Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 810
Filtrar
3.
Ethiop J Health Sci ; 29(3): 401-408, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447509

RESUMO

Background: Frequent stock-out of drugs in the public hospitals causes National Health Insurance Scheme (NHIS) enrollees to purchase most of their medicines out-of-pocket in community pharmacies, thereby imposing financial constraints on them against the main objective of the scheme. The objectives of this study were to determine and compare the level of participation of private retail community pharmacies (PRCPs) in the NHIS of Nigeria and Ghana, to describe their spatial distribution, and to highlight from literature major factors that would influence the participation of these pharmacies in the scheme. Methods: PRCPs data were collected from the Nigerian NHIS active secondary healthcare providers list of 1st July 2017 and the Ghanaian NHIS active providers online list of 2018. PRCPs densities at the national levels were calculated from last published national coverage data for each country. Results: The total number of PRCP accredited by NHIS of both Nigeria and Ghana is 964(639[66.3% versus 325[33.7%]). NHIS accredited PRCPs densities for Nigeria and Ghana were 1 PRCP per 9, 390 enrollees and 1 PRCP per 33, 108 enrollees respectively. Across the Nigerian States, it was noted that Lagos State has the highest proportion (21.4%, n = 137) of community pharmacy participation in the scheme whereas, in Ghan, Greater Accra Region has the highest participation (34.2%, n = 111). Conclusion: This study revealed low participation of PRCPs and skewed spatial distribution between urban and rural areas of both countries, although there was higher participation of these pharmacies in Nigeria due to Nigerian lower NHIS coverage data compared to Ghana.


Assuntos
Medicamentos Essenciais/provisão & distribução , Programas Nacionais de Saúde/organização & administração , Farmácias/organização & administração , Gana , Humanos , Programas Nacionais de Saúde/estatística & dados numéricos , Nigéria , Farmácias/estatística & dados numéricos , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos
4.
Reumatol. clín. (Barc.) ; 15(3): 170-172, mayo-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-184370

RESUMO

Objetivo: Conocer el porcentaje de reumatólogos de Cataluña que atienden a pacientes privados, los procesos reumatológicos más comunes en la consulta privada, determinar la dedicación a la asistencia y las actividades necesarias para garantizar una correcta asistencia: formación continuada, gestión de la consulta y conocer que técnicas son usuales. Material y métodos: Mediante encuesta personalizada a los reumatólogos de los que pudimos conseguir sus datos de correo electrónico. Se sometió a análisis 52 respuestas. Resultados: El porcentaje de varones (52%) y mujeres (48%) es similar, un 33% trabaja exclusivamente en reumatología privada (RP), la mayoría en hospitales o equipos médicos y un 11% trabaja solos. El 27% realiza formación; la enfermedad más frecuentemente atendida es la artrosis, el 51% realiza estudios o ensayos clínicos en el ámbito de la RP. Conclusiones: El concepto de RP como un negocio particular va cambiando y se está convirtiendo en unidades con una estructura de trabajo similar a los hospitales públicos con formación reglada. Este trabajo aporta nuevos datos sobre la actividad que se realiza y características del grupo


Objective: To establish the percentage of Catalonian rheumatologists who attended to private patients, to understand the most common processes in private practice, to determine the dedication to patient care and the necessary activities to guarantee proper care, such as continuing education and office management, and to know what techniques were most widely used. Material and methods: A personalized survey of Catalonian rheumatologists whose e-mail addresses were made available to us. Fifty-two responses were analyzed. Results: The percentage of men (52%) and women (48%) was similar; 33% worked exclusively in private rheumatology (PR), most of them in hospitals or medical teams; 11% worked alone; 27% were in training. The disease most frequently treated was osteoarthritis; 51% were involved in studies or clinical trials in the field of RP. Conclusions: The concept of RP as a private business is changing and is progressively being transformed into working units with a structure similar to public hospitals with formal training. This report provides new data on the activities and characteristics of private rheumatologists


Assuntos
Humanos , Reumatologia/organização & administração , Setor Privado/organização & administração , Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos
5.
Gac. sanit. (Barc., Ed. impr.) ; 33(3): 263-267, mayo-jun. 2019. tab, mapas
Artigo em Inglês | IBECS | ID: ibc-183747

RESUMO

Objective: Until 2016, around 3 million persons had limited access to health care in Greece due to the economic crisis. We describe a massive solidarity movement of community clinics and pharmacies in Greece. Method: We conducted a survey in 2014-15 and describe the characteristics of community clinics and pharmacies spontaneously established all over Greece after 2008. Results: A characteristic of the 92 active solidarity clinics is autonomous collective functioning, free services, and funding from non-governmental sources. The largest clinics examined more than 500 uninsured or partly insured patients per month. Clinics covered a wide range of clinical and preventive services. Funding, availability of drugs, vaccines, medical material and their legal status were the main problems identified. The solidarity movement involved thousands of health professionals covering essential population needs. Conclusions: The community outpatient clinics were an outstanding example of solidarity and temporarily alleviated the health needs of a large part of the population


Objetivo: Hasta 2016, alrededor de 3 millones de personas tenían acceso limitado a la atención médica en Grecia debido a la crisis económica. Describimos un movimiento masivo de solidaridad de clínicas comunitarias y farmacias en Grecia. Métodos: Realizamos una encuesta en 2014-15 y describimos las características de las clínicas comunitarias y de las farmacias espontáneamente establecidas en toda Grecia después de 2008. Resultados: Una característica de las 92 clínicas solidarias activas es el funcionamiento colectivo autónomo, con servicios gratuitos y financiación de fuentes no gubernamentales. Las clínicas más grandes examinaron más de 500 pacientes no asegurados o parcialmente asegurados por mes. Las clínicas cubrieron una amplia gama de servicios clínicos y preventivos. La financiación, la disponibilidad de medicamentos, vacunas y material médico, y su estado legal, son los principales problemas identificados. El movimiento de solidaridad involucró a miles de profesionales de la salud que cubrieron las necesidades esenciales de la población. Conclusiones: Las clínicas ambulatorias comunitarias fueron un ejemplo de solidaridad y aliviaron temporalmente las necesidades de salud de una gran parte de la población


Assuntos
Humanos , Solidariedade , Assistência à Saúde/métodos , Instituições de Assistência Ambulatorial/organização & administração , Mudança Social , Grécia/epidemiologia , Recessão Econômica , Resolução de Problemas , Políticas Públicas de Saúde , Organizações/organização & administração , Setor Privado/organização & administração , Colaboração Intersetorial
7.
Cien Saude Colet ; 24(3): 705-714, 2019 Mar.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30892493

RESUMO

The present study highlighted the labour process of the dental surgeon (DS) in the private healthcare sector from the healthcare professional's perspective based on intervention bioethics. An observational, cross-sectional survey study was performed within the Federal District (Distrito Federal) region. Data were collected from 108 questionnaires completed by DSs affiliated with two types of private health insurers, self-insurance and group insurance, to assess job perception and the degree of job satisfaction in the dentistry market. The main source of dissatisfaction for healthcare professionals was related to the pay for dental procedures by insurers. For self-insurer 1, 38.1% healthcare professionals replied that the pay was satisfactory, whereas in self-insurance 2 and in the group insurance, 100% of healthcare professionals were dissatisfied. Another finding was that the group insurer considerably restricted elective treatments. In conclusion, loss of professional autonomy, depreciation of insurance claims and precarisation of dentistry occurs in the private healthcare sector, thus demonstrating the ethical conflicts in this relationship.


Assuntos
Atitude do Pessoal de Saúde , Odontologia/organização & administração , Odontólogos/estatística & dados numéricos , Satisfação no Emprego , Bioética , Estudos Transversais , Odontólogos/economia , Odontólogos/psicologia , Setor de Assistência à Saúde/economia , Setor de Assistência à Saúde/organização & administração , Humanos , Seguro Saúde/economia , Setor Privado/economia , Setor Privado/organização & administração , Autonomia Profissional , Inquéritos e Questionários
8.
BMC Health Serv Res ; 19(1): 147, 2019 Mar 06.
Artigo em Inglês | MEDLINE | ID: mdl-30841929

RESUMO

BACKGROUND: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM. METHODS: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for a chest X-ray and Xpert MTB/RIF. Presumptive DM cases had random blood glucose (RBS) tested. All individuals with bacteriologically positive TB were referred for diabetes testing (RBS). All pre-diabetics and diabetics were referred for a chest X-ray and Xpert MTB/RIF test. The primary outcomes of this study were uptake of TB and DM testing. RESULTS: A total of 450,385 individuals were screened, of whom 18,109 had presumptive DM and 90,137 had presumptive TB. 14,550 of these individuals were presumptive for both DM and TB. The uptake of DM testing among those with presumptive diabetes was 26.1% while the uptake of TB testing among presumptive TB cases was 5.9%. Despite efforts to promote bi-directional screening of TB and DM, the uptake of TB testing among pre-diabetes and diabetes cases was only 4.7%, while the uptake of DM testing among MTB positive cases was 21.8%. CONCLUSION: While a high yield for TB was identified among pre-diabetics and diabetics along with a high yield of DM among individuals diagnosed with TB, there was a low uptake of TB testing amongst presumptive TB patients who were recorded as pre-diabetic or diabetic. Bi-directional screening for TB and DM which includes the integration of TB diagnostics, DM screening and TB-DM treatment within existing health care programs will need to address the operational challenges identified before implementing this as a strategy in public health programs.


Assuntos
Diabetes Mellitus/diagnóstico , Programas de Rastreamento , Setor Privado , Tuberculose/diagnóstico , Adulto , Idoso , Comorbidade , Estudos Transversais , Diabetes Mellitus/epidemiologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Paquistão/epidemiologia , Setor Privado/economia , Setor Privado/organização & administração , Tuberculose/transmissão , Adulto Jovem
9.
J Med Econ ; 22(5): 478-487, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30757934

RESUMO

BACKGROUND: Both public and private insurers provide drug coverage in Canada. All payers are under pressure to contain costs. It has recently been proposed that private plans leverage the public health technology assessment (HTA) evaluation process in their decision-making. OBJECTIVES: The objectives of the current study were to examine use of public health technology assessments (HTAs) for private payer decision-making in the literature, to gather the perspectives of experts from both public and private insurers on this practice, and to summarize which value parameters of public evaluations can be used for private payer decision-making. METHODS: A targeted literature review was conducted to identify publications on the use of public HTA or cost-effectiveness data for private payer decision-making on pharmaceutical reimbursement. Concurrently, a roundtable meeting was organized with invited panelists, including private payer representatives and health economic consultants (total n = 9). The findings from both were synthesized and expressed in qualitative terms using the PICO framework. RESULTS: The targeted review identified 20 studies meeting the inclusion criteria, primarily originating from the US and Canada. The panelists felt that, despite some similarities, there were substantial differences between both systems. The PICO framework highlighted the issues with transferability between the two systems. Most of the value parameters were either not applicable, needed to be added, needed to be adjusted, or their applicability to private payer systems needed to be confirmed. CONCLUSION: Some components of public HTA may be relevant for private payers, however there are reservations that still exist on whether the HTA process in Canada, designed for a public system, can address the informational needs of private payers. Private insurers need to use caution in assessing which value parameters from public HTAs can be used and which need to be confirmed, ignored, enhanced, or adjusted. One size HTA does not fit all applications.


Assuntos
Tomada de Decisões , Seguro Saúde/organização & administração , Setor Privado/organização & administração , Setor Público/organização & administração , Avaliação da Tecnologia Biomédica/organização & administração , Canadá , Análise Custo-Benefício , Humanos , Seguro Saúde/normas , Medicamentos sob Prescrição/economia , Setor Privado/normas , Setor Público/normas , Avaliação da Tecnologia Biomédica/normas
10.
Eval Program Plann ; 74: 102-109, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30799049

RESUMO

There is a lack of clarity around intra-organisational evaluation roles and pathways into these roles in non-government organisations (NGOs). This article presents three auto-narratives from the authors who are working as internal evaluators in the NGO sector. We examine this phenomenon of role ambiguity by exploring our evaluation journeys and struggles to find identities in the formal evaluation community. Findings from the auto-narratives identify implications for the evaluation field regarding professionalisation. This article explores how aspects of professionalisation, such as clarification of roles and tasks of internal evaluators, could facilitate their recruitment, assess credibility and guide career trajectory. Elucidating internal evaluation career pathways contributes to the evaluation discipline by providing information relevant for evaluation capacity building, evaluator training, and the professionalisation movement.


Assuntos
Assistência à Saúde/organização & administração , Setor Privado/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Fortalecimento Institucional , Escolha da Profissão , Assistência à Saúde/normas , Humanos , Setor Privado/normas , Papel Profissional , Profissionalismo , Avaliação de Programas e Projetos de Saúde/normas
12.
Int J Health Plann Manage ; 34(1): e21-e33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30370564

RESUMO

Portugal has one of the most complete public systems worldwide. Since 1979, the Portuguese National Health Service (NHS) was developed based on the integration and complementarity between different levels of care (primary, secondary, continued, and palliative care). However, in 2009, the absence of economic growth and the increased foreign debt led the country to a severe economic slowdown, reducing the public funding and weakening the decentralized model of health care administration. During the austerity period, political attention has focused primarily on reducing health care costs and consolidating the efficiency and sustainability with no structural reform. After the postcrisis period (since 2016), the recovery of the public health system begun. Since then, some proposals have required a reform of the health sector's governance structure based on the promotion of access, quality, and efficiency. This study presents several key issues involved in the current postcrisis reform of the Portuguese NHS response structure to citizens' needs. The article also discusses the implications of this Portuguese experience based on current reforms with impact on the future of citizens' health.


Assuntos
Reforma dos Serviços de Saúde/organização & administração , Setor de Assistência à Saúde/organização & administração , Programas Nacionais de Saúde/organização & administração , Recessão Econômica , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/métodos , Setor de Assistência à Saúde/economia , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Humanos , Portugal , Setor Privado/organização & administração , Saúde Pública , Setor Público/organização & administração
13.
East Mediterr Health J ; 24(9): 866-876, 2018 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-30570119

RESUMO

Background: One of the work patterns which affects the supply of specialists is the phenomenon of dual practice (DP), i.e., working simultaneously in the public and private sectors. Uncontrolled DP in the surgery health workforce can have adverse effects on access to surgeons, efficiency, effectiveness and quality of surgery services. Aims: The aim of this article is to examine the impact of DP on service delivery time by surgeons. Methods: We used a prestructured form to collect data on surgery specialists in all 925 Iranian hospitals. National medical ID codes, council ID codes, first name, surname and father's name were used for data matching. Multilevel linear regression was used to assess the association between DP and study variables, which were recruitment type, faculty status, experience, sex and age. Results: The 4642 surgery specialists in this study, representing 31.08% of the total number of surgeons identified, spent mean 1.09 (standard deviation 0.33) hours full-time equivalent (FTE) on health care service delivery. Specialists with DP had long service delivery time (ß = 0.427). Female specialists (ß = -0.049) and full-time specialists (ß = -0.082) spent less time on health care service delivery. Permanent specialists had higher FTE (P < 0.001) and as the population increases, FTE increases (P < 0.05). Conclusions: Although DP had a direct impact on surgeons' working hours, it seems that a greater share of the difference in working time was used in the private sector services, leading to poor access to surgery services in the public sector. Therefore, it is necessary to develop a systems approach to regulate DP.


Assuntos
Cirurgia Geral/organização & administração , Adulto , Idoso , Feminino , Cirurgia Geral/estatística & dados numéricos , Humanos , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Setor Privado/organização & administração , Setor Privado/estatística & dados numéricos , Setor Público/organização & administração , Setor Público/estatística & dados numéricos , Inquéritos e Questionários , Fatores de Tempo
14.
East Mediterr Health J ; 24(9): 877-887, 2018 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-30570120

RESUMO

Background: Dual practice (DP) is performing several different jobs at the same time and has effects on healthcare services delivery. Aims: To identify the causes of medical specialists' tendency towards DP in the Islamic Republic of Iran. Methods: We used a qualitative approach to identify the factors affecting DP in medical specialists in 2016. We used a purposive and outlier sampling method to conduct semistructured deep interviews with 14 key informants. The data analysis was performed simultaneously with data collection using thematic content analysis by MAXQDA (version 10.0). Interviews continued up to data saturation. The quality of the study was ensured by addressing the criteria of Guba and Lincoln. Results: The results of the interviews showed six themes and 16 subthemes for specialists' propensity to DP. Major themes included financial incentives, cultural attitudes about professional identity of physicians, experience and academic level of specialists, controlling approaches in the public sector, available infrastructure for responding to the population needs in the public sector, and regional characteristics of health service locations. Conclusions: Medical specialists' DP is a multidimensional issue, influenced by different factors such as financial incentives, cultural attitudes and available infrastructure. Considering the capacities and conditions of each country, control and management of this phenomenon require regulatory and incentive mechanisms, which in the long term can modify private and public sector differences and increase the willingness of doctors to work in the public sector.


Assuntos
Medicina/organização & administração , Atitude do Pessoal de Saúde , Assistência à Saúde/organização & administração , Feminino , Humanos , Entrevistas como Assunto , Irã (Geográfico) , Masculino , Motivação , Setor Privado/organização & administração , Setor Público/normas , Pesquisa Qualitativa
15.
BMC Health Serv Res ; 18(1): 862, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30442126

RESUMO

BACKGROUND: During the last decade, pathology services in England have undergone profound changes with an extensive consolidation of laboratories. This has been driven by some national reviews forecasting a national reduction of costs by £250-£500 million ($315-$630 million) a year as a result. The main aim of this paper is to describe the financial impact of such consolidation, with a specific focus on the forecasted savings. A secondary aim is to describe the development of private sector involvement in laboratory services in a traditionally publicly funded healthcare system and the development of pathology staff size. METHODS: In the English scenario, the majority of hospitals and laboratories are publicly funded and a survey was sent as Freedom of Information request to all directors of pathology. A descriptive comparison of savings among consolidated and non-consolidated pathology services was made by using the pathology budgets in two different periods (2015 versus 2010), adjusted by inflation and increased activity. RESULTS: The hub-and-spoke model has been implemented as part of the consolidation process of pathology services in England. Consolidated pathology networks have achieved higher savings compared to non-consolidated single laboratories. There has been an increased role of private providers and savings were achieved with negligible personnel redundancies. CONCLUSIONS: Consolidated units have on average achieved larger cost savings than non-consolidated units but further analysis with stronger research design is required to independently evaluate the impact of pathology consolidation on both savings and quality.


Assuntos
Laboratórios/economia , Patologia Clínica/economia , Orçamentos , Redução de Custos/economia , Economia Hospitalar , Inglaterra , Hospitais/estatística & dados numéricos , Humanos , Laboratórios/organização & administração , Patologia Clínica/organização & administração , Setor Privado/economia , Setor Privado/organização & administração , Setor Público/economia , Setor Público/organização & administração , Medicina Estatal/economia , Medicina Estatal/organização & administração
16.
Int J Equity Health ; 17(1): 130, 2018 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-30286757

RESUMO

BACKGROUND: A case study was prepared examining government resource contributions (GRCs) to private-not-for-profit (PNFP) providers in Uganda. It focuses on Primary Health Care (PHC) grants to the largest non-profit provider network, the Uganda Catholic Medical Bureau (UCMB), from 1997 to 2015. The framework of complex adaptive systems was used to explain changes in resource contributions and the relationship between the Government and UCMB. METHODS: Documents and key informant interviews with the important actors provided the main sources of qualitative data. Trends for GRCs and service outputs for the study period were constructed from existing databases used to monitor service inputs and outputs. The case study's findings were validated during two meetings with a broad set of stakeholders. RESULTS: Three major phases were identified in the evolution of GRCs and the relationship between the Government and UCMB: 1) Initiation, 2) Rapid increase in GRCs, and 3) Declining GRCs. The main factors affecting the relationship's evolution were: 1) Financial deficits at PNFP facilities, 2) advocacy by PNFP network leaders, 3) changes in the government financial resource envelope, 4) variations in the "good will" of government actors, and 5) changes in donor funding modalities. Responses to the above dynamics included changes in user fees, operational costs of PNFPs, and government expectations of UCMB. Quantitative findings showed a progressive increase in service outputs despite the declining value of GRCs during the study period. CONCLUSIONS: GRCs in Uganda have evolved influenced by various factors and the complex interactions between government and PNFPs. The Universal Health Coverage (UHC) agenda should pay attention to these factors and their interactions when shaping how governments work with PNFPs to advance UHC. GRCs could be leveraged to mitigate the financial burden on communities served by PNFPs. Governments seeking to advance UHC goals should explore policies to expand GRCs and other modalities to subsidize the operational costs of PNFPs.


Assuntos
Financiamento Governamental , Organizações sem Fins Lucrativos/organização & administração , Atenção Primária à Saúde/organização & administração , Cobertura Universal do Seguro de Saúde/organização & administração , Organização do Financiamento , Humanos , Programas Nacionais de Saúde/organização & administração , Setor Privado/organização & administração , Uganda
17.
Nephrology (Carlton) ; 23 Suppl 4: 72-75, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30298664

RESUMO

Hong Kong experiences a progressive rise in the prevalence of treated end-stage renal disease (ESRD) as recorded by the Hong Kong Renal Registry managed by the Hospital Authority (HA) that takes care of 90 - 95% of the ESRD burden. The CKD burden is envisaged to be high, as reflected by 2 initiatives - SHARE which detected a high prevalence of urine or blood pressure abnormalities among 1,201 asymptomatic individuals who underwent screening, and RISKS that aimed to further characterize the spread of CKD in the asymptomatic population. For CKD prevention, two statutory bodies - the HA and Hong Kong College of Physicians (HKCP), and two non-governmental organizations - Hong Kong Society of Nephrology (HKSN) and Hong Kong Kidney Foundation (HKKF), all have a role to play. The Central Renal Committee (CRC) operated under HA co-produces with HKCP and HKSN a clinical practice guideline for the provision of renal service in Hong Kong which includes CKD care and prevention. HKSN now holds annual educational symposia and a Continuous Medical Education (CME) course in partnership with the HKCP and Asian Pacific Society of Nephrology in addition to its Annual Scientific Meeting. The HKSN also provides a collective International Society of Nephrology (ISN) membership for all its full members to enhance education and other pertinent initiatives. For public education, the HKSN and HKKF participate in the annual World Kidney Day event and organize free blood pressure and CKD surveys in public housing estates to increase public awareness of CKD. The latter is also effected via regular promotion through the mass media.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Promoção da Saúde/organização & administração , Serviços Preventivos de Saúde/organização & administração , Insuficiência Renal Crônica/prevenção & controle , Regulamentação Governamental , Hong Kong/epidemiologia , Humanos , Comunicação Interdisciplinar , Relações Interinstitucionais , Prevalência , Setor Privado/organização & administração , Parcerias Público-Privadas/organização & administração , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Fatores de Risco
18.
Cien Saude Colet ; 23(10): 3151-3161, 2018 Oct.
Artigo em Português | MEDLINE | ID: mdl-30365836

RESUMO

The analytical focus is on the role of the Regional Interagency Commissions (CIR), considering the diversity of actors that influence health policy in specific regional contexts. The research involved conducting five case studies in each of the Brazilian macroregions, with the application of 128 questionnaires to public managers, service providers and civil society representatives, between August 2015 and August 2016. The comparative perspective was adopted, by considering three analytical approaches: the configuration of actors (governmental and non-governmental; public and private) on regional decisions and conflicts, operation dynamics and contributions of commissions to health system policy and organization. The results showed the diversity of actors with a high degree of influence in the regions and the role of the Regional Interagency Commissions in policy coordination and conflict resolution. The commissions favor interagency negotiation and the organization of the Unified Health System vis-à-vis the Brazilian federative structure. However, they have limited scope as a space for regional health governance and are unable to incorporate the different configurations of public and private actors with power and influence over health decisions.


Assuntos
Assistência à Saúde/organização & administração , Política de Saúde , Relações Interinstitucionais , Programas Nacionais de Saúde/organização & administração , Brasil , Programas Governamentais/organização & administração , Humanos , Setor Privado/organização & administração , Setor Público/organização & administração , Inquéritos e Questionários
19.
Cien Saude Colet ; 23(10): 3179-3188, 2018 Oct.
Artigo em Português, Inglês | MEDLINE | ID: mdl-30365838

RESUMO

Within the institutional healthcare system, the public and private sectors come into relationship mainly in the context of the execution of medium-complexity health services, especially in small municipalities (SMs). The aim of this study is to analyse the relationship between public managers and private providers in the regional governance process with regard to the factors involved in the contracting process and management and planning mechanisms of medium-complexity actions. This is a qualitative case study conducted in a health region of the state of Paraná via interviews with public and private managers performed from December 2016 to February 2017. Documental analysis of management tools and price schedules in contracts between public and private managers was also performed. The results indicated interdependence in the relationship between public managers and private providers, power asymmetries, interests, and benefits, depending on the type of contract between the municipality and the provider and, of particular note, advantages and clientelistic practices. The incipient planning process and regulatory measures of the municipalities in the region and state indicate the need to invest in actions that favour governance, the regulatory capacity of local governments, and social scrutiny in this region.


Assuntos
Assistência à Saúde/organização & administração , Setor Privado/organização & administração , Setor Público/organização & administração , Brasil , Cidades , Contratos , Programas Governamentais/organização & administração , Humanos , Parcerias Público-Privadas , Regionalização/organização & administração
20.
Implement Sci ; 13(1): 124, 2018 09 24.
Artigo em Inglês | MEDLINE | ID: mdl-30249294

RESUMO

BACKGROUND: A prominent strategy to engage private sector health providers in low- and middle-income countries is clinical social franchising, an organisational model that applies the principles of commercial franchising for socially beneficial goals. The Matrika programme, a multi-faceted social franchise model to improve maternal health, was implemented in three districts of Uttar Pradesh, India, between 2013 and 2016. Previous research indicates that the intervention was not effective in improving the quality and coverage of maternal health services at the population level. This paper reports findings from an independent external process evaluation, conducted alongside the impact evaluation, with the aim of explaining the impact findings. It focuses on the main component of the programme, the "Sky" social franchise. METHODS: We first developed a theory of change, mapping the key mechanisms through which the programme was hypothesised to have impact. We then undertook a multi-methods study, drawing on both quantitative and qualitative primary data from a wide range of sources to assess the extent of implementation and to understand mechanisms of impact and the role of contextual factors. We analysed the quantitative data descriptively to generate indicators of implementation. We undertook a thematic analysis of the qualitative data before holding reflective meetings to triangulate across data sources, synthesise evidence, and identify the main findings. Finally, we used the framework provided by the theory of change to organise and interpret our findings. RESULTS: We report six key findings. First, despite the franchisor achieving its recruitment targets, the competitive nature of the market for antenatal care meant social franchise providers achieved very low market share. Second, all Sky health providers were branded but community awareness of the franchise remained low. Third, using lower-level providers and community health volunteers to encourage women to attend franchised antenatal care services was ineffective. Fourth, referral linkages were not sufficiently strong between antenatal care providers in the franchise network and delivery care providers. Fifth, Sky health providers had better knowledge and self-reported practice than comparable health providers, but overall, the evidence pointed to poor quality of care across the board. Finally, telemedicine was perceived by clients as an attractive feature, but problems in the implementation of the technology meant its effect on quality of antenatal care was likely limited. CONCLUSIONS: These findings point towards the importance of designing programmes based on a strong theory of change, understanding market conditions and what patients value, and rigorously testing new technologies. The design of future social franchising programmes should take account of the challenges documented in this and other evaluations.


Assuntos
Serviços de Saúde Materna/organização & administração , Saúde Materna , Modelos Organizacionais , Setor Privado/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Países em Desenvolvimento , Feminino , Acesso aos Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Humanos , Ciência da Implementação , Índia , Serviços de Saúde Materna/normas , Cuidado Pré-Natal/organização & administração , Setor Privado/normas , Qualidade da Assistência à Saúde/normas , Encaminhamento e Consulta , Telemedicina/organização & administração
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA