The out-of-pocket expenses of people with tinnitus in Europe.

BACKGROUND: Despite the high frequency of tinnitus and its impact on wellbeing, little is known about its economic burden and no data to our knowledge are available on out-of-pocket (OOP) expenses. METHODS: In 2022 a survey was conducted on OOP costs of tinnitus. We enrolled 679 participants with slight, moderate and severe tinnitus in Italy, United Kingdom, Netherlands, Germany and Spain. We estimated annual OOP expenses for tinnitus-related healthcare visits, treatments, medications and alternative medicine practices. Prevalence of tinnitus in the general population, obtained from a representative survey we conducted in Europe in 2017-2018, was used to generalise costs for people with any tinnitus at the national level. RESULTS: OOP expenses were 368€ (95% confidence intervals (CI), 78€-690€), 728€ (95% CI, 316€-1,288€), and 1,492€ (95% CI, 760€-2,688€) for slight, moderate, and severe tinnitus, respectively, with annual expenditure of 565€ for people with any tinnitus: 209€ for healthcare visits, 93€ for treatments, 16€ for drugs, 64€ for hearing supporting systems and 183€ for acupuncture, homeopathy and osteopathy. Individuals with slight, moderate, and severe tinnitus expressed a willingness to invest 1.6, 4.3, and 7.0 times their monthly income, respectively, to achieve complete relief from tinnitus. CONCLUSIONS: This study offers for the first time insights into the OOP expenses incurred by individuals with tinnitus. OOP expenses exhibited substantial variations based on severity status, accounting for more than 17 thousand million€ in the countries considered. In terms of financial burden, these findings align tinnitus to the recognised leading disabilities, including back pain and migraine.

Using Participatory Action Research to Redirect Tinnitus Treatment and Research-An Interview Study.

Background: Chronic bothersome tinnitus is a prevalent tinnitus subtype placing a high burden on affected individuals, economies, and healthcare systems. Patient and professional perspectives seem to be partly misaligned on how to improve tinnitus research and treatments in the future. This qualitative interview study was aimed at exploring, comparing, and stipulating the perspectives of different tinnitus stakeholder groups on ways of redirecting research and treatments to reduce patients' suffering while accounting for challenges within these practices. Methods: This study used the participatory action research approach to facilitate the stakeholder involvement. Semi-structured online interviews including five participants (two tinnitus patients, two tinnitus researchers and medical specialists, one general practitioner) were conducted. Inductive grounded theory and the constant comparative method were used for data analysis. Results: Four categories for suggested research adaptations ((I) ethical patient involvement; (II) prioritising cure versus coping research; (III) funding; (IV) ethical publication) and six categories for suggested treatment adaptations ((I) ethical professional support; (II) patient involvement; (III) interdisciplinarity; (IV) professional tinnitus education; (V) clinical treatment guidelines; (VI) psychological treatment) were identified. Participants held partly similar priorities such as increasing pathophysiological and cure research. Differences between participants included, for instance, patients aiming for increasing patient involvement in tinnitus research and treatments compared to professionals arguing that the excessive focus on patients' conditions might reduce the patients' chances of habituating to their symptoms. Conclusions: Four action redirections for improving tinnitus research and treatment practices were defined: (I) facilitating communication between and within stakeholder groups, (II) increasing the reflective use of patient involvement, (III) increasing interdisciplinarity, and (IV) reducing barriers to receiving psychological treatment.

Saúde Pública no Mundo Lusófono: refletindo a partir e para além da emergência da COVID / Public Health in the Lusophone World: reflecting from and beyond the COVID emergency / Salud Pública en el Mundo Lusófono: reflectindo a partir y más allá de la emergencia de COVID

O autor analisa o livro Responsabilidade em Saúde Pública no Mundo Lusófono: Fazendo Justiça Durante e Além da Emergência da COVID, publicado também em inglês, que é resultado de um projeto financiado pela Organização Mundial de Saúde (OMS) e levado a cabo pelo Instituto Jurídico da Universidade de Coimbra, em parceira com investigadores de outras universidades de vários países lusófonos (Universidade dos Açores, Universidade José Eduardo dos Santos, Universidade Eduardo Mondlane, Universidade de Macau e Fundação Osvaldo Cruz). A obra enriquece o nosso conhecimento sobre as questões éticas e jurídicas decorrentes da pandemia, com enfoque no que se passa nos países de língua portuguesa. O autor apresenta ainda outros estudos recentes que permitem uma visão integrada deste projeto, no contexto internacional e europeu, lançando pistas de reflexão para futuros projetos científicos, que promovam a tão necessária interdisciplinaridade, também nos domínios da área da saúde pública.

The author analyzes the bookResponsibility for Public Health in the Lusophone World:Doing Justice In and Beyond the COVID Emergency, published in English and Portuguese, which results from the development of a project financed by the World Health Organization (WHO), carried out by the Legal Institute of the University of Coimbra, in partnership with researchers from other universities from several Portuguese-speaking countries (University of the Azores, José Eduardo dos Santos University, Eduardo Mondlane University, University of Macau and Osvaldo Cruz Foundation).The studyenriches ourknowledge of ethical and legal issues arising from the pandemic, with a focus on what happens in Portuguese-speaking countries. The author also presents other studies that allow an integrated view of this project, in the international and European context, throwing cues for reflection for future scientific projects, which promote the much-neededinterdisciplinarity, also in the fields of public health.

El autor analiza la obra Responsabilidade em Saúde Pública no Mundo Lusófono: Fazendo Justiça Durante e Além da Emergência da COVID, publicadaenportugués e inglés, que resulta del desarrollo de un proyecto financiado por la Organización Mundial de la Salud (OMS), llevado a cabo por el Instituto Jurídico de la Universidad de Coimbra, en colaboración con investigadores de otras universidades de varios países de hablaportuguesa (Universidad de las Azores, Universidad José Eduardo dos Santos, Universidad Eduardo Mondlane, Universidad de Macao y Fundación Osvaldo Cruz).El libroenriquece nuestro conocimiento de las cuestiones éticas y legales derivadas de la pandemia, con un enfoque en los países de habla portuguesa. El autor también presenta otros estudios recientes que permiten una visión integrada de este proyecto, en el contexto internacional y europeo, abriendo víasde reflexión para futuros proyectos científicos, que promuevan la tan necesaria interdisciplinariedad, también en el ámbito de la salud pública.

The role of the State, the private sector and the social sector in the different health political cycles in Portugal / O papel do Estado, do setor privado e do setor social nos diferentes ciclos políticos de saúde em Portugal

Abstract The Portuguese health system comprises three critical sectors: The State, which intervenes as a regulator of the entire system, and as a planner, provider, and financer of the National Health Service (NHS); the social sector, with a relevant intervention, mainly in continued care; and the private sector, with an essential role in the provision of some types of care. During the last forty years, the State, social, and private sectors' roles have changed either in its definition or terms of the relationship between them. In general, it is possible to identify, and we shall present them in this opinion article, eight political cycles that reflect the political contexts in Portugal, and, consequently, the ideological framework of each cycle.

Resumo O sistema de saúde português é constituído por três importantes setores: o Estado, que intervém como regulador de todo o sistema, como planeador, como prestador e financiador do Serviço Nacional de Saúde (SNS); o setor social, com relevante intervenção, principalmente, nos cuidados continuados; e o setor privado, com importante papel na prestação de alguns tipos de cuidados. Durante os últimos 40 anos, os papéis do Estado, do setor social e do setor privado mudaram, quer na sua definição, quer nas relações entre eles. De um modo geral, é possível identificar, e serão apresentados neste artigo de opinião, oito ciclos políticos que refletem os contextos políticos em Portugal e, consequentemente, o enquadramento ideológico de cada um deles.

Portugal: health system review

This publication reviews recent developments in organization and governance of health system, health financing, health care provision, health reforms and health system performance in Portugal. Overall health indicators such as life expectancy have shown a notable improvement over the last decades. However, improvements in child poverty and its consequences, mental health and quality of life after 65 have been slower and health inequalities remain a problem. All residents in Portugal have access to health care provided by the National Health Service, financed mainly through taxation. Out-of-pocket payments have been increasing over time and the level of cost-sharing is highest for pharmaceutical products. Health care delivery is by both public and private providers. Public provision is predominant in primary care and hospital care, with a gatekeeping system in place for access to hospital care. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. In May 2011, the economic crisis led Portugal to sign a Memorandum of Understanding with the International Monetary Fund, the European Commission and the European Central Bank, in exchange for a loan of 78 billion euros. The agreed Economic and Financial Adjustment Programme included 34 measures aimed at increasing cost-containment, improving efficiency and increasing regulation in the health sector. Reforms implemented since 2011 by the Ministry of Health include improving regulation and governance, health promotion, rebalancing the pharmaceutical market, expanding and coordinating long-term and palliative care, and strengthening primary and hospital care.

Portugal: health system review

The Portuguese population enjoys good health and increasing life expectancy, though at lower levels than other western European countries. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Co-payments have been increasing over time, and the level of cost-sharing is highest for pharmaceutical products. Approximately one fifth to a quarter of the population enjoys a second (or more) layer of health insurance coverage through health subsystems and voluntary health insurance (VHI). Health care delivery is based on both public and private providers. Public provision is predominant in primary care and hospital care, with a gatekeeping system in place for the former. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. The Portuguese health system has not undergone any major changes on the financing side since the early 1990s, despite the steady growth of public health expenditure. On the other hand, many measures have been adopted to improve the performance of the health system, including public–private partnerships (PPPs) for new hospitals, a change in NHS hospital management structures, pharmaceutical reforms, the reorganization of primary care and the creation of long-term care networks. Some of these measures have faced opposition from the (local) population, namely those related to the closure of health care facilities. There is an overall awareness, and concern, about the rise in health care expenditure in Portugal. Most of the reforms that have come into effect have done so too recently to measure any effects at present (January 2011).

Trabalho como subsistência nos hospitais públicos brasileiros: [revisão] / Work as subsistence in Brazilian public hospitlas: [review] / Trabajo como subsistencia en hospitales publicos brasileños: [revisión]

Trata-se de uma pesquisa de revisão que objetivou re-interpretar a interpretação de autores de teses e dissertações sobre os significados expressos por trabalhadores da saúde, acerca das relações de subsistência com o seu trabalho, na cultura organizacional de hospitais públicos brasileiros. A investigação ocorreu a partir de teses e dissertações produzidas em programas de pós-graduação (2002/2006). O referencial teórico-metodológico apoiou-se na antropologia interpretativa defendida por Clifford Geertz. Os resultados apontam que as relações de subsistência conduzem à alienação do trabalho e a remuneração gera insatisfação econômica que alavanca a necessidade de outros empregos. A estabilidade no trabalho alimenta o descomprometimento e ações que estimulam a transgressão de normas e facilitam os autogovernos em hospitais públicos brasileiros.

That was a review study that aimed to analyze the interpretations that authors of dissertations and thesis about the meanings expressed by health workers, about the relations of subsistence with the job, in the organizational culture of public hospitals in Brazil. Data were extracted from from dissertations and theses in the period from 2002 to 2006. The theoretical methodological reference laid in the interpretive anthropology by Clifford Geertz. The results point that the subsistence relations conduct to alienation from work. The payment generates economic non satisfaction that pry the need to have other jobs. The work stability feeds the disengagement and actions that stimulates the transgression of standards and help the own governs in public hospitals in Brazil.

Se trató de una revisión que objetivó re-interpretar la interpretación de los autores de tesis y disertaciones sobre los significados de las relaciones de subsistencia entre los trabajadores de la salud y su trabajo en la cultura organizacional de los hospitales públicos brasileños. La investigación fue realizada a partir de tesis y disertaciones producidas en programas de posgraduación (2002/2006). Como referencial teórico metodológico se empleó la antropología interpretativa defendida por Clifford Geertz. Los resultados señalan que las relaciones de subsistencia se concilian con la alienación del trabajo y que la remuneración es símbolo de insatisfacción económica traducida en una cultura de múltiples empleos. La estabilidad laboral alimenta la falta de compromiso con el trabajo, favoreciendo la transgresión de normas por los autogobiernos.

Portugal: health system review

The Health Systems in Transition (HiT) profiles are country-based reports that provide a detailed description of a health system and of policyinitiatives in progress or under development. HiTs examine different approaches to the organization, financing and delivery of health services and therole of the main actors in health systems; describe the institutional framework, process, content and implementation of health and health care policies; and highlight challenges and areas that require more in-depth analysis. The Portuguese population enjoys good health and increasing life expectancy, though at lower levels than other western European countries. All residents in Portugal have access to health care provided by the National Health Service (NHS), financed mainly through taxation. Co-payments have beenincreasing over time, and co-insurance is higher for pharmaceutical products. Approximately a quarter of the population enjoys a second (or more) layer of health insurance coverage through health subsystems and voluntary health insurance (VHI). Health care delivery is based on both public and private providers. Public provision is particularly present in primary care and hospitalcare, with a gatekeeping system in place for the former. Pharmaceutical products, diagnostic technologies and private practice by physicians constitute the bulk of private health care provision. The Portuguese health system has not undergone any major changes on the financing side since the early 1990s, despite the steady growth of public health expenditure. On the other hand, many measures have been adopted to improve the performance of the health system. Measures since 2002 have included: public–private partnerships (PPPs) for new hospitals; a change in NHS hospital management rules towards a more entrepreneurial approach and a more effective purchaser–provider split; promoting generic substitution of pharmaceuticals; liberalization of prices and entry into the over-the-counter (OTC) market; administrative price reductions for pharmaceutical products; introduction of a reference pricing mechanism for pharmaceuticals facing competition from generics; regular updates of the co-payments for public health care services; reorganization of the public network of services (closure of delivery roomsin some hospitals, reshuffling of emergency departments, mergers of hospital management teams); definition of a national health plan; reform of primary care (creation of Family Health Units (USFs, Unidades de Saúde Familiar)); and creation of long-term care networks. Some of these measures have faced opposition from the (local) population, namely those related to the closure of health care facilities. There is an overall awareness, and concern, about the rise in health care expenditure in Portugal. Most of the reforms that have come into effect have done so too recently to measure any effects at the time of writing.

Simpósios sobre Saúde 200 anos Brasil-Portugal - Jorge Simões.

Apresentou uma visão global do Sistema Nacional de Saúde português (SNS) com suas caracterizações e combinações do público com o privado por meio de subsistemas e seguros voluntários. Mostrou a proporção de consultas privadas, despesas totais na saúde e o percentual do PIB, baseado em estatística da Comissão para a Sustentabilidade do Financiamento do SNS. Fez uma análise das políticas de saúde e as principais medidas políticas na saúde no período de 2002-2008. Os arquivos estão disponíveis para audição, leitura e/ou download por meio dos ícones ao lado.