Porque não instituir copagamento no Sistema Único de Saúde: efeitos nocivos para o acesso a serviços e a saúde dos cidadãos

Holst, Jens; Giovanella, Lígia; Andrade, Gabriella Carrilho Lins de

doi:10.1590/0103-11042016s18

Cited by 5 publications

(10 citation statements)

References 32 publications

(11 reference statements)

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“…There are also challenges related to the system itself and to structural aspects of society that interfere in the realization of social rights, such as inequality and the nonimplementation of redistributive and inclusive public policies (Garbois;Vargas;Cunha, 2008;Paula et al, 2009;Silva, 2013). Such challenges are present in the current Brazilian context, as austerity policies and attacks on rights and social policies seriously threaten the financing, access and quality of care (Costa;Rizzotto, 2017;Holst;Giovanella;Andrade, 2016;Moutinho;Dallari, 2019).…”

Section: The Expansion Of Rights In Brazil and Colombia And The Challmentioning

confidence: 99%

“…This model assumes that health is the responsibility of people, families and companies, and the State is responsible for investing in basic actions aimed at the poor and vulnerable, discriminating groups according to their ability to pay (Araujo et al, [2019? ];Cebes, 2014;Heredia et al, 2015;Holst;Giovanella;Andrade, 2016).…”

Section: The Expansion Of Rights In Brazil and Colombia And The Challmentioning

confidence: 99%

“…It is worth mentioning that the comparison between Brazil and Colombia is strategic as in addition to the convergence in relation to the relevance of judicialization for access to health, both countries had their current Constitutions promulgated at the same historical moment (Brazil in 1988, Colombia in 1991, based on a process of democratic rupture against a context of human rights abuses and profound social inequalities. At the same time, although the two health systems have differences, particularly on the scope of the right to health, financing and public-private relationship (Almeida, 1999;Cebes, 2014;Gargarella, 2017;Holst;Giovanella;Andrade, 2016;Vélez, 2016), the changes imposed on the Brazilian system may have turned both of them more alike.…”

Section: Introductionmentioning

confidence: 99%

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A judicialização da saúde no Brasil e na Colômbia: uma discussão à luz do novo constitucionalismo latino-americano

2020

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Resumo Este artigo busca analisar a judicialização da saúde no Brasil e na Colômbia à luz do novo constitucionalismo latino-americano (NCLA), corrente conceitual adotada na região que rompe com os modelos constitucionais europeus e norte-americanos clássicos. No Brasil, a Constituição de 1988 veio em resposta a um longo período de governos militares e, na Colômbia, a Constituição de 1991 surgiu em um contexto de abusos de direitos humanos e altos níveis de violência. O NCLA se materializa a partir dessas novas Cartas Políticas e se sustenta no incremento das formas de participação e na ampliação do papel do Judiciário e dos direitos, como o da saúde. Entretanto, as constituições que trazem uma ampla carta de direitos não conseguiram enfrentar as políticas orientadas para o mercado e a privatização dos serviços de saúde, colocando em xeque a efetivação do direito à saúde e levando ao aumento das ações judiciais. Nesse cenário emerge o protagonismo do Judiciário, fortalecido pelas novas constituições, como poder estatal capaz de concretizar um direito previsto, mas marginalizado. A identificação das necessidades de saúde e reivindicações de segmentos sociais apresenta-se como princípio basilar nesse processo e sinaliza o resgate do NCLA para a efetivação do direito à saúde por meio do litígio estrutural.

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Section: The Expansion Of Rights In Brazil and Colombia And The Challmentioning

confidence: 99%

Section: The Expansion Of Rights In Brazil and Colombia And The Challmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A judicialização da saúde no Brasil e na Colômbia: uma discussão à luz do novo constitucionalismo latino-americano

2020

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“…The efforts of Brazil to achieve UHC for medicines resulted in increased public financing of medicines and their availability, ranging from <50 in 1999 to 62% in 2014 (Table 1), reducing avoidable hospitalization and mortality. However, the lack of access still remains in Brazil with still lower levels of access compared with other middle-income countries (Holst et al, 2016). Health benefits that have accrued include an increase of 13.8 years in life expectancy since the inception of the NHS in Brazil (IBGE, 2019).…”

Section: Introductionmentioning

confidence: 99%

Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario.

et al. 2020

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Background: There are many health benefits since 31 years after the foundation of the National Health Service (NHS) in Brazil, especially the increase in life expectancy. However, family-income inequalities, insufficient funding, and suboptimal private sectorpublic sector collaboration are still areas for improvement. The efforts of Brazil to achieve universal health coverage (UHC) for medicines have resulted in increased public financing of medicines and their availability, reducing avoidable hospitalization and mortality. However, lack of access to medicines still remains. Due to historical reasons, pharmaceutical service organization in developing countries may have important differences from high-income countries. In some cases, developing countries finance and promote medicine access by using the public infrastructure of health care/medical units as dispensing sites and cover all costs of medicines dispensed. In contrast, many high-income countries use private community pharmacies and cover the costs of medicines dispensed plus a fee, which includes all logistic costs. In this study, we will undertake an economic evaluation to understand the funding needs of the Brazilian NHS to reduce inequalities in access to medicines through adopting a pharmaceutical service organization similar to that seen in many high-income countries with hiring/accrediting private pharmacies. Methods: We performed an economic evaluation of a model to provide access to medicines within public funds based on a decision tree model with two alternative scenarios public pharmacies (NHS, state-owned facilities) versus private pharmacies

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“…Currently, challenges regarding the provision of services by specialized care are numerous, and, possibly, will be aggravated by the Constitutional Amendment (EC) 95/2016, which limits public spending for 20 years and can hinder the increase of resources for health and other social policies, posing a major threat to these demands. Budget cuts could impact the population health indicators 29, 30 .…”

Section: Introductionmentioning

confidence: 99%

Absenteísmo de usuários como fator de desperdício: desafio para sustentabilidade em sistema universal de saúde

et al. 2019

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Non-attendance to specialized healthcare appointments, diagnostic, and therapeutic procedures is a global problem in healthcare, leading to the wastage of resources both in the public and private sectors. This study aims to estimate financial wastage of resources linked to non-attendance to scheduled health specialist appointments and procedures in the metropolitan region of the Espírito Santo State (ES), Brazil, between 2014 and 2016. We studied 1.002.719 specialized healthcare procedures, being 666.182 appointments with specialized physicians and other healthcare professionals, and 336.537 specialized diagnostic and other therapeutic procedures. Non-attendance date were retrieved from the administrative procedure scheduling database (SisReg-ES) available in the ES Regulatory Agency and provided by the ES Health Office. Financial values used to estimate wastage were retrieved from the SUS and other standard tariff lists for medical procedures, and used according to the administrative regime of the three types of service providers. Non-attendance average rate for medical and health specialists' appointments achieved 38.6%, or 257.025 missed appointments, equivalent to an estimated waste of resources of R$3.558.837,88. Non-attendance as for other specialized procedures reached 32.1%, or 108.103 missed procedures, equivalent to R$15.007.624,15. Total wasted resources reached significant values, evincing the ongoing challenge to managers seeking to attain SUStainable universal health care systems.KEYWORDS Absenteeism. Secondary care. Health management. Integrality in health. RESUMO O absenteísmo de usuários em consultas e exames é considerado um problema mundial na assistência à saúde, gerando desperdício de recursos tanto no setor público como no setor privado. O objetivo deste estudo foi o de estimar o desperdício de recursos monetários vinculado ao absenteísmo em procedimentos especializados no Sistema Único de Saúde (SUS) naRegião de Saúde Metropolitana do Espírito Santo (RSM-ES) entre os anos de 2014 e 2016. Analisaram-se 1.002.719 procedimentos, sendo 666.182 consultas e 336.537 exames especializados. Os dados de absenteísmo foram retirados dos registros administrativos do Sistema de Regulação do ES (SisReg-ES), fornecidos pela Secretaria Estadual de Saúde. Os valores monetários foram obtidos por meio da Tabela SUS, da tabela complementar de convênios e da tabela de custos estimados, segundo o tipo de prestador envolvido no atendimento. A taxa média de absenteísmo para consultas foi de 38,6% (257.025 consultas), gerando um total estimado de R$3.558.837,88; e para exames especializados, foi de 32,1% (108.103 exames), em um total estimado de R$15.007.624,15. Os valores totais desperdiçados são significativos e evidenciam o desafio constante na agenda dos gestores na busca pela SUStentabilidade em sistemas universais de saúde. PALAVRAS-CHAVE Absenteísmo. Atenção secundária à saúde. Gestão em saúde. Integralidade em saúde.

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Porque não instituir copagamento no Sistema Único de Saúde: efeitos nocivos para o acesso a serviços e a saúde dos cidadãos

Cited by 5 publications

References 32 publications

A judicialização da saúde no Brasil e na Colômbia: uma discussão à luz do novo constitucionalismo latino-americano

A judicialização da saúde no Brasil e na Colômbia: uma discussão à luz do novo constitucionalismo latino-americano

Funding and Service Organization to Achieve Universal Health Coverage for Medicines: An Economic Evaluation of the Best Investment and Service Organization for the Brazilian Scenario.

Absenteísmo de usuários como fator de desperdício: desafio para sustentabilidade em sistema universal de saúde

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