The time and type of the States' responses to the COVID‐19 pandemic varied with the severity of the epidemiological situation, the perceived risk, the political organisation and the model of health system of the country. We discuss the response of Germany, Spain, France, Italy, Portugal and the United Kingdom during the first months of the COVID‐19 epidemic in 2020, considering the political organisation of the country and its health system model. We analyse public health measures implemented to contain or mitigate the pandemic, as well as those related to governance, resources and reorganisation of services, financing mechanisms, response of the health system itself and health outcomes. To measure the burden of COVID‐19, we use several indicators. The adoption of measures, to contain and mitigate epidemic varied in degree and time of adoption. All countries reorganised their governance structure and the provision of care, despite the differences in political models and health systems (ranging from a more unitary and centralised political organisational model—France and Portugal; to a decentralised matrix—Germany, Spain, Italy and the United Kingdom). Rather than the differences in political models and health systems, the explanation for the success in tackling the epidemic seems to lay in other social determinants of health.
Equal and adequate access to healthcare is one of the pillars of Portuguese health policy. Despite the controversy over commissioning processes’ contribution to equity in health, this article aims to clarify the relationship between socio-economic factors and the results of primary healthcare (PHC) commissioning indicators through an analysis of four years of data from all PHC units in Portugal. The factor that presents a statistically significant relationship with a greater number of indicators is the organizational model. Since the reform of PHC services in 2005, a new type of unit was introduced: the family health unit (USF). At the time of the study, these units covered 58.1% of the population and achieved better indicator results. In most cases, the evolution of the results achieved by commissioning seems to be similar in different analyzed contexts. Nevertheless, the percentage of patients of a non-Portuguese nationality and the population density were analyzed, and a widening of discrepancies was observed in 23.3% of the cases. The commissioning indicators were statistically related to the studied context factors, and some of these, such as the nurse home visits indicator, are more sensitive to context than others. There is no evidence that the best results were achieved at the expense of worse healthcare being offered to vulnerable populations, and there was no association with a reduction in inequalities in healthcare. It would be valuable if the Portuguese Government could stimulate the increase in the number of working USFs, especially in low-density areas, considering that they can achieve better results with lower costs for medicines and diagnostic tests.
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The monastic and conventual complex of S. Salvador de Vilar de Frades, located in the municipality of Barcelos (Portugal), has an attested occupation since the 11th century. As a result of the different constructive phases, the current edification integrates a diversified group of material and raw material applied according to different construction techniques.
Through a methodological approach that favours the intersection between different types of sources, the present article aims to analyse wood as building construction material in Vilar de Frades, namely in the beam systems of the 16th century, as well as in the long-term articulation between liturgical furniture and the edification.
Primary healthcare (PHC) governance model, namely its financing scheme, might impact the health outcomes, particularly in chronic conditions, through avoidable hospital admissions (AvH). Therefore, the study aims to assess how the PHC financial governance model determines AvH, as well as how this interacts with the health system financing (HSF) scheme. An observational study comparing the GP employment type (publicly and self/privately) with asthma and COPD, and Diabetes AvH per 100,000 habitants in 26 countries of the European Region, was performed. It considered 4 regression models with structural determinants, service delivery and HSF schemes. GP self/privately employed group associated with social health insurance scheme was significantly associated with higher total AvH (OR = 28.27 [CI 95% 2.34–77.54]), and for asthma and COPD AvH (OR = 21.88 [CI 95% 6.69–180.18]). Diabetes AvH were significantly associated with increasing GP outpatient coverage (model 1) and GP availability (model 2) under a GP self/privately employed group (respectively, OR = 17.01 [CI 95% 3.67–20.63] and OR = 17.80 [CI 95% 8.12–130.35]). The study evidenced that publicly employed GPs working in a tax‐based HSF scheme ensure better health outcomes for the population. Although some limitations of equity and categorisation, the results show that the governance model might influence population health outcomes.
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