scholarly journals The differential impact of economic recessions on health systems in middle-income settings: a comparative case study of unequal states in Brazil

2020 ◽  
Vol 5 (2) ◽  
pp. e002122 ◽  
Author(s):  
Lucas Salvador Andrietta ◽  
Maria Luiza Levi ◽  
Mário C Scheffer ◽  
Maria Teresa Seabra Soares de Britt Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
...  
Keyword(s):  
Public Health ◽  
Health Systems ◽  
System Performance ◽  
Health Financing ◽  
Sao Paulo ◽  
Comparative Case Study ◽  
São Paulo ◽  
Middle Income ◽  
Economic Recessions

IntroductionAlthough economic crises are common in low/middle-income countries (LMICs), the evidence of their impact on health systems is still scant. We conducted a comparative case study of Maranhão and São Paulo, two unevenly developed states in Brazil, to explore the health financing and system performance changes brought in by its 2014–2015 economic recession.MethodsDrawing from economic and health system research literature, we designed a conceptual framework exploring the links between macroeconomic factors, labour markets, demand and supply of health services and system performance. We used data from the National Health Accounts and National Household Sample Survey to examine changes in Brazil’s health spending over the 2010–2018 period. Data from the National Agency of Supplementary Health database and the public health budget information system were employed to compare and contrast health financing and system performance of São Paulo and Maranhão.ResultsOur analysis shows that Brazil’s macroeconomic conditions deteriorated across the board after 2015–2016, with São Paulo’s economy experiencing a wider setback than Maranhão’s. We showed how public health expenditures flattened, while private health insurance expenditures increased due to the recession. Public financing patterns differed across the two states, as health funding in Maranhão continued to grow after the crisis years, as it was propped up by transfers to local governments. While public sector staff and beds per capita in Maranhão were not affected by the crisis, a decrease in public physicians was observed in São Paulo.ConclusionOur case study suggests that in a complex heterogeneous system, economic recessions reverberate unequally across its parts, as the effects are mediated by private spending, structure of the market and adjustments in public financing. Policies aimed at mitigating the effects of recessions in LMICs will need to take such differences into account.

Environmental and public health effects of vehicle emissions in a large metropolis: Case study of a truck driver strike in Sao Paulo, Brazil

2020 ◽  
Vol 11 (6) ◽  
pp. 24-31 ◽  
Author(s):  
Luciana Ferreira Leite Leirião ◽  
Daniela Debone ◽  
Theotonio Pauliquevis ◽  
Nilton Manuel Évora do Rosário ◽  
Simone Georges El Khouri Miraglia
Keyword(s):  
Public Health ◽  
Health Effects ◽  
Vehicle Emissions ◽  
Sao Paulo ◽  
Truck Driver ◽  
São Paulo

scholarly journals How the ‘plates’ of a health system can shift, change and adjust during economic recessions. A qualitative interview study of public and private health providers in Brazil’s São Paulo and Maranhão states

2020 ◽  
Author(s):  
Giuliano Russo ◽  
Maria Luiza Levi Paim ◽  
Maria Teresa Seabra Soares de Britto e Alves ◽  
Bruno Luciano Carneiro Alves de Oliveira ◽  
Ruth Helena de Souza Britto Ferreira de Carvalho ◽  
...  
Keyword(s):  
Health System ◽  
Access To Care ◽  
Health Systems ◽  
Low Income ◽  
Sao Paulo ◽  
São Paulo ◽  
Public And Private ◽  
Qualitative Interview Study ◽  
Economic Recessions ◽  
The Impact

Background. Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world’s most affected countries, and its health system was already living the aftermath of the 2015 recession. Methods. Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings.Results. We found the concept of ‘health sector crisis’ to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible – if insecure – working arrangements. Following a drop in employment and health plans, private health insurance companies streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but also credited for having moved to cater for higher-income customers in Maranhão.Conclusions. The ‘plates’ of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.

scholarly journals SISTEMA DE MEDIÇÃO INDIVIDUALIZADA DE ÁGUA: ESTUDO DE CASO DE EDIFÍCIO COMERCIAL EM SÃO PAULO

2016 ◽  
Vol 11 (3) ◽  
Author(s):  
Bárbara Cattapreta Lima ◽  
Juliana Keiko Yamaguchi ◽  
Lika Livia Kussaba ◽  
Armando Traini Ferreira
Keyword(s):  
System Performance ◽  
Sao Paulo ◽  
São Paulo ◽  
Commercial Building ◽  
Performance Study ◽  
Rational Use ◽  
Advantages And Disadvantages ◽  
The Common ◽  
The Individual

RESUMO: Este artigo utiliza para seu desenvolvimento dados reais coletados da observação de um Sistema de Medição Individualizada (SMI) de água de um edifício comercial situado em São Paulo – SP e, apresenta como objetivos um estudo da redução de consumo resultante da instalação do SMI e um levantamento a respeito das vantagens e desvantagens da sua utilização em edifícios. O SMI consiste na instalação de um medidor em cada unidade habitacional a fim de contabilizar individualmente o consumo de água, energia, gás e outros insumos ou serviços, salvo a porção utilizada nas áreas comuns do edifício, que continua sendo rateada entre os condôminos. Dessa maneira, permite uma cobrança mais justa e o surgimento de um pensamento voltado para um uso mais racional e, consequentemente mais sustentável, induzido pelo maior controle dos gastos, por parte dos consumidores, referente ao item medido. Os resultados obtidos no estudo de caso apontaram para um uso mais racional, proveniente da melhor gestão de consumo de água, possibilitada pela instalação do SMI. Como principal contribuição, este artigo apresenta um panorama geral e simples do SMI de água, atentando para as principais vantagens de sua instalação em ambientes comerciais. ABSTRACT: This article uses for its development actual data collected from the observation of a Water Individualized Measurement System (W-IMS) of a commercial building located in São Paulo - SP, and aims at achieving a system performance study and also a survey of the main advantages and disadvantages of using an W-IMS in buildings. The SMI consists of installing a meter on each housing unit to enable the individual metering of water, energy, gas and other supplies or services consumption, except the portion used in the common areas of the building, which remains divided among all building residents. The W-IMS allows a fairer charging for water consumption, and encourages the emergence of a more sustainable thinking, focused to a water rational use, induced by the consumer’s spending control. The results of the case study point to a more rational use of water from its better consumption management, made possible by the IMS facilities. Finally, the main contribution of this paper is to present an simplified overview about W-IMS, paying attention on its design details and the advantages of its installation in commercial built-up environments.

scholarly journals Machine Learning for Neonatal Mortality Risk Assessment: A Case Study Using Public Health Data from São Paulo

2020 ◽  
Author(s):  
Carlos Eduardo Beluzo ◽  
Luciana Correia Alves ◽  
Rodrigo Bresan ◽  
Natália Arruda ◽  
Ricardo Sovat ◽  
...  
Keyword(s):  
Public Health ◽  
Machine Learning ◽  
Risk Assessment ◽  
Network Architecture ◽  
Health Data ◽  
Sao Paulo ◽  
São Paulo ◽  
Public Health Data ◽  
Tools And Techniques

AbstractInfant mortality is a reflection of a complex combination of biological, socioeconomic and health care factors that require various data sources for a thorough analysis. Consequently, the use of specialized tools and techniques to deal with a large volume of data is extremely helpful. Machine learning has been applied to solve problems from many domains and presents great potential for the proposed problem, which would be an innovation in Brazilian reality. In this paper, an innovative method is proposed to perform a neonatal death risk assessment using computer vision techniques. Using mother, pregnancy care and child at birth features, from a dataset containing neonatal samples from São Paulo city public health data, the proposed method encodes images features and uses a custom convolutional neural network architecture to classification. Experiments show that the method is able to detect death samples with accuracy of 90.61%.

Patchwork of Industrial Neighborhoods around São Paulo Core Area: Mooca’s Case Study

2017 ◽  
Vol 03 (05) ◽  
pp. 314-324
Author(s):  
Adilson Costa Macedo ◽  
Gastão Santos Sales ◽  
Maria Isabel Imbronito
Keyword(s):  
Sao Paulo ◽  
Core Area ◽  
São Paulo

Geoelectrical characterization using joint inversion of VES/TEM data: A case study in Paraná Sedimentary Basin, São Paulo State, Brazil

2014 ◽  
Vol 111 ◽  
pp. 33-46 ◽  
Author(s):  
Cassiano Antonio Bortolozo ◽  
Marco Antonio Couto ◽  
Jorge Luís Porsani ◽  
Emerson Rodrigo Almeida ◽  
Fernando Acácio Monteiro dos Santos
Keyword(s):  
Sedimentary Basin ◽  
Joint Inversion ◽  
Sao Paulo ◽  
São Paulo ◽  
Paulo State ◽  
São Paulo State ◽  
Paraná Sedimentary Basin

Satisfação dos clientes: estudo de caso em uma pequena empresa do interior paulista / Customer satisfaction: case study in a small company in the interior paulista

2021 ◽  
Vol 3 (4) ◽  
pp. 3466-3477
Author(s):  
Amanda Stefany Francisco Silva ◽  
João Victor Vaz Fontes ◽  
Maria Eduarda Moraes Dos Santos
Keyword(s):  
Customer Satisfaction ◽  
Sao Paulo ◽  
São Paulo ◽  
Small Company

No atual ambiente competitivo é imperativo que as empresas busquem a contínua satisfação dos consumidores, a fim de atingir a fidelização. Diante da importância da satisfação para as empresas, este estudo analisa o grau de satisfação e propõe melhorias contínuas para um restaurante no interior de São Paulo. Para isso, aplicou-se o Método de Análise e Solução de Problemas – MASP, juntamente com um questionário para identificação do nível de satisfação dos consumidores. Os resultados indicaram que o atendimento foi o fator de insatisfação dos consumidores. Diante disso, foi elaborado um plano de ação que resultou na programação de um aplicativo e treinamentos aos funcionários, com o objetivo de melhorar o atendimento e obter melhores resultados.

Management of personal protective equipment during the COVID-19 pandemic in England and the state of New York: A comparative case study

2020 ◽  
Vol 18 (7) ◽  
pp. 71-89
Author(s):  
Amy Barber, BSc ◽  
Annaëlle Vinzent, BS ◽  
Imani Williams, BA
Keyword(s):  
New York ◽  
Supply Chain ◽  
Health Systems ◽  
Personal Protective Equipment ◽  
New York State ◽  
The United States ◽  
Mitigation Strategies ◽  
Comparative Case Study ◽  
Protective Equipment

Background: The COVID-19 crisis placed extraordinary demands on the supply of personal protective equipment (PPE) at the beginning of 2020. These were coupled with shocks to the supply chain resulting from the disease. Many typically well-resourced health systems faced subsequent shortages of equipment and had to implement new strategies to manage their stocks. Stockpiles of protective equipment were held in both the United States and United Kingdom intended to prevent shortages. Method: Cross-comparative case study approach by applying Pettigrew and Whipp’s framework for change management. Setting: The health systems of England and New York state from January 2020 to the end of April 2020. Results: Both cases reacted slowly to their outbreaks and faced problems with supplying enough PPE to their health systems. Their stockpiles were not enough to prevent shortages, with many distribution problems resulting from inadequate governance mechanisms. No sustainable responses to supply disruptions were implemented during the study period in either case. Health systems planned interventions along each part of the supply chain from production and importing, to usage guidelines. Conclusion: Global supply chains are vulnerable to disruptions caused by international crises, and existing mitigation strategies have not been wholly successful. The existence of stockpiles is insufficient to preventing shortages of necessary equipment in clinical settings. Both the governance and quality of stockpiles, as well as distribution channels are important for preventing shortages. At the time of writing, it is not possible to judge the strength of strategies adopted in these cases.

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