Orientadores: Antonio Carlos Pereira, Luciane Miranda Guerra / Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-24T18:15:23Z (GMT). No. of bitstreams: 1 SotoRojas_GabrielaChristiel_M.pdf: 1152282 bytes, checksum: 82faf924e89a35748696e48cec06bfeb (MD5) Previous issue date: 2014 / Resumo: Apesar dos avanços e esforços feitos na implementação de políticas publicas de saúde bucal, ainda persiste a dificuldade no acesso e uso dos serviços odontológicos, como é refletido nos resultados das ultimas pesquisas de interesse nacional como a Pesquisa Nacional por Amostra de Domicílios (PNAD) 2008 e SB Brasil 2010, onde grande porcentagem da população refere nunca ter ido ao dentista. São múltiplos os fatores que facilitam ou dificultam o acesso e uso destes serviços, um deles é o modelo de organização da demanda odontológica adotada pelas Equipes de Saúde Bucal (ESB), a qual deve desenvolver ações que lidem com as necessidades agudas e crónicas dos pacientes. Assim estas ações são registradas por meio dos indicadores no Sistema de Informação Ambulatorial (SIA) e no Sistema de Informação da Atenção Básica (SIAB), para ser avaliadas e monitoradas visando um melhor acesso aos serviços. Nesse contexto, o objetivo do estudo foi analisar a influencia da organização da demanda nos indicadores de saúde bucal, por meio da comparação destes indicadores entre 5 Unidades de Saúde da Família (USF) que trabalham com modelo de demanda espontânea e 5 USF que trabalham com demanda programada em saúde bucal. Todas as USF pertencentes ao município de Piracicaba, foram escolhidas aleatoriamente. Foram coletados os dados secundários da produção odontológica ambulatorial proveniente do SIA e do SIAB, do período de fevereiro até setembro 2013. Os dados coletados de cada USF foram organizados em indicadores, levando em conta a população de cada USF, estes indicadores foram: 1) acessibilidade; 2) razão de urgência odontológica; 3) resolutividade; 4) razão de exodontias por restaurações 5) razão de procedimentos básicos (dentística, periodontia, exodontia) 6) razão de procedimentos preventivos. Aplicou-se o teste t de Student ao nível de significância de 5% . Houve diferenças entre as unidades que trabalham com demanda livre e demanda organizada nos indicadores de razão de urgências, exodontia/restauração e razão de exodontias, sendo estes valores maiores no modelo da demanda espontânea. Conclui-se que o modelo de organização da demanda odontológica adotado pelas ESB nas USF interfere na procura de urgências odontológicas e razão de exodontias / Abstract: Despite advances and efforts in the implementation of public policies for oral health, there remains the difficulty in access to and use of dental services, as reflected in the results of the latest research of national interest such as the National Research by Sample (PNAD) 2008 and SB Brazil 2010 where a large percentage of the population reported having never been to the dentist. There are multiple factors that facilitate or hinder access to and use of these services, one of them is the organizational model adopted by the demand of dental oral health teams (ESB), which should develop actions that address acute and chronic needs of patients. So these actions are recorded by means of the indicators in the Outpatient Information System (SIA) and the Primary Care Information System (SIAB), to be evaluated and monitored to better access to services. In this context, the aim of the study was to analyze the influence of two models of clinical care in oral health indicators, by comparing these indicators between 5 Family Health Units (USF) working with the spontaneous demand model and 5 USF working with demand model scheduled in oral health. All USF are located in Piracicaba and were randomly chosen. Secondary data of daily production spreadsheets were collected from the information system (SIA and SIAB). Data belong to the period from February to September 2013. These data collected from each USF were organized into indicators: 1) reason of accessibility; 2) ratio of dental emergency; 3) solving; 4) reason for extractions restorations 5) ratio of basic procedures (esthetic dentistry, periodontics, tooth extraction) 6) ratio of preventive procedures. Was applied the Student's t test at a significance level of 5 %. There were differences between the USF working with spontaneous demand model and demand model scheduled, due to indicators of emergency, extraction/restoration and tooth extraction ratio, with higher values in the spontaneous demand model. Concluding that the model of clinical dental care adopted by ESB interferes in seeking emergency dental and extractions reason / Mestrado / Odontologia em Saude Coletiva / Mestra em Odontologia em Saúde Coletiva

Research in Canada and abroad has shown that newcomers face multiple obstacles in their search for health care during their resettlement and integration to the host society. In Ontario, primary care services are organized in three main models based on the remuneration scheme to physicians: fee for service, capitation, and salaried. During the Primary Care reforms in early 2000s, the province introduced new models of primary care practices to enhance the quality of care through the expansion of comprehensive multidisciplinary care, applying more preventive measures and enhanced chronic disease management strategies. Along with these innovative reforms, the province promoted an enrollment system with a family doctor in the primary care practices. This research examined the access of immigrants to the enrollment system in Ontario. A review of the literature contrasting a PMC and PHC approaches showed that the latter has more potential to address social determinants of health of immigrant populations. Taking into account the organization of health services in the province, immigrants can receive primary care services mainly through PMC practices (FFS and capitation-based), but also through PHC-type of models, such as Community Health Centers. The analysis of enrollment in primary care was conducted using a secondary analysis of administrative data. The main findings have shown that immigrants’ enrollment in primary care services has increased over time, but the levels of enrollment remain lower compared to long-term residents. Moreover, compared to long-term residents, immigrants have less access to the most comprehensive models of care, which represents an important inequity. In exploring the perceptions of immigrants in two major cities of the province, most of the participants perceived that important factors, such as information, knowledge, language barriers, cultural issues; are affecting their capacity to understand and navigate the system. Hence, it takes a long time for them to make sense and learn how to connect and use the system.

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Yes / Refugees often face barriers to accessing health services, especially after resettlement. The aim of this study is to identify key elements of effective public health interventions that address barriers to health services for refugees. Methods: Key online databases were searched to identify studies published between 2010 and 2019. Six studies met the inclusion criteria: two qualitative, one quantitative and three mixed-methods studies. An adapted narrative synthesis framework was used which included thematic analysis for systematic reviews. Results: Five themes were identified: peer support, translation services, accessible intervention, health education and a multidisciplinary approach. Conclusion: These key elements identified from this review could be incorporated into public health interventions to support refugees’ access to health services. They could be useful for services targeting refugees generally, but also supporting services targeting refugee resettlement programmes such as the Syrian resettled refugees in the UK. Future research is needed to evaluate the impact of public health interventions where these elements have been integrated into the intervention.

AIMS Managed care is a market model of health care distribution, aspects of which are being incorporated into the Australian health care environment. Justifications for adopting managed care lie in purported claims to higher levels of efficiency and greater ‘consumer’ choice. The purpose of this research, then, is to determine the ethical implications of adapting this particular administrative model to Australia’s health care system. In general, it is intended to provide ethical guidance for health care administrators and policy-makers, health care practitioners, patients and the wider community. SCOPE Managed care emerges as a product of the contemporary, neo-liberal market with which it is inextricably linked. In order to understand the nature of this concept, then, this research necessarily includes a limited account of the nature of the market in which managed care is situated and disseminated. While a more detailed examination of the neo-liberal market is worthy of a thesis in itself, this project attends, less ambitiously, to two general concerns. Firstly, against a background of various histories of health care distribution, it assesses the market’s propensity for upholding the moral requirements of health care distributive decision-making. This aspect of the analysis is informed by a framework for health care morality the construction of which accompanies an inquiry into the moral nature of health care, including a deliberation about rights-claims to health care and the proper means of its distribution. Secondly, by way of offering a precautionary tale, it examines the organisational structures and regulations by which its expansionary ambitions are promoted and realised. CONCLUSIONS As a market solution to the problem of administering health care resources, the pursuit of cost-control, if not actual profit, becomes the primary objective of health care activity under managed care. Hence, the moral purposes of health care provision, as pursued within the therapeutic relationship and expressed through the social provision of health care, are displaced by the economic purposes of the ‘free’ market. Accordingly, the integrity of both health care practitioners and communities is corrupted. At the same time, it is demonstrated that the claims of managed care proponents to higher levels of efficiency are largely unfounded; indeed, under managed care, health care costs have continued to rise. At the same time, levels of access to health care have deteriorated. These adverse outcomes of managed care are borne, most particularly, by poorer members of communities. Further, contrary to the claims of its proponents, choice as to the availability and kinds of health care services is diminished. Moreover, the competitive market in which managed care is situated has given rise to a plethora of bankruptcies, mergers and alliances in the United States where the market is now characterised by oligopoly and monopoly providers. In this way, a viable market in health care is largely disproved. Nonetheless, when protected within a non-market context and subject to the requirements of justice, a limited number of managed care techniques can assist Australia’s efforts to conserve the resources of health care. However, any more robust adoption of this concept would be ethically indefensible.

Background: In the last two decades Bogota, Colombia has seen a massive influx of internally displaced people (IDP) settling in its periphery where residents face the worst living, social, and economic conditions despite the 2011 passing of The Victims Law entitling IDP victims access to free shelter, food, education, and healthcare. Objective: To understand the circumstances and health care needs of Colombian IDPs, determine trends of health perceptions among IDPs and assess and quality of health services among IDPs in Bogota. Methods: Semi-structured, in-depth interviews were conducted with 12 professionals who work with IDPs and 36 IDPs. Interviews explored opinions of common health conditions and barriers to access health services in IDP communities. The EQ-5D survey about perceptions of health was administered measuring mobility, self-care, daily activities, pain, and depression/anxiety. All interviews were recorded, transcribed, coded for analysis. Results: Most IDPs did not indicate suffering with mobility, self-care, and ability to conduct daily activities. Seventy-five percent of participants indicated moderate to severe pain and 86.85% expressed feeling some form of depression or anxiety. Environmental factors are common contributors to poor health conditions. Individual and societal factors surfaced as detriments to accessing health services. The process to be included in The Victims Law registry is arduous. Although the Victims Law allows IDPs to access health services, many missing links in the system thwart quality health care delivery and discourage IDPs to utilize the health care system. Conclusion: Despite efforts to mitigate the struggles IPDs suffer there remain much needed health services and organizational improvements for the IDP community in Bogota.

Six out of every ten children in South Africa are living in poverty. This situation is aggravated by the AlDS pandemic. The pandemic is also the cause of a generation of AlDS orphans and as a consequence a lot of pressure is put on society's resources. Although the fundamental rights of children are entrenched in the Constitution of the Republic of South Africa, 1996, the current legal and administrative framework is not being implemented effectively in order to realise these rights. The Constitutional Court has adjudicated upon several matters regarding the realisation of socio-economic rights, thereby confirming that socio-economic rights are indeed justiciable. This research is specifically concerned with the realisation of children's right to have access to health care as entrenched in sections 27 and 28(l)(c) of the Constitution. Read with section 7(2) of the Constitution, this right places negative as well as positive obligations on the state to respect, protect, promote and fulfil children's right to have access to health care. Children's right to health care are however dependent on the internal limitations contained in section 27(2) of the Constitution which states that the state must take reasonable legislative and other measures, within its available resources, to achieve the progressive realisation of these rights. Having ratified the UN Convention on the Rights of the Child (CRC), the state is further bound to recognize the right of the child to the enjoyment of the highest attainable standard of health and to facilities for the treatment of illness and rehabilitation of health. Parties to the CRC shall also strive to ensure that no child is deprived of his or her right of access to such health care services. Good health is dependent on more than a mere right to have access to health care. In order to ensure the highest attainable standard of health for all children, it is necessary that the available services are affordable and accessible on an equitable basis. Access to health care should be seen as part of a more comprehensive social protection package to ensure a minimum standard of living, consistent with the value of human dignity in our Constitution. In order to achieve this, the fragmented health care system which existed before 1994 and which was mainly a result of the previous dispensation of oppression and racial discrimination, had to be transformed in order to reach the ideal of improving the quality of life of all citizens as contained in the preamble of the Constitution. Ten years after the inception of the new constitutional dispensation, it can be said that the government is making progress with the transformation of the health system and making it accessible to all people, including children. After extensive research on the legislative and other measures that the government has implemented in order to realise children's right to access to health care, the following conclusions has been reached: State policies regarding health care are taking account of the needs of children as a vulnerable group of society and it can be said to be reasonable in the formulation thereof. Regarding the implementation of these policies, much remains to be done to ensure that the benefits thereof reach the children, especially more vulnerable groups such as street children and child-headed households - a common occurrence with the high prevalence of HIVIAIDS in South Africa. The enactment of the National Health Act 61 of 2003 is still awaited although it has already been signed. This legislation provides a national framework of norms and standards regarding the health care system and it is mainly based on the rights of patients. A new Children's Bill [B32 - 20031 has been introduced to parliament. The bill deals extensively with the rights of children as contained in the Constitution and also aims to give effect to governments' obligations in terms of the CRC. The enactment of the bill should be given priority, although measures should be implemented to ensure that health care services are also accessible to children who are not assisted by adults such as child-headed households. The allocation of public funds should be considered in order to provide better social assistance to families in dire need but mechanisms to ensure that children benefit from social grants must be implemented. Many of these grants are being abused by parents which means that although the grants are available, the money is not always spent to better the plight of the children. This is especially important in the light of the fact that the primary obligation to take care of children vests in the parents. The courts and especially the Constitutional Court, has taken their role in realising socio-economic rights seriously and very important guidelines has been formulated regarding the reasonableness of legislative and other measures in this regard. After the Khosa-case it should be said that although the courts are allowed to overstep the boundaries of separation of powers, they should not rewrite these boundaries by not taking appropriate account of the availability of financial resources. This also applies to the executive and legislature which should act more effectively to implement the court's decisions. The Human Rights Commission is playing an important role with regard to the realisation of socio-economic rights by monitoring and evaluating the implementation of government programmes and legislation. The Commission also provides valuable guidelines with regard to the realisation of socio-economic rights in the form of annual reports submitted to parliament. It is submitted that the Commission should however consider to define minimum core obligations of socio-economic rights since the Commission is better equipped to do this than the courts are. / Thesis (LL.M. (Public Law))--North-West University, Potchefstroom Campus, 2005.