Citizens’ initiatives for care and welfare in the Netherlands: an ecological analysis

Background In the Netherlands as well as in other countries citizens take initiatives to provide or maintain services in the area of care and welfare. Citizens’ initiatives (CI’s) are organisations some of which have a formal structure while others are informally connected groups of citizens, that are established by a group of citizens with the aim to increase the health and welfare within their local community and that are not focused on making a profit. Although CI’s have been around since at least the 1970’s little research has been done on the phenomenon, with most of it consisting of case studies or qualitative exploratory research. To fill part of this gap in knowledge, we have studied the geographical variation in the presence of CI’s in the Netherlands and tried to explain this variation. Methods Data on the presence of CI’s were obtained by combining two existing inventories. We did an ecological regression analysis to test hypotheses about the relationship between the presence of CI’s and the existence of a care vacuum, the capacity for self-organisation and models of action in local communities. Results We counted 452 CI’s in care and welfare in the Netherlands in January 2016. Our results show a spatial concentration of care initiatives in urban areas in the Randstad cities in the west of the country and in rural areas in the south-east. The presence of CI’s is only weakly associated with a care vacuum, but is related to indicators for the capacity of concerted action and models of action. Conclusion There are by now a considerable number of CI’s in the area of care and welfare in the Netherlands. Apparently, citizens take collective initiatives to provide services that are not, or no longer, available to the local community. The initiatives are concentrated in certain parts of the country. However, our theoretical model to explain this geographical pattern is only partially confirmed.

Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care

SUMMARY INTRODUCTION Structural disparities between different Brazilian regions in public health system cause patients to migrate in search of better conditions to treat their diseases. Besides patient’s discomfort, there is a concentration of care in large centres, causing overload to current capacity. OBJECTIVE To evaluate migratory flow and associated factors in a reference service in oncology. METHODS Cross-sectional study conducted at a referral oncology service in Great ABC region of São Paulo. Patients were interviewed, and clinical and demographic data collected. RESULTS Between March-July 2016, 217 patients were included. Analysis showed a divergence between the postal code registered in the medical record and that recorded during the interview in approximately 10% of cases. Of these, 42.9% were residents of other states. Search for treatment motivated most patients to seek service outside their city. CONCLUSION Results reflect the informal search for medical care outside the home area. Besides the direct impact on patients’ quality of life, migratory flow has an economic-social impact because these patients place a burden and impose costs on services of cities where they do not perform their responsibilities as citizens. Confirmation of the existence of a significant migratory flow demonstrates the need to discuss restructuring public health policies.