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‣ Health surveys and use of maternal and child health care services in three municipalities within the Sao Paulo metropolitan area

CARVALHO, Wladithe Organ de; CESAR, Chester Luiz Galvao; CARANDINA, Luana; BARROS, Marilisa Berti de Azevedo; ALVES, Maria Cecilia Goi Porto; GOLDBAUM, Moises
Fonte: PAN AMER HEALTH ORGANIZATION Publicador: PAN AMER HEALTH ORGANIZATION
Tipo: Artigo de Revista Científica
Português
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Objectives. To describe the changes in the use of maternal and child health care services by residents of three municipalities-Embu, Itapecerica da Serra, and Taboao da Serra-in the Sao Paulo metropolitan area, 12 years after the implementation of the Unified Health System (SUS) in Brazil, and to analyze the potential of population-based health care surveys as sources of data to evaluate these changes. Methods. Two population-based, cross-sectional surveys were carried out in 1990 and 2002 in municipalities located within the Sao Paulo metropolitan area. For children under 1 year of age, the two periods were compared in terms of outpatient services utilization and hospital admission; for the mothers, the periods were compared in terms of prenatal care and deliveries. In both surveys, stratified and multiple-stage conglomerate sampling was employed, with standardization of interview questions. Results. The most important changes observed were regarding the location of services used for prenatal care, deliveries, and hospitalization of children less than 1 year of age. There was a significant increase in the use of services in the surrounding region or hometown, and decrease in the utilization of services in the city of Sao Paulo (in 1990...

‣ Health promotion and health education conceptions of future nurses and other university students : influence of the initial training

Carvalho, Graça Simões de; Carvalho, Amâncio
Fonte: International Union of Health Promotion and Education (IUHPE) Publicador: International Union of Health Promotion and Education (IUHPE)
Tipo: Conferência ou Objeto de Conferência
Publicado em 09/09/2008 Português
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The general aim of the present study was to compare the system of values in HP/HE conveyed in courses in the area of health, pre-school teaching, basic teaching and social service, in order to understand the relation between the conceptions to be taught and the taught conceptions. For this purpose, we first carried out a content analysis of HP/HE models in national and international publications and developed a descriptive, comparative and cross-sectional study. For the latter an auto-filling questionnaire was applied to a sample of 709 students of seven university courses. The mental representation of the health concept by the total of the students’ sample was expressed in five key words (by decreasing order): Well-being, Hospital, Disease, Doctors and Nurses. The predominance of these key words is connected to a reductionist vision of the health determinants, centred in the system of health, excluding the other ones. When looking at the evolution of the concept of health from the 1st to the 4th year of university training, the Braga Nursing course (BR-N) was the one with higher decrease in the key words associated to the reductionist vision of the term and, similarly, the course of Basic Teaching Teachers (BTT) was the one with more increases associated to the wide concept of health. In contrast...

‣ Editorial: Health Education: fostering public health literacy through innovative educational activities and resources; Editorial [to] Frontiers in public health, 3:208 (2015) 1-3

Fonseca, Maria João; Carvalho, Graça Simões de
Fonte: Frontiers in Public Health Publicador: Frontiers in Public Health
Tipo: Outros
Publicado em //2015 Português
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CIEC – Research Centre on Child Studies, IE, UMinho (FCT R&D unit 317), Portugal.; With the purpose of highlighting current topics in health education research, this Research Topic on “Health education: fostering public health literacy through innovative education activities and resources” brings together six articles aimed at the education of both the lay community and health professionals. Educational interventions targeting younger population segments tend to be regarded as effective, as they increase the chance of nurturing a healthy lifestyle throughout life [1,2]. The articles by Pais et al [3], Raved and Yarden [4], and Horn et al [5] address key interacting challenges aimed at younger generations through school health programs. Pais et al focus on improving the capacity of individuals and the community to deal with health-related issues [3]. Raved and Yarden consider the development of the knowledge-base and the system thinking skills required to process the complexity and vast amount of information about those issues [4]. Horn et al study the promotion of informed decision-making about health-related behaviors [5]. Each article examines the impact of innovative methodologies and perspectives that can boost the effectiveness of health education initiatives.

‣ National Environmental Public Health Tracking Program: Bridging the Information Gap

McGeehin, Michael A.; Qualters, Judith R.; Niskar, Amanda Sue
Fonte: National Institue of Environmental Health Sciences Publicador: National Institue of Environmental Health Sciences
Tipo: Artigo de Revista Científica
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In January 2001 the Pew Environmental Health Commission called for the creation of a coordinated public health system to prevent disease in the United States by tracking and combating environmental health threats. In response, the Centers for Disease Control and Prevention initiated the Environmental Public Health Tracking (EPHT) Program to integrate three distinct components of hazard monitoring and exposure and health effects surveillance into a cohesive tracking network. Uniform and acceptable data standards, easily understood case definitions, and improved communication between health and environmental agencies are just a few of the challenges that must be addressed for this network to be effective. The nascent EPHT program is attempting to respond to these challenges by drawing on a wide range of expertise from federal agencies, state health and environmental agencies, nongovernmental organizations, and the program’s academic Centers of Excellence. In this mini-monograph, we present innovative strategies and methods that are being applied to the broad scope of important and complex environmental public health problems by developing EPHT programs. The data resulting from this program can be used to identify areas and populations most likely to be affected by environmental contamination and to provide important information on the health and environmental status of communities. EPHT will develop valuable data on possible associations between the environment and the risk of noninfectious health effects. These data can be used to reduce the burden of adverse health effects on the American public.

‣ Approaching Health Disparities From a Population Perspective: The National Institutes of Health Centers for Population Health and Health Disparities

Warnecke, Richard B.; Oh, April; Breen, Nancy; Gehlert, Sarah; Paskett, Electra; Tucker, Katherine L.; Lurie, Nicole; Rebbeck, Timothy; Goodwin, James; Flack, John; Srinivasan, Shobha; Kerner, Jon; Heurtin-Roberts, Suzanne; Abeles, Ronald; Tyson, Frederic
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2008 Português
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Addressing health disparities has been a national challenge for decades. The National Institutes of Health–sponsored Centers for Population Health and Health Disparities are the first federal initiative to support transdisciplinary multilevel research on the determinants of health disparities. Their novel research approach combines population, clinical, and basic science to elucidate the complex determinants of health disparities. The centers are partnering with community-based, public, and quasi-public organizations to disseminate scientific findings and guide clinical practice in communities. In turn, communities and public health agents are shaping the research. The relationships forged through these complex collaborations increase the likelihood that the centers’ scientific findings will be relevant to communities and contribute to reductions in health disparities.

‣ US Opinions on Health Determinants and Social Policy as Health Policy

Robert, Stephanie A.; Booske, Bridget C.
Fonte: American Public Health Association Publicador: American Public Health Association
Tipo: Artigo de Revista Científica
Publicado em /09/2011 Português
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To examine what factors the public thinks are important determinants of health and whether social policy is viewed as health policy, we conducted a national telephone survey of 2791 US adults from November 2008 through February 2009. Respondents said that health behaviors and access to health care have very strong effects on health; they were less likely to report a very strong role for other social and economic factors. Respondents who recognized a stronger role for social determinants of health and who saw social policy as health policy were more likely to be older, women, non-White, and liberal, and to have less education, lower income, and fair/poor health. Increasing public knowledge about social determinants of health and mobilizing less advantaged groups may be useful in addressing broad determinants of health.

‣ What have we learnt about the cultural, social and behavioural determinants of health? From Selected Readings to the first Health Transition Workshop

Caldwell, John C
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: 52049 bytes; application/pdf
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The article explores the issue of whether the holding of an international workshop in Canberra in 1989, and the preparation of papers for it, increased our knowledge of the cultural, social and behavioural determinants of health and whether the publication of the proceedings placed new knowledge in the public domain. The approach adopted is to compare those proceedings with a collection of selected readings on the subject made shortly before as part of the same program and also with certain other publications. The conclusions reached are that, in addition to having stimulated interest in the field, the workshop and its proceedings furthered knowledge in at least five important areas: (1) the existence of mortality-prone households; (2) the impact of differing cultural situations of women in terms of individualism on their children’s survival; (3) the mechanisms whereby maternal education is translated into child survival; (4) the impact of culture and ethnicity on mortality; and (5) indirect indices of the impact of care. The workshop failed to contribute to substantial advances (or draw attention to the lack of advance) in the following areas: (1) the measurement of Third World morbidity or health; (2) adult health transition; (3) the impact of radicalism or egalitarianism in communities other than Kerala and Sri Lanka on mortality; (4) the impact of lifestyle diseases on Third World mortality; (5) the identification of economically optimum mixes of social change and the provision of health services in reducing mortality and improving health; and (6) the employment of health transition knowledge in the reduction of mortality and the improvement of health.; no

‣ Community context of health system development: implications for health sector reform in Pakistan

Mahmood, M.; Moss, J.; Karmaliani, R.
Fonte: World Health Organization, Regional Office for the Eastern Mediterranean Publicador: World Health Organization, Regional Office for the Eastern Mediterranean
Tipo: Artigo de Revista Científica
Publicado em //2003 Português
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To describe local sociopolitical and organizational factors that influence health system development in Karachi, Pakistan, we conducted participant observation while working with health providers and communities in one urban district to reorient services towards a primary health care district health system. We found that the community characteristics, particularly the diverse socialpolitical and cultural make-up and organizational complexity that involved multiple levels of government, influenced efforts towards collaboration and shaped the development of the health system. We conclude that for effective implementation of health sector reform there is a need to comprehend fully the community context and complexity of existing health service provision.; M.A. Mahmood, J. Moss and R. Karmaliani; © World Health Organisation. Regional Office for the Eastern Mediterranean

‣ Prevalence of South Australia's online health seekers

Bessell, T.; Silagy, C.; Anderson, J.; Hiller, J.; Sansom, L.
Fonte: Public Health Assoc Australia Inc Publicador: Public Health Assoc Australia Inc
Tipo: Artigo de Revista Científica
Publicado em //2002 Português
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OBJECTIVE: To determine the proportion of South Australians accessing online health care information, predictive characteristics of online health seekers, nature of the information sought and consumer behaviour. METHODS: A probability-based survey of 3,027 South Australians, aged 15 years and older, as part of the Spring 2000 South Australian Health Omnibus. RESULTS: Internet access decreases with age, while the prevalence of online health seekers is constant (26% to 28%) among people aged between 15 and 54 years. Predictive characteristics of online health seekers include gender, age, education and income. Most commonly sought information is the cause or description of disease (60%). Consumers use online health information as a second opinion (19%), discuss it with their doctor or pharmacist (16%), or change their health care management (11%). CONCLUSIONS: The Australian prevalence of online health seekers is likely to be slightly higher than 21%. Implications: The Intemet can deliver preventative and clinical health information to a critical mass of Australians, but poorer and older Australians may be unable to access it.; Tracey L. Bessell, Christopher Silagy, Jeremy N. Anderson, Janet E. Hiller and Lloyd N. Sansom; © Public Health Association Australia

‣ Australia's national men's health policy: Masculinity matters

Saunders, Margo; Peerson, Anita
Fonte: Australian Health Promotion Association Publicador: Australian Health Promotion Association
Tipo: Artigo de Revista Científica
Publicado em //2009 Português
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Issue addressed: The development of Australia’s first national men’s health policy provides an important opportunity for informed discussions of health and gender. It is therefore a concern that the stated policy appears to deliberately exclude hegemonic masculinity and other masculinities, despite evidence of their major influence on men’s health-related values, beliefs, perspectives, attitudes, motivations and behaviour. Methods: We provide an evidence-based critique of the proposed approach to a national men’s health policy which raises important questions about whether the new policy can achieve its aims if it fails to acknowledge ‘masculinity’ as a key factor in Australian men’s health. Conclusions: The national men’s health policy should be a means to encourage gender analysis in health. This will require recognition of the influence of hegemonic masculinity, and other masculinities, on men’s health. Recognising the influence of ‘masculinity’ on men’s health is not about ‘blaming’ men for ‘behaving badly’, but is crucial to the development of a robust, meaningful and comprehensive national men’s health policy.; http://search.informit.com.au/documentSummary;dn=979081828290747;res=IELHEA; Margo Saunders and Anita Peerson

‣ A population health approach to reducing observational intensity bias in health risk adjustment: cross sectional analysis of insurance claims

Wennberg, David E.; Sharp, Sandra M.; Bevan, Gwyn; Skinner, Jonathan S.; Gottlieb, Daniel J.; Wennberg, John E.
Fonte: BMJ Publishing Group and the Health Foundation Publicador: BMJ Publishing Group and the Health Foundation
Tipo: Article; PeerReviewed Formato: application/pdf
Publicado em 10/04/2014 Português
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Objective:- To compare the performance of two new approaches to risk adjustment that are free of the influence of observational intensity with methods that depend on diagnoses listed in administrative databases. Setting:- Administrative data from the US Medicare program for services provided in 2007 among 306 US hospital referral regions. Design:- Cross sectional analysis. Participants:- 20% sample of fee for service Medicare beneficiaries residing in one of 306 hospital referral regions in the United States in 2007 (n=5 153 877). Main outcome measures:- The effect of health risk adjustment on age, sex, and race adjusted mortality and spending rates among hospital referral regions using four indices: the standard Centers for Medicare and Medicaid Services—Hierarchical Condition Categories (HCC) index used by the US Medicare program (calculated from diagnoses listed in Medicare’s administrative database); a visit corrected HCC index (to reduce the effects of observational intensity on frequency of diagnoses); a poverty index (based on US census); and a population health index (calculated using data on incidence of hip fractures and strokes, and responses from a population based annual survey of health from the Centers for Disease Control and Prevention). Results:- Estimated variation in age...

‣ Knowledge for better health: a conceptual framework and foundation for health research systems

Pang,Tikki; Sadana,Ritu; Hanney,Steve; Bhutta,Zulfiqar A.; Hyder,Adnan A.; Simon,Jonathon
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/11/2003 Português
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Health research generates knowledge that can be utilized to improve health system performance and, ultimately, health and health equity. We propose a conceptual framework for health research systems (HRSs) that defines their boundaries, components, goals, and functions. The framework adopts a systems perspective towards HRSs and serves as a foundation for constructing a practical approach to describe and analyse HRSs. The analysis of HRSs should, in turn, provide a better understanding of how research contributes to gains in health and health equity. In this framework, the intrinsic goals of the HRS are the advancement of scientific knowledge and the utilization of knowledge to improve health and health equity. Its four principal functions are stewardship, financing, creating and sustaining resources, and producing and using research. The framework, as it is applied in consultation with countries, will provide countries and donor agencies with relevant inputs to policies and strategies for strengthening HRSs and using knowledge for better health.

‣ The implications of health sector reform for human resources development

Alwan,Ala'; Hornby,Peter
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2002 Português
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The authors argue that "health for all" is not achievable in most countries without health sector reform that incorporates a process of coordinated health and human resources development. They examine the situation in countries in the Eastern Mediterranean Region of the World Health Organization. Though advances have been made, further progress is inhibited by the limited adaptation of traditional health service structures and processes in many of these countries. National reform strategies are needed. These require the active participation of health professional associations and academic training institutions as well as health service managers. The paper indicates some of the initiatives required and suggests that the starting point for many countries should be a rigorous appraisal of the current state of human resources development in health.

‣ The two faces of enhancing utilization of health-care services: determinants of patient initiation and retention in rural Burkina Faso

Mugisha,Frederick; Bocar,Kouyate; Dong,Hengjin; Chepng'eno,Gloria
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/08/2004 Português
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OBJECTIVE: To explore the factors that determine whether a patient will initiate treatment within a system of health-care services, and the factors that determine whether the patient will be retained in the chosen system, in Nouna, rural Burkina Faso. METHODS: The data used were pooled from four rounds of a household survey conducted in Nouna, rural Burkina Faso. The ongoing demographic surveillance system provided a sampling framework for this survey in which 800 households were sampled using a two-stage cluster sampling procedure. More than one treatment episode was observed for a single episode of illness per patient. The multinomial logit model was used to explore the determinants of patient initiation to systems of modern, traditional and home treatment, and a binary logit model was used to explore the determinants of patient retention within the chosen health-care provider system. FINDINGS: The results suggest that the determinants of patient initiation and their subsequent retention are different. Household income, education, urban residence and expected competency of the provider are positive predictors of initiation, but not of retention, for modern health-care services. Only perceived quality of care positively predicted retention in modern health-care services. CONCLUSION: Interventions focusing on patient initiation and patient retention are likely to be different. Policies directed at enhancing initiation for modern health-care services would primarily focus on reducing financial barriers...

‣ Evidence-based reproductive health care in Cameroon: population-based study of awareness, use and barriers

Tita,Alan TN; Selwyn,Beatrice J; Waller,D Kim; Kapadia,Asha S; Dongmo,Sylvestre
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/12/2005 Português
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OBJECTIVE: To estimate the prevalence of awareness and use of evidence-based reproductive health interventions and to describe the barriers associated with the use of evidence-based interventions among health providers in north-west Cameroon. METHODS: In February 2004, a population-based descriptive study of the awareness and use of 13 evidence-based interventions targeted health workers providing reproductive health care. Their awareness and use of a composite of four vital interventions was also evaluated. These were peripartum use of antiretrovirals to prevent transmission of HIV, antenatal corticosteroid administration, magnesium sulfate prophylaxis and active management of placental delivery with uterotonics. In-depth interviews with key informants were conducted as part of a qualitative substudy to discover the barriers to the use of evidence-based interventions. FINDINGS: Overall, 91.4% (328/359) of reproductive health workers were surveyed. Their awareness of evidence-based interventions varied from 29% for the use of antenatal corticosteroids to 97% for the use of iron and folic acid supplementation during pregnancy. Their use of these interventions ranged from 10.2% for antenatal corticosteroids to 94.8% for iron and folic acid supplementation. Only 50/322 (15.5%; 95% confidence interval (CI) = 11.8-20.0) of health workers were aware of all four vital interventions...

‣ Socioeconomic status overrides age and gender in determining health-seeking behaviour in rural Bangladesh

Ahmed,Syed Masud; Tomson,Göran; Petzold,Max; Kabir,Zarina Nahar
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/02/2005 Português
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OBJECTIVE: To study the health-seeking behaviour of elderly members (aged > 60 years) of households in rural Bangladesh, to ascertain how their behaviour differs from that of younger people (aged 20-59 years) living in the same household and to explore the determinants of health-seeking behaviour. METHODS: Structured interviews were conducted to elicit information on the health-seeking behaviour of household members aged > 20 years. Respondents were asked about major illnesses occurring within 15 days prior to the interview. The sample consisted of 966 households that had at least one resident who was aged > 60 (32% of 3031 households). FINDINGS: We found no major differences in health-seeking behaviour between elderly people and younger adults. On average about 35% (405/1169) of those who reported having been ill during the previous 15 days in both age groups chose self-care/self-treatment; for both age groups the most commonly consulted type of provider was a paraprofessional such as a village doctor, a medical assistant or a community health worker. A household's poverty status emerged as a major determinant of health-seeking behaviour. The odds ratio (OR) that individuals from poor households would seek treatment from unqualified allopathic practitioners was 0.6 (95% confidence interval (CI) = 0.40-0.78); the odds ratio that individuals from poor households would seek treatment from qualified allopathic practitioners was 0.7 (95% CI = 0.60-0.95). For self-care or self-treatment it was 1.8 (95% CI = 1.43-2.36). Patients' level of education affected whether they avoided self-care/self-treatment and drugstore salespeople (who are usually unlicensed and untrained but who diagnose illnesses and sell medicine) and instead chose a formal allopathic practitioner (OR = 1.5; 95% CI = 1.15-1.96). When a household's poverty status was controlled for...

‣ Global trade and health: key linkages and future challenges

Bettcher,Douglas W.; Yach,Derek; Guindon,G. Emmanuel
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/01/2000 Português
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Globalization of trade, marketing and investment has important implications for public health, both negative and positive. This article considers the implications of the single package of World Trade Organization (WTO) agreements for public health research and policy, focusing on three themes: commodities, intellectual property rights, and health services. The main aims of the analysis are as follows: to identify how trade issues are associated with the transnationalization of health risks and possible benefits; to identify key areas of research; and to suggest policy-relevant advice and interventions on trade and health issues. The next wave of international trade law will need to take more account of global public health issues. However, to become more engaged in global trade debates, the public health community must gain an understanding of the health effects of global trade agreements. It must also ensure that its own facts are correct, so that public health is not blindly used for political ends, such as justifying unwarranted economic protectionism. ‘‘Healthy trade’’ policies, based on firm empirical evidence and designed to improve health status, are an important step towards reaching a more sustainable form of trade liberalization.

‣ Challenges for health systems in Member Countries of the Organisation for Economic Co-operation and Development

Hurst,Jeremy
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/06/2000 Português
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For reasons of equity most OECD countries have chosen to base their funding of health care mainly on public sources. There is an almost universal problem of affordability in the health systems of these countries, arising from the tension between the willingness of populations to pay taxes and the eagerness of patients to use health services where these are free or heavily subsidized at the point of use. These tensions are likely to be exacerbated by a surge of new medical technologies adding to demands for health care. Some observers have predicted the breakdown of publicly funded systems of health care under new spending pressures. However, governments can deploy a range of policies for handling new demands. They can also take comfort from the fact that many of them have already coped with successive waves of technological change in health care without abandoning their core commitment to the public funding of health systems. Furthermore, if standards of living continue to rise, public and private insurers should find it easier to obtain the revenues needed to pay for the improved health care expected by consumers.

‣ Knowledge-based changes to health systems: the Thai experience in policy development

Tangcharoensathien,Viroj; Wibulpholprasert,Suwit; Nitayaramphong,Sanguan
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/10/2004 Português
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Over the past two decades the government in Thailand has adopted an incremental approach to extending health-care coverage to the population. It first offered coverage to government employees and their dependants, and then introduced a scheme under which low-income people were exempt from charges for health care. This scheme was later extended to include elderly people, children younger than 12 years of age and disabled people. A voluntary public insurance scheme was implemented to cover those who could afford to pay for their own care. Private sector employees were covered by the Social Health Insurance scheme, which was implemented in 1991. Despite these efforts, 30% of the population remained uninsured in 2001. In October of that year, the new government decided to embark on a programme to provide universal health-care coverage. This paper describes how research into health systems and health policy contributed to the move towards universal coverage. Data on health systems financing and functioning had been gathered before and after the founding of the Health Systems Research Institute in early 1990. In 1991, a contract capitation model had been used to launch the Social Health Insurance scheme. The advantages of using a capitation model are that it contains costs and provides an acceptable quality of service as opposed to the cost escalation and inefficiency that occur under fee-for-service reimbursement models...

‣ Ethical issues in health workforce development

Cash,Richard
Fonte: World Health Organization Publicador: World Health Organization
Tipo: Artigo de Revista Científica Formato: text/html
Publicado em 01/04/2005 Português
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Increasing the numbers of health workers and improving their skills requires that countries confront a number of ethical dilemmas. The ethical considerations in answering five important questions on enabling health workers to deal appropriately with the circumstances in which they must work are described. These include the problems of the standards of training and practice required in countries with differing levels of socioeconomic development and different priority diseases; how a society can be assured that health practitioners are properly trained; how a health system can support its workers; diversion of health workers and training institutions; and the teaching of ethical principles to student health workers. The ethics of setting standards for the skills and care provided by traditional health-care practitioners are also discussed.