Reinventing Privatization: A Political Economic Analysis of the Social Health Organizations in Brazil

2020 ◽  
Vol 51 (1) ◽  
pp. 90-100
Author(s):  
Fabiana Turino ◽  
Jonathan Filippon ◽  
Francis Sodré ◽  
Carlos Eduardo Siqueira
Keyword(s):  
Health Care ◽  
Public Management ◽  
Health Care Services ◽  
New Public Management ◽  
Public Health Care ◽  
Social Health ◽  
Health Organizations ◽  
Non Profit ◽  
Care Services ◽  
National Constitution

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations ( Organizações Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen’s right following its national constitution.

scholarly journals The Association of Residence Permits on Utilization of Health Care Services by Migrant Workers in China

2021 ◽  
Vol 18 (18) ◽  
pp. 9623
Author(s):  
Haochuan Xu ◽  
Han Yang ◽  
Hui Wang ◽  
Xuefeng Li
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Care Access ◽  
Migrant Workers ◽  
Health Care Services ◽  
Public Health Care ◽  
Chinese Government ◽  
Care Access ◽  
Care Services ◽  
The Impact

Due to the limitations in the verifiability of individual identity, migrant workers have encountered some obstacles in access to public health care services. Residence permits issued by the Chinese government are a solution to address the health care access inequality faced by migrant workers. In principle, migrant workers with residence permits have similar rights as urban locals. However, the validity of residence permits is still controversial. This study aimed to examine the impact of residence permits on public health care services. Data were taken from the China Migrants Dynamic Survey (CMDS). Our results showed that the utilization of health care services of migrant workers with residence permits was significantly better than others. However, although statistically significant, the substantive significance is modest. In addition, megacities had significant negative moderating effects between residence permits and health care services utilization. Our research results emphasized that reforms of the household registration system, taking the residence permit system as a breakthrough, cannot wholly address the health care access inequality in China. For developing countries with uneven regional development, the health care access inequality faced by migrant workers is a structural issue.

The importance of the partnership between the public and private healthcare institutions to improve interhospital patient transfers

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Rimantas Stašys ◽  
Gintautas Virketis ◽  
Daiva Labanauskaitė
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Public Health Care ◽  
Urgent Care ◽  
Private Health Care ◽  
Content Type ◽  
Patient Transfers ◽  
Care Services ◽  
Interhospital Transfer ◽  
Health Care Institutions

Purpose The purpose of this study/paper is to identify the importance of the partnership between the public and private health-care institutions to improve interhospital patient transfers. Scientific research and statistical data show the increased number of interhospital transportation services; therefore, timely and qualified patient transportation between different health-care institutions must be considered, the activity that directly and significantly impacts the patient’s health status and overall quality of the health-care services. The successful patient transportation from the smaller hospitals to the health-care institutions with advanced intensive care or urgent care units can be enhanced through the partnership between private and public health-care institutions. Design/methodology/approach The methodology included quantitative method, statistical data analysis and theoretical data generalization. Both primary and secondary data were collected and analyzed during the research. Expert quantification was performed using the survey research method. The survey was conducted in Lithuania. The respondents were selected to be the general managers of the health-care and urgent care institutions, the chief doctors of the reanimation and intensive care department also the chief doctors of the emergency department. Findings Because of the centralization and regionalization of health-care services, the number of patients transferred between hospitals by the emergency medical services (EMS) and personal health-care institutions has increased. University hospitals are not sufficiently prepared to accept an increasing flow of patients in accordance with the Ministry of Health orders. Not all regional or district hospitals have the right to provide such assistance, which increases transportation time and costs as well as requires additional human resources. The five EMS categories could be used to improve the patient transfer between different levels of health-care institutions. To increase partnership between private and public health-care organizations, incentives should be provided for the development of private health-care organizations, as well as encouraging actions should be taken to increase the demand for private health-care services by Lithuanian patients. Practical implications Five EMS categories identified in this paper could be used to ensure a smooth mechanism for the patient transfer between different levels of the personal health-care institutions. The proposed categories should also be used in the pre-stationary emergency phase (for reducing the interhospital patient transportation amount). Social implications Properly organized secondary and tertiary interhospital patient transfers influence the availability and quality of the EMS and reduce inequalities in the provided services and social exclusion. Originality/value This paper presents the classification of the interhospital transfer issues, determines the main reasons for the patient interhospital transfer, creates the model for the EMS patient process flows and defines five EMS categories for the assessment of patient conditions. Therefore, the research conducted and the results obtained have both theoretical and social-practical value.

scholarly journals An estimation of willingness to pay for secondary health care services in Tamil Nadu, India

2016 ◽  
Vol 5 (1) ◽  
pp. 12
Author(s):  
K Ramu
Keyword(s):  
Public Health ◽  
Health Care ◽  
Willingness To Pay ◽  
Tamil Nadu ◽  
Health Care Services ◽  
Public Health Care ◽  
The Public ◽  
Care Services ◽  
Secondary Health Care ◽  
User Fee

The present study has estimated the willingness to pay (WTP) for secondary health care services (SHCS) in rural and urban environment of three districts in the state of Tamil Nadu during 2009-2011. Since the governments are struggling to mobilise additional financial        resources to provide essential health care services to the deprived population in the country, assessing the WTP for utilising the public health care services are realised as very important at this juncture. In realizing the importance of augmentation of resources, it has been decided to introduce contingent valuation method (CVM) for WTP of SHCS. A disproportionate systematic random sampling method has been adopted for the selection of 720 households; representing 240 respondents from each of the three districts represent 120 from rural and 120 from urban. A major portion (92%) of the surveyed respondents’ gender was male, literacy was high (90%) and they belonged to productive age group. They generally involve themselves in the farm and non - farm activities and avail employment. Their per capita income is Rs.17871, and it is lower than the India’s PCI. The SHCS are classified into 26 categories as per the guidelines provided by public health medical officers in the state of Tamil Nadu. The different health care services started with entry fee to dental problem. The 98.6 per cent of the total surveyed respondents are ready to pay for SHCS in a public hospital and the remaining 2.4 per cent of them are not willing to pay for the same. The range of WTP for 26 SHCS is Rs. 2 - 7000; the range of mean value is Rs. 6 - 5008 and the range of SD is 2 - 2854. Considering the view of majority of the respondents, this study prescribes to introduce the range of user fee for the identified major public health care services. Since the range is differed significantly, it is suggested to follow the minimum amount initially and in a phased manner, the policy makers may prescribe to enhance the user fee after assessing the ground realities and loopholes. The estimated R2 value for SHCS is 20 per cent, which indicates that the selected 12 independent variables have low influence on WTP for SHCS. The study reports that the other exogenous factors like intensity of disease, accessibility of services, quality, urgency, need and perception are the predominant determinants of WTP for SHCS. The present research contends that constitution of district level co-ordination committee for fixing and implementing user fee for SHCS. Introduction of nominal fee (user fee) for SHCS may be fixed for affordable population, free services for BPL population and it would improve the efficiency and equity of the public health care services for the marginalised population. Finally, it is of utmost importance for health professionals to follow ethics in their profession.

scholarly journals Financial Crisis in Portugal: Effects in the Health Care Sector

2019 ◽  
Vol 49 (2) ◽  
pp. 237-259 ◽  
Author(s):  
Alexandre Morais Nunes ◽  
Diogo Cunha Ferreira ◽  
Adalberto Campos Fernandes
Keyword(s):  
Health Care ◽  
Financial Crisis ◽  
Access To Health Care ◽  
Health Care Services ◽  
Health Care Sector ◽  
Public Health Care ◽  
Positive Effects ◽  
Care Services ◽  
Access To Health ◽  
Care System

Portugal has faced an economic and financial crisis that began circa FY2009 and whose effects are still ongoing. In FY2011, the Portuguese state and the European triumvirate – composed of the European Commission, the International Monetary Fund, and the European Central Bank – signed the Memoranda of Understanding. This troika agreement aimed to improve the operational efficiency of public services. This crisis had a considerable impact on the Portuguese citizens’ life and productivity, as well as on the public health care system. Cuts over public expenditures have been made to reduce the risk of noncompliance with budgetary targets, despite their potential impact on quality and access to health care services. We analyzed the main policies and measures undertaken by the Portuguese Ministry of Health with respect to the bailout program associated with the troika agreement. Then, we focused on the budgetary cuts–related risks over the social performance of the care system. Evidence suggests that structural reforms in the health care sector in the troika period had positive effects in terms of drugs administration and consumption, on the one hand, and secondary care expenditures reduction, on the other hand. Nonetheless, we observed some divestitures on infrastructures and the worsening of access to health care services.

scholarly journals Trends in horizontal inequity in access to public health care services by immigrant condition in Spain (2006–2017)

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Jaime Pinilla ◽  
Miguel A. Negrín ◽  
Ignacio Abásolo
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Care Services ◽  
Public Health Care ◽  
Specialist Care ◽  
Public Health Services ◽  
Horizontal Inequity ◽  
Latin Americans ◽  
Care Services

Abstract Background The objective of this research is to analyse trends in horizontal inequity in access to public health services by immigration condition in Spain throughout the period 2006–2017. We focus on “economic immigrants” because they are potentially the most vulnerable group amongst immigrants. Methods Based on the National Health Surveys of 2006–07 (N = 29,478), 2011–12 (N = 20,884) and 2016–17 (N = 22,903), hierarchical logistic regressions with random effects in Spain’s autonomous communities are estimated to explain the probability of using publicly-financed health care services by immigrant condition, controlling by health care need and other socioeconomic and demographic variables. Results Our results indicate that there are several horizontal inequities, though they changed throughout the decade studied. Regarding primary care services, the period starts (2006–07) with no global evidence of horizontal inequity in access (although the analysis by continent shows inequity that is detrimental to Eastern Europeans and Asians), giving way to inequity favouring economic immigrants (particularly Latin Americans and Africans) in 2011–12 and 2016–17. An opposite trend happens with specialist care, as the period starts (2006–07) with evidence of inequity that is detrimental to economic immigrants (particularly those from North of Africa) but this inequity disappears with the economic crisis and after it (with the only exception of Eastern Europeans in 2011–12, whose probability to visit a specialist is lower than for natives). Regarding emergency care, our evidence indicates horizontal inequity in access that favours economic immigrants (particularly Latin Americans and North Africans) that remains throughout the period. In general, there is no inequity in hospitalisations, with the exception of 2011–12, where inequity in favour of economic immigrants (particularly those from Latin America) takes place. Conclusions The results obtained here may serve, firstly, to prevent alarm about negative discrimination of economic immigrants in their access to public health services, even after the implementation of the Royal Decree RD Law 16/2012. Conversely, our results suggest that the horizontal inequity in access to specialist care that was found to be detrimental to economic immigrants in 2006–07, disappeared in global terms in 2011–12 and also by continent of origin in 2016–17.

Post-Fordism's Contradictory Trends: The Case of the Israeli Health Care System

2004 ◽  
Vol 33 (3) ◽  
pp. 417-436 ◽  
Author(s):  
DANI FILC
Keyword(s):  
Health Care ◽  
Health Care System ◽  
Health Care Services ◽  
Health Care Facilities ◽  
Public Health Care ◽  
Political Struggle ◽  
Care Services ◽  
National Health Insurance Law ◽  
The Right ◽  
Care System

The transition from the Fordist hegemonic model to post-Fordism is a complex process. It is not the unavoidable result of technological changes, but the contingent consequence of a hegemonic, political, struggle taking place at the different spheres of the social. This article studies the transformations that took place in the Israeli health care system during the last two decades in order to exemplify the political and contradictory character of the transition to post-Fordism. The article emphasises the contradiction between the partial commodification of financing and the privatisation of certain health care facilities, and the legislation of the National Health Insurance Law, which guaranteed the right to access to public health care services.

Interstate Level Comparison of People’s Health Status and the State of Public Health Care Services in India

2014 ◽  
Vol 16 (4) ◽  
pp. 489-507 ◽  
Author(s):  
Rajkishor Meher ◽  
Rajendra Prasad Patro
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Status ◽  
Tamil Nadu ◽  
Health Care Services ◽  
Health Indicators ◽  
Well Being ◽  
Sub Saharan Africa ◽  
Public Health Care ◽  
Care Services

Health is an essential component of economic development and there is a strong correlation between health of human population and societal well-being. We cannot just think of the development of the human capital without the development of health and education of the people. However, it is found that although India has made large gains on the health front of its population, there exist wide variations between and within states. While states such as Kerala, Punjab and Tamil Nadu have a very developed health sector and the health indicators of these states are comparable to those of developed middle-income countries, states such as Bihar, Jharkhand, Madhya Pradesh, Chhattisgarh, Uttar Pradesh, Odisha, etc., are almost at the level of Sub-Saharan Africa. By using a few of the key health indicators the present article makes a critical analysis of the health status of people in the 17 major states of India, the ongoing health development programmes and the present state of public health care services in different parts of the country. The article further delves into an arena of specific policy intervention measures that are required to be undertaken in order to increase the health status of people.

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