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Acesso ao diagnóstico de tuberculose em serviços de saúde do município de Ribeirão Preto - São Paulo (2006 - 2007); Access to tuberculosis diagnosis in health services in the city of Ribeirão Preto SP (2006-2007).

Oliveira, Mayra Fernanda de
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 21/08/2009 Português
Relevância na Pesquisa
66.12%
O presente estudo avalia o acesso ao diagnóstico da tuberculose município de Ribeirão Preto São Paulo. O estudo foi baseado num instrumento do Primary Care Assessment Tool (PCAT) elaborado por Starfield (1998; 2000), adequado e validado para o Brasil por Macincko e Almeida (2006) e adaptado para a atenção a TB por Villa e Ruffino-Netto (2007). A amostra, por conveniência, foi constituída de 100 doentes de TB residentes em Ribeirão Preto, diagnosticados entre junho de 2006 a julho de 2007. Os dados foram coletados por entrevista estruturada. Os doentes responderam às questões seguindo uma escala do tipo Likert com 5 escores. Também foram coletados dados referentes aos endereços dos doentes e condições sócio-econômicas. Foi utilizado o geoprocessamento para identificar os serviços de referência para cada doente e as distâncias entre os domicílios e os serviços de saúde. A análise dos dados foi realizada por meio de análise exploratória e, em seguida, da Análise Fatorial de Correspondência Múltipla (AFCM). Houve predomínio do sexo masculino, ensino fundamental incompleto e residentes em moradia própria. Com relação à porta de entrada observou-se que, apesar da maioria dos doentes ter procurado por atendimento em UBS...

Avaliação da efetividade dos serviços de saúde no diagnóstico da tuberculose em Foz do Iguaçu, PR - Tríplice fronteira Brasil, Paraguai e Argentina; Evaluation of the effectiveness of health services in the diagnosis of tuberculosis in Foz do Iguaçu, Paraná - triple border Brazil, Paraguay and Argentina

Silva Sobrinho, Reinaldo Antonio da
Fonte: Biblioteca Digitais de Teses e Dissertações da USP Publicador: Biblioteca Digitais de Teses e Dissertações da USP
Tipo: Tese de Doutorado Formato: application/pdf
Publicado em 13/02/2012 Português
Relevância na Pesquisa
66.11%
O controle da tuberculose implica em organizar serviços de saúde para realizar ações de diagnóstico de forma integrada e colaborativa. O estudo objetivou avaliar a efetividade dos diferentes serviços de saúde no diagnóstico da tuberculose no município de Foz do Iguaçu, PR. Realizou-se uma pesquisa avaliativa com desenho epidemiológico do tipo corte transversal. Foram entrevistados 101 doentes de tuberculose diagnosticados no município com população estimada de 325.137 mil habitantes, localizado na tríplice fronteira Brasil- Paraguai-Argentinha, nos meses de janeiro a novembro de 2009. O instrumento de coleta foi baseado no "The Primary Care Assessment Tool" (PCAT), adaptado para a atenção à tuberculose. Os dados foram analisados por meio de técnicas de análise descritiva (frequência absoluta e relativa). A efetividade foi avaliada pela ocorrência do diagnóstico da tuberculose no primeiro serviço de saúde procurado pelo doente, e a seguir foram construídos indicadores para avaliar os tipos de serviços de saúde frente às ações de diagnóstico. Verificou-se ainda o número de vezes que o doente foi ao serviço até receber o diagnóstico da tuberculose e o tempo decorrido entre o primeiro contato com o serviço e a ocorrência do diagnóstico. Os resultados das análises foram contextualizados pelas dimensões acessibilidade e desempenho. A proporção de doentes que conseguiram consulta no mesmo dia foi superior a 70% em todos os serviços. Verificou-se que o primeiro serviço de saúde procurado pelo doente que obteve maior percentual na suspeição da tuberculose...

Expenditures for Mental Health Services in the Utah Prepaid Mental Health Plan

Stoner, Tamara; Manning, Willard; Christianson, Jon; Gray, Donald Z.; Marriott, Sally
Fonte: CENTERS for MEDICARE & MEDICAID SERVICES Publicador: CENTERS for MEDICARE & MEDICAID SERVICES
Tipo: Artigo de Revista Científica
Publicado em //1997 Português
Relevância na Pesquisa
76.02%
This article examines the effect of a mental health carve-out, the Utah Prepaid Mental Health Plan (UPMHP), on expenditures for mental health treatment and utilization of mental health services for Medicaid beneficiaries from July 1991 through December 1994. Three Community Mental Health Centers (CMHCs) provided mental health services to Medicaid beneficiaries in their catchment areas in return for capitated payments. The analysis uses data from Medicaid claims as well as “shadow claims” for UPMHP contracting sites. The analysis is a pre/post comparison of expenditures and utilization rates, with a contemporaneous control group in the Utah catchment areas not in the UPMHP. The results indicate that the UPMHP reduced acute inpatient mental health expenditures and admissions for Medicaid beneficiaries during the first 2½ years of the UPMHP. In contrast, the UPMHP had no statistically significant effect on outpatient mental health expenditures or visits. There was no significant effect of the UPMHP on overall mental health expenditures.

Trade in Health Services : What’s in it for Developing Countries?

Cattaneo, Olivier
Fonte: Banco Mundial Publicador: Banco Mundial
Português
Relevância na Pesquisa
66.13%
This study summarizes the existing knowledge and relevant abstracts and case-studies on the design of health and/or trade reforms and policies. The study aims to contribute to the understanding of the potential benefits and risks - and ways to maximize the former and minimize the latter - of trade in the health sector. It is designed for non-trade (health) experts to understand how trade can help to improve health systems and access to health services, and for trade specialists to understand the specific characteristics of the health sector.

Performance-Based Contracting for Health Services in Developing Countries : A Toolkit

Loevinsohn, Benjamin
Fonte: Washington, DC : World Bank Publicador: Washington, DC : World Bank
Português
Relevância na Pesquisa
66.12%
This toolkit provides practical advice to anyone involved in, or who is interested in becoming involved in, performance-based contracting of health services with non state providers in the context of developing countries. It addresses many of the issues that may be encountered. Input from experienced contracting professionals will give newcomers increased confidence as they go forward. Experts directly involved in contracting on a large scale have contributed to the development of this toolkit. The first section provides summary before moving on to the main part of the toolkit. The section provides background on contracting, including definitions of key terms, the types of services that can be contracted, how contracting relates to other ways of organizing health services, and which contracting approaches work in different settings. The third section provides a systematic way of thinking about contracting and how to do it in practice. It looks at seven aspects of the contracting process from initial dialogue with stakeholders through carrying out the bidding process and managing contracts. This framework will help ensure a systematic consideration of the choices and challenges. The fourth section provides checklist which contains tasks and issues to address while designing and implementing a contract. The checklist can also be used to review an existing contract to see what is missing or could be improved. The fifth and final section reviews the evidence for contracting in developing countries...

Trade in Health Services in the ASEAN Region

Arunanondchai, Jutamas; Fink, Carsten
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
66.14%
Promoting quality health services to large population segments is a key ingredient to human and economic development. At its core, healthcare policymaking involves complex tradeoffs between promoting equitable and affordable access to a basic set of health services, creating incentives for efficiencies in the healthcare system, and managing constraints in government budgets. International trade in health services influences these tradeoffs. It presents opportunities for cost savings and access to better quality care, but it also raises challenges in promoting equitable and affordable access. Drawing on a research project of the ASEAN Economic Forum, this paper offers a discussion of trade policy in health services for the ASEAN region. It reviews the state of healthcare in the region, existing patterns of trade, and remaining barriers to trade. The paper also identifies policy measures that could further harness the benefits from trade in health services and address potential pitfalls that deeper integration may bring about.

The Political Economy of Health Services Provision and Access in Brazil

Mushfiq Mobarak, Ahmed; Rajkumar, Andrew Sunil; Cropper, Maureen
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
66.11%
The authors examine the impact of local politics and government structure on the allocation of publicly subsidized (SUS) health services across municipios (counties) in Brazil, and on the probability that uninsured individuals who require medical attention actually receive access to those health services. Using data from the 1998 PNAD survey they demonstrate that higher per capita levels of SUS doctors, nurses, and clinic rooms increase the probability that an uninsured individual gains access to health services when he, or she seeks it. The authors find that an increase in income inequality, an increase in the percentage of the population that votes, and an increase in the percentage of votes going to left-leaning candidates are each associated with higher levels of public health services. The per capita provision of doctors, nurses, and clinics is also greater in counties with a popular local leader, and in counties where the county mayor and state governor are politically aligned. Administrative decentralization of health services to the county decreases provision levels, and reduces access to services by the uninsured, unless it is accompanied by good local governance.

Demand-side Financing for Sexual and Reproductive Health Services in Low and Middle-Income Countries : A Review of the Evidence

Witter, Sophie; Somanathan, Aparnaa
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
66.13%
Demand-side financing approaches have been introduced in a number of low and middle-income countries, with a particular emphasis on sexual and reproductive health. This paper aims to bring together the global evidence on demand-side financing mechanisms, their impact on the delivery of sexual and reproductive health services, and the conditions under which they have been effective. The paper begins with a discussion of modalities for demand-side financing. It then examines 13 existing schemes, including cash incentives, vouchers, and longer term social protection policies. Based on the available literature, it collates evidence of their impact on utilization of services, access for the poor, financial protection, quality of care, and health outcomes. Evidence on costs and cost-effectiveness are examined, along with analysis of funding and sustainability of policies. Finally, the paper discusses the preconditions for effectiveness of demand-side financing schemes and the strengths and weaknesses of different approaches. It also highlights the extent to which results for sexual and reproductive health services are likely to be generalizable to other types of health care. It is clear that some of these policies can produce impressive results...

Contracting for the Delivery of Community Health Services : A Review of Global Experience

Loevinsohn, Benjamin; Harding, April
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Português
Relevância na Pesquisa
66.13%
To achieve the health-related Millennium Development Goals, it will be necessary to improve the delivery of health services, particularly to poor people. One proposed approach to improving both coverage and quality of care is to contract with NGOs or other non-state entities to deliver health services. This paper reviews experiences with contracting in which some coherent form of evaluation was carried out, using at least before and after, or controlled evaluation designs. Ten examples of contracting with NGOs were found and from these studies, it appears that in developing countries, contracting with non-state providers to deliver primary health or nutrition services can be very effective and that improvements can be rapid. These results were found in a variety of services and settings. Six of the ten studies compared contractor performance to government provision of the same services and all six found that the contractors achieved better results. There are a number of concerns about contracting that have been raised...

The determinants of use of maternal and child health services in Metro Cebu, the Philippines

Becker, Stan; Peters, David H; Gray, Ronald H; Gultiana, Connie; Black, Robert E
Fonte: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University Publicador: Health Transition Centre, National Centre for Epidemiology and Population Health, The Australian National University
Tipo: Artigo de Revista Científica Formato: 49308 bytes; application/pdf
Português
Relevância na Pesquisa
75.96%
The determinants of the use of family planning, prenatal care, childhood immunizations and oral rehydration salts (ORS) were studied with survey data of 8000 women in Metro Cebu, the Philippines. Polytomous logistic regression methods were used. The level of maternal education was the most consistent and important determinant of use of these four health services in both urban and rural areas. For example, the estimated odds of using modern contraception increased by six and eleven per cent for each additional year of schooling in urban and rural strata respectively. Economic status and access to service variables had less consistent patterns: women’s work status, for example, was associated only with contraceptive use.; no

Parallel Systems and Human Resource Management in India's Public Health Services : A View from the Front Lines

La Forgia, Gerard; Raha, Shomikho; Shaik, Shabbeer; Maheshwari, Sunil Kumar; Ali, Rabia
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
Português
Relevância na Pesquisa
66.11%
There is building evidence in India that the delivery of health services suffers from an actual shortfall in trained health professionals, but also from unsatisfactory results of existing service providers working in the public and private sectors. This study focusses on the public sector and examines de facto institutional and governance arrangements that may give rise to well-documented provider behaviors such as absenteeism, which can adversely affect service delivery processes and outcomes. The paper considers four human resource management subsystems: postings, transfers, promotions, and disciplinary practices. The four subsystems are analyzed from the perspective of front line workers, that is, physicians working in rural health care facilities operated by two state governments. Physicians were sampled in one post-reform state that has instituted human resource management reforms and one pre-reform state that has not. The findings are based on quantitative and qualitative measurement. The results show that formal rules are undermined by a parallel modus operandi in which desirable posts are often determined by political connections and side payments. The evidence suggests an institutional environment in which formal rules of accountability are trumped by a parallel set of accountabilities. These systems appear so entrenched that reforms have borne no significant effect.

Empowering Women : The Effect of Women’s Decision-Making Power on Reproductive Health Services Uptake - Evidence from Pakistan

Hou, Xiaohui; Ma, Ning
Fonte: Banco Mundial Publicador: Banco Mundial
Tipo: Publications & Research :: Policy Research Working Paper; Publications & Research
Português
Relevância na Pesquisa
66.13%
A large body of research has attempted to explore the links between women's autonomy and their uptake of reproductive health services in the South Asia region, but the evidence so far is inconclusive. This study uses the Pakistan Social and Living Standards Measurement Survey to examine the influence of household decision making on women's uptake of reproductive health services. The analysis finds that women's decision-making power has a significant positive correlation with reproductive health services uptake and that influential males' decision-making power has the opposite effect, after controlling for socio-economic indicators and supply-side conditions. The findings suggest that empowering women and increasing their ability to make decisions may increase their uptake of reproductive health services. They also suggest that policies directed toward improving women's utilization of maternity services must target men as well as women in Pakistan.

International Trade in Health Services and the GATS : Current Issues and Debates

Blouin, Chantal; Drager, Nick; Smith, Richard
Fonte: Washington, DC: World Bank Publicador: Washington, DC: World Bank
Tipo: Publications & Research :: Publication; Publications & Research :: Publication
Português
Relevância na Pesquisa
66.15%
Health ministries around the world face a new challenge: to assess the risks and respond to the opportunities of the increasing openness in health services under the World Trade Organization's (WTO) General Agreement on Trade in Services (GATS). This publication addresses this challenge head-on by providing analytical tools to policymakers in health and trade ministries alike who are involved in the liberalization agenda and, specifically, in the GATS negotiations. This book informs and assists policymakers in formulating trade policy and negotiating internationally. There is ongoing and animated international debate about the impact of GATS on public services in general and health in particular. In response, the book offers different perspectives from more than 15 leading experts. Some of the authors stress opportunities linked to trade in health services, others focus more on the risks. The book offers: Detailed legal analysis of the impact of the agreement on health policy; an overview of trade commitments in health-related services; new empirical evidence from nine country studies; and a simple 10-step explanation on how to deal with GATS negotiations.

How are Health Services, Financing and Status Evaluated? An Analysis of Implementation Completion Reports of World Bank Assistance in Health

Subramanian, Savitha; Peters, David; Willis, Jeffrey
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
Relevância na Pesquisa
66.12%
This paper reports on an analysis of how World Bank assistance at the country level has influenced health services, health financing, and status on peoples' health. The Implementation Completion Reports used to evaluate all 118 projects involving health services completed between fiscal years 2003-2005 were systematically analyzed to determine how they measured changes in health services, health financing, and health status outcomes. The results showed that few Bank-assisted projects in the health sector evaluated changes in health services, health financing, or health status, with nearly all those measuring change demonstrating improvements. In multivariate models including the type of project organization (e.g. disease program, sector wide approach), project inputs, key project activities, and contextual factors including per capita income level, geographic region, and Country Policy and Institutional Assessment ratings, there was a statistically significant association between use of a sector-wide approach (SWAp) and measurement of improvements in health services and improvements in health status. Projects that used contracting mechanisms were also more likely to show an improvement in health services. No other type of organization of project support...

Kenya : Reaching the Poor through the Private Sector, A Network Model for Expanding Access to Reproductive Health Services

Montagu, Dominic; Prata, Ndola; Campbell, Martha M.; Walsh, Julia; Orero, Salomon
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
Relevância na Pesquisa
66.12%
This study, carried out in the summer of 2003, measured the effectiveness of a Kenyan program dedicated to increasing the availability of reproductive health services to the poor through training and networking of private medical providers. The Kisumu Medical and Educational Trust (KMET) program focuses on family planning services and encourages providers to add these services to the normal range of consultations, commodity sales, and clinical care they already provide. The central question addressed in this study is whether it is possible to offer reproductive health services through a network of private sector, for-profit providers without exacerbating inequity in access to these services.. The study also looked at a pool of potential clients of KMET members to evaluate which wealth group benefits from the subsidy given to private providers through KMET. And finally, an analysis of actual KMET clients was used to better understand the program's success in providing quality reproductive health care.

Pricing Health Services for Purchasers : A Review of Methods and Experiences

Waters, Hugh; Hussey, Peter
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research :: Working Paper; Publications & Research
Português
Relevância na Pesquisa
66.11%
This paper reviews methodologies and international experience related to costing and pricing health services. Several factors affect the determination of the prices purchasers pay for health services. These include: the method of provider payment; the availability of information on costs, volumes, outcomes, and patient and provider characteristics; methods used to calculate providers' costs; and characteristics of purchasers and providers-including the regulatory environment, provider autonomy, negotiating power, and the degree of competition. The paper focuses on methods for setting levels of payment under different provider payment mechanisms. Line item and global budgets remain the most common reimbursement methods in developing countries. However, many of these countries are implementing mixed payment systems that have greater information demands. The principal payment types used in high-income countries-capitation, payments per case or diagnosis, and fee-for-service-are reviewed here, and implications for low- and middle-income countries discussed. To minimize incentives for under- or over-utilization...

Multisectoral Preventive Health Services in Sri Lanka : Lessons for Developing Countries in Providing Public Goods in Health

Das Gupta, Monica; Dalpatadu, K.C.S.; Shanmugarajah, C.K.; Herath, H.M.S.S.D.
Fonte: World Bank, Washington, DC Publicador: World Bank, Washington, DC
Tipo: Publications & Research; Publications & Research :: Policy Research Working Paper
Português
Relevância na Pesquisa
66.12%
What can other developing countries learn from Sri Lanka on achieving good health at low cost? While its well-organized medical and maternal-child health services have been documented elsewhere, this paper fills a gap in documenting how it organizes services to reduce the population's exposure to disease -- a pure public good. The key factors underlying the effectiveness of these services are (1) strong focal points in the central Health Ministry for supporting preventive services; (2) pro-active outreach by the health line agency to collaborate with other sectors / agents whose work influences public health outcomes; and (3) community-level delivery institutions with well-trained multivalent Public Health Inspectors -- all underpinned by (4) assured tax-based financing. This paper describes this system in some detail such that other countries can learn from Sri Lanka's successful approach to improving population health. It also makes some recommendations for strengthening the system in response to changing conditions.

Rating maternal and neonatal health services in developing countries

Bulatao,Rodolfo A.; Ross,John A.
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/09/2002 Português
Relevância na Pesquisa
76.08%
OBJECTIVE: To assess maternal and neonatal health services in 49 developing countries. METHODS: The services were rated on a scale of 0 to 100 by 10 - 25 experts in each country. The ratings covered emergency and routine services, including family planning, at health centres and district hospitals, access to these services for both rural and urban women, the likelihood that women would receive particular forms of antenatal and delivery care, and supporting elements of programmes such as policy, resources, monitoring, health promotion and training. FINDINGS: The average rating was only 56, but countries varied widely, especially in access to services in rural areas. Comparatively good ratings were reported for immunization services, aspects of antenatal care and counselling on breast feeding. Ratings were particularly weak for emergency obstetric care in rural areas, safe abortion and HIV counselling. CONCLUSION: Maternal health programme effort in developing countries is seriously deficient, particularly in rural areas. Rural women are disadvantaged in many respects, but especially regarding the treatment of emergency obstetric conditions. Both rural and urban women receive inadequate HIV counselling and testing and have quite limited access to safe abortion. Improving services requires moving beyond policy reform to strengthening implementation of services and to better staff training and health promotion. Increased financing is only part of the solution.

Health services under the General Agreement on Trade in Services

Adlung,Rudolf; Carzaniga,Antonia
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2001 Português
Relevância na Pesquisa
76.06%
The potential for trade in health services has expanded rapidly in recent decades. More efficient communication systems have helped to reduce distance-related barriers to trade; rising incomes and enhanced information have increased the mobility of patients; and internal cost pressures have led various governments to consider possibilities for increased private participation. As yet, however, health services have played only a modest role in the General Agreement on Trade in Services (GATS). It is possible that Members of the World Trade Organization have been discouraged from undertaking access commitments by the novelty of the Agreement, coordination problems between relevant agencies, widespread inexperience in concepts of services trade, a traditionally strong degree of government involvement in the health sector, and concerns about basic quality and social objectives. However, more than five years have passed since GATS entered into force, allowing hesitant administrations to familiarize themselves with its main elements and its operation in practice. The present paper is intended to contribute to this process. It provides an overview of the basic structure of GATS and of the patterns of current commitments in health services and of limitations frequently used in this context. The concluding section discusses possibilities of pursuing basic policy objectives in a more open environment and indicates issues that may have to be dealt with in current negotiations on services.

Trade in health services

Chanda,Rupa
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 Português
Relevância na Pesquisa
76.11%
In light of the increasing globalization of the health sector, this article examines ways in which health services can be traded, using the mode-wise characterization of trade defined in the General Agreement on Trade in Services. The trade modes include cross- border delivery of health services via physical and electronic means, and cross-border movement of consumers, professionals, and capital. An examination of the positive and negative implications of trade in health services for equity, efficiency, quality, and access to health care indicates that health services trade has brought mixed benefits and that there is a clear role for policy measures to mitigate the adverse consequences and facilitate the gains. Some policy measures and priority areas for action are outlined, including steps to address the "brain drain"; increasing investment in the health sector and prioritizing this investment better; and promoting linkages between private and public health care services to ensure equity. Data collection, measures, and studies on health services trade all need to be improved, to assess better the magnitude and potential implications of this trade. In this context, the potential costs and benefits of trade in health services are shaped by the underlying structural conditions and existing regulatory...