scholarly journals Reactions to institutional violence: patient strategies for facing infringements of the right to health in Brazil

2013 ◽  
Vol 9 (1) ◽  
pp. 11-25
Author(s):  
Sonia Fleury ◽  
Valéria Bicudo ◽  
Gabriela Rangel
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Participant Observation ◽  
Structural Factors ◽  
Public Health Services ◽  
Structured Interviews ◽  
Institutional Violence ◽  
Care Services ◽  
Individual Solution ◽  
The Right

In this article we identify evidences of inequalities, prejudices and discrimination in the access and utilization of public health services belonging to the Brazilian Unified Health Care System, considering them to be institutional violence and a negation of rights, in order to look at the reactions of the subjects victimized by this process. This research study utilized different methodologies, articulating participant observation, semi-structured interviews, focus groups and dramatization. The results highlight the trajectory in seeking health care as the main expression of inequalities, strengthened by structural factors such as the precarious condition of health care services, which potentiate power asymmetries, and the presence of discrimination derived from stigmas and prejudices. Most patients' reactions to the situation of institutional violence seek an individual solution to the problem, often reaffirming the conditions that generate rights violations. Few patients' reactions question the systemic conditions that determine the continued discrimination.

Characterizing the health experience of Tuvaluan migrants in Auckland, New Zealand

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Jordan Paul Emont ◽  
Seipua O’Brien ◽  
Vili Nosa ◽  
Elizabeth Terry Toll ◽  
Roberta Goldman
Keyword(s):  
Climate Change ◽  
Health Care ◽  
New Zealand ◽  
Health Care Services ◽  
Participant Observation ◽  
Full Time ◽  
Structured Interviews ◽  
Content Type ◽  
Care Services ◽  
Full Time Employment

Purpose It is predicted that increasing numbers of citizens of the Pacific Island nation of Tuvalu will migrate to New Zealand in the coming decades due to the threat of climate change. Tuvaluans currently living in New Zealand face disparities in income, education and health. This study aims to understand the views of recent Tuvaluan immigrants to Auckland, New Zealand on health behaviors, health care and immigration. Design/methodology/approach The authors conducted semi-structured interviews, key informant interviews and participant observation using a focused ethnography methodology. Findings Participants explained that Tuvaluans in New Zealand do not fully use primary care services, have a poorer diet and physical activity compared to those living in Tuvalu, and struggle to maintain well-paying, full-time employment. Practical implications As Tuvaluan immigration to New Zealand continues, it will be important to educate the Tuvaluan community about the role of primary health-care services and healthy behaviors, facilitate the current process of immigration and provide job training to recent immigrants to improve their opportunities for full-time employment and ensure cultural survival in the face of the threat of climate change. Originality/value This paper contributes to a greater understanding of the challenges to be faced by Tuvaluan environmental migrants in the future and features a high proportion of study participants who migrated due to climate change.

scholarly journals Setting Health Care Services Tariffs in Iran: Half a Century Quest for a Window of Opportunity

2020 ◽  
Author(s):  
Leila Doshmangir ◽  
Arash Rashidian ◽  
Farhad Kouhi ◽  
Vladimir S Gordeev
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Services ◽  
Analysis Data ◽  
Lessons Learned ◽  
Structured Interviews ◽  
Public And Private ◽  
Middle Income ◽  
Care Services ◽  
The Right

Abstract Background: The process of medical tariffs setting in Iran remains to be a contentious issue and is heavily criticized by many stakeholders. This paper explores the experience of setting health care services tariffs in the Iranian health care system over the last five decades. Methods: We analyzed data collected through literature review and reviews of the official documents developed at the various levels of the Iranian health system using inductive and deductive content analysis. Twenty-two face-to-face semi-structured interviews supplemented the analysis. Data were analysed and interpreted using 'policy triangle' and 'garbage can' models.Results: Our comprehensive review of changes in the medical tariff setting provides valuable lessons for major stakeholders. Most changes were implemented in a sporadic, inadequate, and a non-evidence-based manner. Disparities in tariffs between public and private sectors continue to exist. Lack of clarity in tariffs setting mechanisms and its process makes negotiations between various stakeholders difficult and can potentially become a source of a corrupt income. Such clarity can be achieved by using fair and technically sound tariffs. Technical aspects of tariff setting should be separated from the political negotiations over the overall payment to the medical professionals. Transparency regarding a conflict of interest and establishing punitive measures against those violating the rules could help improving trust in the doctor-patient relationship. Conclusion: Use of evidence-informed models and methods in medical tariff setting could help to strike the right balance in the process of health care services provision to address health system objectives. A sensitive application of policy models can offer significant insights into the nature of medical tariff setting and highlight existing constraints and opportunities. This study generates lessons learned in tariffs setting, particularly for low- and middle-income countries.

Reaction of New Soviet Immigrants to Primary Health Care Services in Israel

1998 ◽  
Vol 28 (3) ◽  
pp. 555-574 ◽  
Author(s):  
Larissa I. Remennick ◽  
Naomi Ottenstein-Eisen
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
The Elderly ◽  
Medical Services ◽  
Structured Interviews ◽  
Cultural Aspects ◽  
Care Services ◽  
Israeli Population ◽  
Primary Health Care Services ◽  
Diverse Cultures

The post-1989 immigration wave from the former U.S.S.R. has increased the Israeli population by over 12 percent, seriously affecting the host health care system. This study draws on semi-structured interviews with the immigrants visiting outpatient clinics in the Tel-Aviv area in order to explore organizational and cultural aspects of their encounter with the Israeli medical services. While instrumental aspects of care were seen as an improvement over the Soviet standards, communication between providers and clients was seriously flawed, reflecting both a language barrier and diverse cultures of illness and cure. Many interviewees complained of the impersonal, “technical” attitude of Israeli physicians toward patients and the lack of holism in care, which they allegedly enjoyed before emigration. Some immigrant patients feel deprived of the paternalism of the Soviet medical system, complaining that Israeli providers “forego responsibility” for patients' health. A consumerist approach to medical services is also a novelty, and immigrants have to learn to be informed and assertive clients. Most problems are experienced by the elderly patients; overall, women seem to adjust to the new system better than men.

The making and sustaining of leaders in health care

2019 ◽  
Vol 33 (2) ◽  
pp. 241-262 ◽  
Author(s):  
Terry J. Boyle ◽  
Kieran Mervyn
Keyword(s):  
Health Care ◽  
Community Health ◽  
Health Care Services ◽  
Health Care Systems ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Triple Aim ◽  
Content Type ◽  
Care Services ◽  
Care Systems

Purpose Many nations are focussing on health care’s Triple Aim (quality, overall community health and reduced cost) with only moderate success. Traditional leadership learning programmes have been based on a taught curriculum, but the purpose of this paper is to demonstrate more modern approaches through procedures and tools. Design/methodology/approach This study evolved from grounded and activity theory foundations (using semi-structured interviews with ten senior healthcare executives and qualitative analysis) which describe obstructions to progress. The study began with the premise that quality and affordable health care are dependent upon collaborative innovation. The growth of new leaders goes from skills to procedures and tools, and from training to development. Findings This paper makes “frugal innovation” recommendations which while not costly in a financial sense, do have practical and social implications relating to the Triple Aim. The research also revealed largely externally driven health care systems under duress suffering from leadership shortages. Research limitations/implications The study centred primarily on one Canadian community health care services’ organisation. Since healthcare provision is place-based (contextual), the findings may not be universally applicable, maybe not even to an adjacent community. Practical implications The paper dismisses outdated views of the synonymity of leadership and management, while encouraging clinicians to assume leadership roles. Originality/value This paper demonstrates how health care leadership can be developed and sustained.

scholarly journals Perceived risks and barriers to care for international migrants in transit through Mexico

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
S Larrea ◽  
R Leyva-Flores ◽  
N Guarneros-Soto ◽  
C Infante-Xibille
Keyword(s):  
Public Health ◽  
Health Care ◽  
Health Services ◽  
Health Personnel ◽  
Health Care Services ◽  
Barriers To Care ◽  
Human Security ◽  
Public Health Services ◽  
Care Services ◽  
In Transit

Abstract Background Mexico has implemented policies seeking to reduce barriers to care for migrants in transit; however, it is estimated that only 3% of migrants use public health services when needed. The main purpose of this study was to identify the barriers to access public health services faced by migrants in transit through Mexico. Methods Under the human security perspective, in 2018, a qualitative study was carried out in Mexican communities with high migrant mobility. 34 semi-structured interviews were conducted with migrants in transit, and personnel from public health services and migrant shelters (NGOs). Values and meanings related to risks, health problems, barriers to care, experiences of health services utilization, and opinions on facilitating elements to diminish these barriers were identified. Results Migrants in transit through Mexico face risks that affect all dimensions of human security. Perceived anti-migratory and discriminative attitudes during the journey were constantly mentioned in the interviews. Barriers to care were found in the four stages of health care access, classified according to the Tanahashi framework, with the majority related to accessibility and acceptability. The following facilitating elements were also identified: political willingness of local government, knowledge and talent management of health personnel, and strategies implemented for adapting local health care services to migrants. Conclusions Social and political conditions in Mexico disrupt any effort to reduce social risks and barriers to care for migrants in transit. Non-governmental actors are key players for facilitating interactions between migrants and local governmental health care institutions. However, the general anti-migratory context negatively affects access to health care and influence the perspectives of migrants, NGOs, and health personnel. Key messages The predominant perceived barriers to care are in counterpoint to local governmental pro-migrant rights perspectives. NGOs are key actors to promote access to public 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.

Pengalaman Perempuan Bekerja Dalam Melaksanakan Tugas Kesehatan Keluarga di Wilayah Jakarta, Bogor, Tangerang, Bekasi

2008 ◽  
Vol 12 (1) ◽  
pp. 21-28
Author(s):  
Henny Permatasari ◽  
Achir Yani S. Hamid ◽  
Setyowati Setyowati
Keyword(s):  
Health Care ◽  
Gender Discrimination ◽  
Health Care Services ◽  
Family Health ◽  
Working Women ◽  
Study Data ◽  
Health Providers ◽  
Care Services ◽  
Professional Health ◽  
The Right

AbstrakPenelitian fenomenologi yang berperspektif perempuan ini bertujuan mendapatkan gambaran pengalaman perempuan bekerja berkeluarga dalam melaksanakan perawatan keluarga. Partisipan ditetapkan dengan metode purposif berjumlah enam orang. Data dikumpulkan melalui wawancara mendalam dan dianalisis dengan metode Collaizz’s. Hasil penelitian mengidentifikasi delapan tema utama dan satu tema tambahan yaitu alasan perempuan bekerja, kekhususan perempuan bekerja, kemampuan manajerial perempuan bekerja, dukungan sosial, kemampuan melaksanakan tugas kesehatan keluarga, kesenjangan antara harapan pekerja dan dukungan institusi kerja, diskriminasi gender, kebutuhan pekerja terhadap pelayanan kesehatan. Penelitian ini menyimpulkan bahwa perempuan bekerja mampu melaksanakan tugas kesehatan keluarga dengan dipengaruhi pengetahuan tentang masalah kesehatan, dukungan dari keluarga dan tenaga kesehatan profesional serta hak pekerja untuk mendapatkan jaminan pelayanan kesehatan. Perempuan bekerja juga memiliki kebutuhan khusus terhadap pelayanan kesehatan. Perawat kesehatan kerja diharapkan dapat meningkatkan pelayanan keperawatan yang bersifat promotif untuk memelihara dan meningkatkan derajat kesehatan perempuan bekerja. AbstractThere is evident that the working women experience numerous problems. The purpose of this feminine perspective phenomenological research was to describe the experience of married working women in carrying out family’s health tasks. There were six women purposively selected to participate in this study. Data was collected using in-depth-interview, exploring the experience of working women in carrying out family’s health tasks and issues related to the experience. Collaizz’s method was utilized to analyse the corrected qualitative data. The result of this study revealed nine themes were the reason for women to work, specification of social support, ability to carry out family health tasks, gap between expectation and insitution’s supporting, working women perception of gender discrimination, women’s need to health care. The research concluded that the working women were capable to carry family health taks which is influenced by their knowledge on health problems, the support of family and professional health providers and the right of providers to have health insurance. The working women also have the special needs of health care services. It is recommended that occupational health nurses should provide nursing care including health promotion and maintenance of health status of working women.

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.

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