In 1988, Brazilian Constitution definedhealth as a universal right and state responsibility. Progress towards universal health coverage (UHC) has been achieved through a Unified Health System (Sistema Único de Saúde, SUS) which was created in 1990. With successes and setbacks in the implementation of health programmes and organization of its health system, Brazil has achieved nearly-universal access to health services for her citizens. The trajectory of the development and expansion of the SUS offers valuable lessons on how to scale UHC in a health system in a highly-unequal country and relatively low resources. The analysis of the 30 years since the inception of SUS shows that innovations in the Brazilian health system extend beyond the development of new models of care and highlights the importance of establishing political, legal, organizational and management-related structures, and the role of the federal and local governments in the governance, planning, financing, and provision of health services. The expansion of SUS has allowed Brazil to rapidly address the changing health needs, with dramatic scaling up health service coverage in just three decades. However, despite its successes, analysis of future scenarios suggests the urgent need to address lingering geographic inequalities, insufficient funding, and the suboptimal private-public collaboration. Recent fiscal policies that ushered austerity measures, environmental, educational and health policies of the new administraion introduced in Brazil could reverse the hard-earned achievements of the SUS and threaten its sustainability and its ability to fulfil its constitutional mandate of providing 'health for all'. 2000 2010 2015 Births attended by skilled health staff (% of total) 87•6 98•6 98•9 99•1 Immunization, BCG (% of one-year-old children) 79 99 99 99 Immunization, measles (% of children ages 12-23 months) 78 99 99 96 Immunization, DPT (% of children ages 12-23 months) 66 98 99 96 Immunization, Hib3 (% of children ages 12-23 months) 90 99 96 Immunization, Pol3 (% of one-year-old children) 58 99 99 98 Immunization, HepB3 (% of one-year-old children) 94 96 96 Antiretroviral therapy coverage (% people living with HIV) 27 38 57
Desigualdades no uso e acesso aos serviços de saúde entre idosos do município de São PauloInequalities in access to health care services and utilization for the elderly in São Paulo, Brazil RESUMO OBJETIVO: Analisar os fatores relacionados à determinação e às desigualdades no acesso e uso dos serviços de saúde por idosos. MÉTODOS:Estudo integrante do Projeto Saúde, Bem-estar e Envelhecimento (SABE), no qual foram entrevistados 2.143 indivíduos com 60 anos ou mais no município de São Paulo, SP, em 2000. A amostra foi obtida em dois estágios, utilizando-se setores censitários com reposição, probabilidade proporcional à população e complementação da amostra de pessoas de 75 anos. Foi mensurado o uso de serviços hospitalares e ambulatoriais nos quatro meses anteriores à entrevista, relacionando-os com fatores de capacidade, necessidade e predisposição (renda total, escolaridade, seguro saúde, morbidade referida, auto-percepção, sexo e idade). O método estatístico utilizado foi regressão logística multivariada. RESULTADOS: Dos entrevistados, 4,7% referiram ter utilizado a internação hospitalar e 64,4% o atendimento ambulatorial. Dos atendimentos ambulatoriais em serviço público, 24,7% ocorreram em hospital e 24,1% em serviço ambulatorial; dentre os que ocorreram em serviços privados, 14,5% foram em hospital e 33,7% em clínicas. Pela análise multivariada, observou-se associação entre a utilização de serviços e sexo, presença de doenças, autopercepção de saúde, interação da renda e escolaridade e posse de seguro saúde. A análise isolada com escolaridade apresentou efeito inverso. CONCLUSÕES:Foram observadas desigualdades no uso e acesso aos serviços de saúde e inadequação do modelo de atenção, indicando necessidade de políticas públicas que levem em conta as especifi cidades dessa população, facilitem o acesso e possam reduzir essas desigualdades. DESCRITORES
Um dos problemas mais graves identificados na implantação do Programa de Saúde da Família no Brasil é a rotatividade do médico generalista. Já que o modelo se fundamenta no vínculo entre profissionais da equipe e população, a alta rotatividade dos médicos pode comprometer a efetividade do modelo. Pesquisa realizada no município de São Paulo para verificar a existência de correlação entre satisfação no trabalho dos médicos do programa e a rotatividade desses profissionais confirmou a hipótese da existência de correlação negativa. O prestígio da instituição parceira do município na implantação do programa foi o fator mais importante na determinação da rotatividade dos médicos. Outros fatores de satisfação no trabalho
The paper reports the results of a literature review on cesarean rates and models of childbirth care in different countries according to their utilization of technology. There were reviewed 60 studies published between 1999 and 2010 retrieved from the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) and ProQuest databases. The Brazilian model of childbirth care relies on the physician-patient relationship, level of technology utilization and cesarean delivery.
This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.
Neste momento de crise financeira do Estado, é importante o uso adequado dos recursos econômicos disponíveis, e este trabalho objetiva estudar os fatores que determinam o aumento dos gastos em saúde; é uma revisão crítica do tema, com um levantamento sistemático das publicações dos últimos dez anos, considerando-se os principais estudiosos da disciplina da economia da saúde no Brasil e de outros países. Os fatores que agem na demanda por serviços de saúde são de natureza variada, podendo se sobrepor, o que aumenta ainda mais a demanda: necessidade sentida, fatores psicossociais, seguridade social, demografía, epidemiología, utilização dos serviços, regulamentação e fatores culturais. Os que agem na oferta da assistência à saúde são: progresso técnico-médico, difusão da inovação e multiplicação dos centros de assistência à saúde. Os fatores da demanda não podem ser rapidamente contidos, enquanto que os de oferta são muito mais facilmentecontrolados, mas são poucos os exemplos encontrados na literatura sobre o sucesso das medidas de controle.
Purpose To systematically review the impact of hospital accreditation on healthcare quality indicators, as classified into seven healthcare quality dimensions. Data source We searched eight databases in June 2020: EBSCO, PubMed, Web of Science, Emerald, Proquest, Science Direct, Scopus, and Virtual Health Library. Search terms were conceptualized into three groups: hospitals, accreditation, and terms relating to healthcare quality. The eligibility criteria included academic articles that applied quantitative methods to examine the impact of hospital accreditation on healthcare quality indicators. Data extraction We applied the PICO framework to select the articles according to the following criteria: Population - all types of hospitals; Intervention - hospital accreditation; Comparison – quantitative method applied to compare accredited vs. non-accredited hospitals, or hospitals before vs. after accreditation; Outcomes - regarding the seven healthcare quality dimensions. After a critical appraisal of the 943 citations initially retrieved, 36 studies were included in this review. Results of data synthesis Overall results suggest that accreditation may have a positive impact on efficiency, safety, effectiveness, timeliness, and patient-centeredness. In turn, only one study analyzes the impact on access, and no study has investigated the impact on equity dimension yet. Conclusion Mainly due to the methodological shortcomings, the positive impact of accreditation on healthcare dimensions should be interpreted with caution. This study provides an up-to-date overview of the main themes examined in the literature, highlighting critical knowledge-gaps and methodological flaws. The findings may provide value to healthcare stakeholders in terms of improving their ability to assess the relevance of accreditation processes.
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