healthcare workers experience lack of personal protective equipment, fear of coronavirus infection, concerns with their children and other family members, and illness and death of coworkers and themselves. The article highlights the need for government attention and management of healthcare work and professional societies, analyzing the work conditions female healthcare workers are experiencing in confronting the pandemic.


Assuntos
Humanos , Feminino , Pessoal de Saúde/economia , Pessoal de Saúde/psicologia , Infecções por Coronavirus/epidemiologia , Atenção à Saúde/economia , Atenção à Saúde/normas , Atenção à Saúde/tendências , Pandemias , Salários e Benefícios/tendências , Brasil/epidemiologia , Atitude Frente a Morte , Família , Fatores Sexuais , Local de Trabalho/normas , Local de Trabalho/psicologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/transmissão , Medo , Fatores Sociológicos , Equipamento de Proteção Individual/provisão & distribuição , Programas Nacionais de Saúde
19.
Am J Public Health ; 111(4): 718-725, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33600245

RESUMO

Objectives. To examine the association between wage-setting policy and food insecurity.Methods. We estimated multilevel regression models, using data from the Gallup World Poll (2014-2017) and UCLA's World Policy Analysis Center, to examine the association between wage setting policy and food insecurity across 139 countries (n = 492 078).Results. Compared with countries with little or no minimum wage, the probability of being food insecure was 0.10 lower (95% confidence interval = 0.02, 0.18) in countries with collective bargaining. However, these associations varied across employment status. More generous wage-setting policies (e.g., collective bargaining or high minimum wages) were associated with lower food insecurity among full-time workers (and, to some extent, part-time workers) but not those who were unemployed.Conclusions. In countries with generous wage-setting policies, employed adults had a lower risk of food insecurity, but the risk of food insecurity for the unemployed was unchanged. Wage-setting policies may be an important intervention for addressing risks of food insecurity among low-income workers.


Assuntos
Emprego , Internacionalidade , Análise Multinível , Salários e Benefícios , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Adulto Jovem
20.
Health Aff (Millwood) ; 40(2): 343-348, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33523743

RESUMO

In 2019, as in prior years, Medicaid physician fees remained well below Medicare and private insurance fees despite growth in Medicaid enrollment. Low Medicaid physician fees have important implications in terms of access to care for Medicaid enrollees and the effects of proposals to expand coverage through a Medicaid buy-in program or a Medicaid-like public option.


Assuntos
Medicaid , Médicos , Idoso , Honorários e Preços , Acesso aos Serviços de Saúde , Humanos , Medicare , Salários e Benefícios , Estados Unidos
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