The Catholic Church is one of the largest providers of medical care in the US, with 1 in 6 acute-care beds residing in a Catholic hospital. One third of these hospitals are in rural or underserved areas in the US, and advocacy for the vulnerable is a central platform of the Catholic Healthcare Association. Despite this, the Church has been under attack for allegedly putting women at risk of injury or death due to the care restrictions concerning reproductive health stipulated in the Ethical and Religious Directives (ERDs). Additionally, scholars are questioning the distinctiveness of the Catholic healthcare mission in practice, pointing to the increased homogenization of Catholic and non-Catholic hospitals. For these reasons, it is necessary to assess if and how women are being harmed in Catholic hospitals and, if there is harm being done, if there is a way to prevent these harms while preserving the Catholic Social Tradition in medicine. In carrying out this assessment, I read the current literature closely to explore both the origins and the practical consequences of these ethical conflicts. Subsequently, I use Chris Durante's "pragmatic perspectivism" to formulate a proposal that considers both Catholic medical ethics and secular medical ethics on the same plane. The proposal suggests the adoption of an alternative and complementary lens for Catholic health care. Using this framework would allow the Church to pursue its health care mission in a fuller sense, unencumbered by the inertia of the medical industry towards homogenization due to legal and economic pressures. It also provides the potential for Catholics to more easily receive Catholic care in all hospitals, not just those under Catholic sponsorship. Importantly, it would also prevent any American woman from being practically forced to receive Catholic care, circumventing many of the ethical conflicts present in the current system.

Introdução: A Atenção Primária à Saúde (APS) é considerada pela Organização Mundial da Saúde como o componente essencial para a organização da assistência à saúde. Muitas evidências dos benefícios da APS são descritas, entretanto, verifica-se uma grande heterogeneidade na assistência oferecida, o que repercute nos resultados em saúde. Dessa forma, os estudos que avaliam a qualidade da APS têm sido considerados fundamentais para identificar como o cuidado tem sido oferecido, em que pontos estão ocorrendo falhas e quais são as prioridades para a atuação, buscando aumentar a efetividade e a eficiência da atenção prestada. O Brasil passa, atualmente, por um momento de reestruturação do sistema e de organização da APS. As avaliações realizadas em nosso meio, até o momento, têm verificado alguns impactos positivos, porém os resultados ainda são inconsistentes. Um desses resultados é a manutenção de taxas elevadas de Internações por Condições Sensíveis À Atenção Primária (ICSAP) além da constatação de aumento dessas condições no município de São Paulo. Esse estudo partiu da hipótese de que as altas porcentagens de ICSAP devem estar relacionadas a uma baixa orientação aos princípios norteadores (atributos) da APS dos serviços de atenção básica oferecidos à população infantil. Objetivo: Avaliar os atributos da atenção primária oferecida às crianças moradoras da região oeste do município de São Paulo e que foram internadas por condições sensíveis à atenção primária. Métodos: Estudo de corte transversal de abordagem quanti-qualitativa. A população alvo foram as crianças internadas na enfermaria pediátrica do Hospital Universitário da USP, de 1º de janeiro a 31 de dezembro de 2011, usuárias de uma das 14 Unidades Básicas de Saúde (UBS) da região oeste do município de São Paulo. Foram entrevistados também os profissionais dessas UBS. Os dados quantitativos foram obtidos com o Instrumento de Avaliação da Atenção Primária à Saúde (Primary Care Assessment Tool validado no Brasil - PCATool-Brasil) e os dados qualitativos foram obtidos por entrevista semi-estruturada. As variáveis independentes foram: idade, escolaridade materna, renda familiar, tipo de diagnóstico e modelo de atenção oferecido, e as variáveis dependentes foram os atributos de APS, de acordo com o referencial de Starfield. Realizou-se análises bivariadas e um modelo hierárquico final. Resultados: 65,2% das hospitalizações foram ICSAP. Foram entrevistados 501 usuários e 42 profissionais. Sob a perspectiva dos usuários, com exceção do atributo coordenação, todos os demais apresentaram baixa orientação aos princípios da APS, verificando-se influência das variáveis nos resultados obtidos pelas análises bivariadas. O modelo hierárquico final demonstrou modelo de Estratégia de Saúde da Família (ESF) foi associado a 2 vezes mais chances de uma melhor avaliação do Escore Geral da APS oferecida. Os profissionais atribuíram bons escores para a maioria dos atributos avaliados, com exceção do acesso, observando-se diferenças em comparação às avaliações feitas pelos usuários. Conclusões: A proporção de ICSAP foi alta na população estudada. Sob a perspectiva dos usuários, foi verificada uma baixa orientação aos princípios da APS, com exceção do atributo coordenação. O modelo da ESF apresentou o dobro de chance de que seus usuários avaliassem melhor o serviço. Com exceção do atributo acesso, os profissionais avaliaram bem os serviços de APS oferecidos / Introduction: The World Health Organization considers the Primary Health Care (PHC) as an essential component for the organization of health care. Much evidence of the benefits of APS are described, however, there is a great heterogeneity in the care provided, which affects health outcomes. Thus, studies that evaluate the quality of health care have been considered essential to identify how care has been offered, in which points are occurring faults and what are the priorities for action, seeking to increase the effectiveness and efficiency of care provided. Actually, the Brazilian health system and the PHC organization are being restructured. Evaluations undertaken in our country are showing some positive impacts, but the results are still inconsistent. One of these results is the maintenance of high rates of Hospitalizations for Primary Care Sensitive Conditions (ICSAP) and the increase of these conditions the city of São Paulo. We believe that the high ICSAP percentages must be related to a low orientation to principles (attributes) of PHC offered to the child population. Objective: Evaluate the attributes of primary care offered to children living in the western region of São Paulo who were hospitalized for conditions sensitive to primary care. Methods: It\'s a cross-sectional study with a quantitative and qualitative approach. The target population were children admitted to the pediatric ward of the University Hospital of University of São Paulo, from January 1 to December 31, 2011, users of the 14 Basic Health Units (BHU) in the western region of São Paulo. The UBS\'s professionals were also interviewed. Quantitative data were obtained with the Primary Care Assessment Tool validated in Brazil (PCATool - Brazil) and qualitative data were collected by semi-structured interview. The independent variables were: age, maternal literacy, family income, type of diagnosis and model of care offered, and the dependent variables were the attributes of PHS, according to the Starfield\'s referential. We conducted bivariate analyzes and a hierarchical model approach. Results: 65.2 % of hospitalizations were ICSAP. We interviewed 501 users and 42 professionals. From the perspective of users, the attributes showed lower orientation to the PHC principles, with the exception of the coordination and we observe the influence of the variables on the results from bivariate analyzes. The hierarchical model showed that the Family Health Strategy (FHS) was associated with twice as likely to be better evaluated in relation to the traditional model of care. Professionals assigned scores good for most of the attributes evaluated, with the exception of access, observing differences in comparison to assessments made by users. Conclusions: The proportion of ICSAP was high in this population. From the perspective of users, there was a low orientation to the principles of PHC, with the exception of the coordination attribute. The model presented FHS double the chance that your users better evaluate the service. Except the attribute access, services were better evaluated by professionals

O advento da Constituição Federal de 1988, que positivou a saúde como direito social de todos dependente de políticas de Estado (art. 196, CF) e criou o Sistema Único de Saúde (SUS) para garantir ações e serviços assistenciais universais, igualitários e integrais (art. 198, CF), propiciou, em pouco tempo, o incremento da judicialização da saúde no Brasil, em dimensões preocupantes, sobretudo por conta do significativo impacto orçamentário gerado. Mas a ingerência do Poder Judiciário nas políticas públicas de saúde, que ocorre principalmente em ações civis individuais de medicamentos e produtos de interesse à saúde, aguarda ainda uma crítica mais definitiva, que ultrapasse posicionamentos meramente teóricos e avalie o fenômeno empiricamente. O presente estudo desenvolve, em primeiro lugar, uma análise da CF e da legislação sanitária, inclusive a Lei Orgânica da Saúde (Lei 8.080/90) e os novos marcos legais da integralidade (Lei 12.401/11, Lei 12.466/11, Decreto 7.508/11 e LC 141/12), para identificar o regime jurídico-constitucional do SUS e o conteúdo material do direito à saúde, que corresponde ao que foi denominado integralidade sistêmica ou regulada (análise jurídica). Em seguida, o estudo faz uma pesquisa retrospectiva das ações judiciais de medicamentos, insumos terapêuticos e produtos de interesse à saúde, registradas no sistema informatizado do CODES (Coordenação de Demandas Estratégicas do SUS) da Secretaria de Estado da Saúde de São Paulo, durante o período de 2010 a 2014, objetivando constatar as suas principais características, buscando compreender o fenômeno enquanto realidade prática (análise fenomenológica). Em conclusão, verificou-se que, em regra, as ordens judiciais determinam escolha de marca comercial, medicamentos não previstos nos protocolos clínicos e nas relações de medicamentos, sem registro na Anvisa, importados e experimentais, e mesmo sem qualquer relação com as atividades assistenciais do SUS, frequentemente com base em prescrições médicas irregulares e privadas, gerando grande impacto orçamentário e desorganização das atividades administrativas. O confronto com o regime jurídico-constitucional do SUS e a legislação demonstra que o Poder Judiciário descumpre, em bloco, o ordenamento jurídico sanitário, uma ruptura do Estado Democrático de Direito que coloca em risco o projeto constitucional do SUS. Algumas sugestões de enfrentamento do problema são apresentadas / The advent of the Federal Constitution of 1988, which stated health as a social right for everyone dependent on government policies (art. 196, CF) and created the Unified Health System (\"SUS\") to ensure universal, egalitarian and integral assistance services and actions (art. 198, CF), provided, in a short time, the increased judicialization of health in Brazil, in alarming proportions, particularly due to significant budget impact generated. But the interference of the Judiciary in public health policies, which occurs primarily in individual civil actions of drugs and supplies, still awaiting a more definitive critical, going beyond merely theoretical positions and assess the phenomenon empirically. This study develops, first, an analysis of CF and health legislation, including the Organic Law of Health (Law 8.080/90) and the new legal frameworks of integrality (Law 12.401/11, Law 12.466/11, Decree 7.508/11 and LC 141/12), to identify the legal and constitutional arrangements of the \"SUS\" and the material content of the right to health, which corresponds to what is called systemic or regulated integrality (legal analysis). Then, the study makes a retrospective survey of judicial decisions concerning medications, therapeutic supplies and health-related products, recorded in the computerized system CODES (Coordination Strategic Demands of SUS) of the Secretariat of Health for the State of São Paulo, during the period from 2010 to 2014, aiming to realize its main features, trying to understand the phenomenon as a practical reality (phenomenological analysis). In conclusion, the study found that, as a rule, the court orders determine the choice of trade mark, medications not covered in the clinical protocols and relationships of drugs, without registration at ANVISA, imported and experimental, and even unrelated to the welfare activities of the \"SUS\", often based on rough and private medical prescriptions, generating large budget impact and disruption of administrative activities. The confrontation with the legal and constitutional arrangements of the \"SUS\" and the legislation shows that the Judiciary violates, as a whole, the health law, a breach of the Democratic State of Law that endangers the constitutional SUS project. Some suggestions of trouble confrontation are presented

Os processos de formação científica do profissional Fisioterapeuta envolvem além do conhecimento científico, compreendido nos currículos, práticas profissionais que, juntamente com as configurações dos serviços, marcam a constituição de sujeitos. Neste sentido, os modos de ser dos futuros profissionais são influenciados pela organização curricular do seu curso de formação, neste caso, da Fisioterapia. Pelo fato do trabalho em saúde se aproximar de questões que envolvem a existência humana, objetiva-se com este estudo mostrar as condições e as possibilidades de determinação, bem como as implicações entre a constituição do sujeito e a formação profissional nas dimensões científica e não científica do profissional Fisioterapeuta. Coerente com este objetivo, a constituição do sujeito define o âmbito do problema de pesquisa a ser examinado, nas áreas da educação e da saúde. Este estudo tem como apoio teórico o pensamento de Michel Foucault, especialmente as obras A História da Sexualidade e A Hermenêutica do Sujeito, sendo complementado por contribuições de especialistas na área da saúde, entre os quais, Sílvio Paulo Botomé e Rubens Rebelatto. O método empregado consistiu em levantar, identificar e analisar algumas determinações na formação do sujeito que dependem do tipo de formação científica. Para isto o trabalho teve como referência a experiência do ensino do Curso de Fisioterapia da Universidade de Caxias do Sul e da Clínica de Fisioterapia desta mesma universidade, sendo ainda complementado por entrevistas com alunos, professores e profissionais da área. A dissertação compreende, além da introdução e conclusão, três capítulos, sendo o primeiro intitulado A Constituição do Sujeito e a formação profissional, o segundo, A Constituição do sujeito na formação científica profissional em Fisioterapia e o terceiro, A Constituição do Sujeito na integração ensino-serviço aprendizado. A relevância desta dissertação reside na sua contribuição para avaliar e qualificar os serviços, bem como os cursos de graduação, neste caso de Fisioterapia, mas também para e os demais cursos da área da saúde, tanto da Universidade de Caxias do Sul, quanto de outras instituições. Igualmente deduz-se destes estudos a relevância social presente nas atividades dos profissionais da área da saúde. / Submitted by Marcelo Teixeira (mvteixeira@ucs.br) on 2014-06-02T17:19:27Z No. of bitstreams: 1 Dissertacao Suzete Grandi.pdf: 1000332 bytes, checksum: 319c8745b07ac8097c14713cd86b3851 (MD5) / Made available in DSpace on 2014-06-02T17:19:27Z (GMT). No. of bitstreams: 1 Dissertacao Suzete Grandi.pdf: 1000332 bytes, checksum: 319c8745b07ac8097c14713cd86b3851 (MD5) / The processes of scientific formation of the professionals in Physiotherapy involve, besides the scientific knowledge comprised in the curriculums, professional practice which, along with the service settings, marks the constitution of subjects. In this sense, the modes of being of the future professionals are influenced by the organization of the curriculum of their formation course, in this case, Physiotherapy. As the health work address issues that involve the human existence, the objective of this study is to show the conditions and possibilities of determination, as well as the implications of the constitution of the subject and the professional formation in the scientific and nonscientific dimensions of professionals in Physiotherapy. Coherent with this objective, the constitution of the subject defines the scope of the research problem to be examined in the areas of Education and Health. This study is supported by the thinking of Michel Foucault, especially the works "The History of Sexuality" and "The Hermeneutics of the Subject", and it is also complemented by contributions from experts in Healthcare, as Silvio Paulo Botomé and Rubens Rebelatto, among others. The method employed consisted of raising, identifying and analyzing some determinations in the formation of the subject that depend on the type of scientific formation. In order to do this, the work took into consideration the teaching experience at the Course of Physiotherapy of the University of Caxias do Sul and the Clinic of Physiotherapy at the same university and it is further complemented by interviews with students, teachers and professionals in the field. The dissertation includes, besides the introduction and conclusion, three chapters. The first is entitled The Constitution of the Subject and the professional formation, the second, The Constitution of the subject in professional scientific formation in Physiotherapy and the third, The Constitution of the Subject in the learning / teachingservice integration. The relevance of this dissertation lies in its contribution to assess and qualify the services as well as the graduation courses, in this case Physiotherapy, but also for other courses of the healthcare field, both from the University of Caxias do Sul, and other institutions. It is equally inferred from these studies the social relevance present in the activities of healthcare professionals.

Os processos de formação científica do profissional Fisioterapeuta envolvem além do conhecimento científico, compreendido nos currículos, práticas profissionais que, juntamente com as configurações dos serviços, marcam a constituição de sujeitos. Neste sentido, os modos de ser dos futuros profissionais são influenciados pela organização curricular do seu curso de formação, neste caso, da Fisioterapia. Pelo fato do trabalho em saúde se aproximar de questões que envolvem a existência humana, objetiva-se com este estudo mostrar as condições e as possibilidades de determinação, bem como as implicações entre a constituição do sujeito e a formação profissional nas dimensões científica e não científica do profissional Fisioterapeuta. Coerente com este objetivo, a constituição do sujeito define o âmbito do problema de pesquisa a ser examinado, nas áreas da educação e da saúde. Este estudo tem como apoio teórico o pensamento de Michel Foucault, especialmente as obras A História da Sexualidade e A Hermenêutica do Sujeito, sendo complementado por contribuições de especialistas na área da saúde, entre os quais, Sílvio Paulo Botomé e Rubens Rebelatto. O método empregado consistiu em levantar, identificar e analisar algumas determinações na formação do sujeito que dependem do tipo de formação científica. Para isto o trabalho teve como referência a experiência do ensino do Curso de Fisioterapia da Universidade de Caxias do Sul e da Clínica de Fisioterapia desta mesma universidade, sendo ainda complementado por entrevistas com alunos, professores e profissionais da área. A dissertação compreende, além da introdução e conclusão, três capítulos, sendo o primeiro intitulado A Constituição do Sujeito e a formação profissional, o segundo, A Constituição do sujeito na formação científica profissional em Fisioterapia e o terceiro, A Constituição do Sujeito na integração ensino-serviço aprendizado. A relevância desta dissertação reside na sua contribuição para avaliar e qualificar os serviços, bem como os cursos de graduação, neste caso de Fisioterapia, mas também para e os demais cursos da área da saúde, tanto da Universidade de Caxias do Sul, quanto de outras instituições. Igualmente deduz-se destes estudos a relevância social presente nas atividades dos profissionais da área da saúde. / The processes of scientific formation of the professionals in Physiotherapy involve, besides the scientific knowledge comprised in the curriculums, professional practice which, along with the service settings, marks the constitution of subjects. In this sense, the modes of being of the future professionals are influenced by the organization of the curriculum of their formation course, in this case, Physiotherapy. As the health work address issues that involve the human existence, the objective of this study is to show the conditions and possibilities of determination, as well as the implications of the constitution of the subject and the professional formation in the scientific and nonscientific dimensions of professionals in Physiotherapy. Coherent with this objective, the constitution of the subject defines the scope of the research problem to be examined in the areas of Education and Health. This study is supported by the thinking of Michel Foucault, especially the works "The History of Sexuality" and "The Hermeneutics of the Subject", and it is also complemented by contributions from experts in Healthcare, as Silvio Paulo Botomé and Rubens Rebelatto, among others. The method employed consisted of raising, identifying and analyzing some determinations in the formation of the subject that depend on the type of scientific formation. In order to do this, the work took into consideration the teaching experience at the Course of Physiotherapy of the University of Caxias do Sul and the Clinic of Physiotherapy at the same university and it is further complemented by interviews with students, teachers and professionals in the field. The dissertation includes, besides the introduction and conclusion, three chapters. The first is entitled The Constitution of the Subject and the professional formation, the second, The Constitution of the subject in professional scientific formation in Physiotherapy and the third, The Constitution of the Subject in the learning / teachingservice integration. The relevance of this dissertation lies in its contribution to assess and qualify the services as well as the graduation courses, in this case Physiotherapy, but also for other courses of the healthcare field, both from the University of Caxias do Sul, and other institutions. It is equally inferred from these studies the social relevance present in the activities of healthcare professionals.

Thesis title: Right to health and legitimate expectations in perspective of the standards and above-standards in Czech health care system This diploma thesis deals with the legal regulation of the right to health as a social right. In the first chapter, the genesis of the social rights, their specific characteristics and the social rights' role in relation to civil and political rights are analysed for the purpose of interpretation of the right to health. The actual problematics of legitimation crisis based on the states' inability to fulfil the obligations and expectations rising from social rights are later discussed. In relation to the socio-legal context, the international legislation as well as some specific national legislation of the right to health are analysed in detail within subsequent chapter. With this regard, the practice of the courts as well as the practice of the quasi-judicial bodies is considered in the following chapter, especially with respect to the right to health and its relation to some civil and political rights. The standardization process of right to health within this decision-making practice is also examined. Moreover, the right to health is explored in perspective of the Czech legislation. The diploma thesis deals with the content and the protection of the...

La ville d’Abidjan est localisée au Sud de la Côte d’Ivoire. Elle est la capitale économique depuis 1983 et la première ville du pays. Elle concentre le potentiel humain et une offre de soins dense et diversifiée répartie sur de faibles distances physiques, donnant l’impression que tout est accessible. En effet, l’État Ivoirien a consenti d’importants investissements pour construire et équiper des services de santé depuis l’émergence de la ville au début du siècle dernier pour améliorer l’accès aux soins des abidjanais. Pourtant, malgré une augmentation considérable du nombre d’infrastructures sanitaires et de leur disponibilité, les taux d’utilisations et de fréquentations des services de santé modernes dans les communes de la ville d’Abidjan restent faibles et les indicateurs de santé demeurent très préoccupants et les besoins de soins sont importants. En plus, la croissance spatiale et démographique accélérée que connaît la ville entraînent des changements rapides dans son organisation territoriale empêchant les autorités publiques chargées de la planification de suivre le rythme de sa croissance urbaine. Ils ne sont pas toujours parvenus à équiper en services urbains les nouveaux espaces au fur et à mesure de leur création et à intégrer les nouveaux citadins aux origines diverses. Cette thèse permet d’étudier, comment, dans un contexte considéré comme privilégié, se pose la problématique de l’accès et du recours aux services de santé modernes. Pour réaliser ce projet, cette étude, à partir des combinaisons d’analyses spatiales, statistiques, et d’un travail de terrain, analyse les inégalités socio-spatiales d’accès aux services de santé pour mettre en exergue le problème de l’accessibilité aux soins, tant physique, culturelle, matérielle que sociale. Elle mesure également l’adéquation de cette offre de soins moderne aux besoins de soins des populations pour identifier les zones et les populations défavorisées pour l’accès aux soins. Et enfin, cette étude analyse les pratiques citadines du recours aux soins, ainsi que les déterminants qui limitent ou facilitent l’accès aux soins dans la ville d’Abidjan. Les résultats des études montrent que les services de santé existent, ils sont denses et diversifiés, mais ils ne sont pas repartis là où il y a le plus de besoins de soins. Dans notre étude, on souligne aussi une prédominance de la prise en charge à domicile des épisodes morbides notamment à travers l’automédication et une diminution de l’utilisation des services de soins modernes. Le recours aux structures de soins se fait rare dans les quartiers où les besoins en soins de santé sont les plus importants. L’automédication ou la médecine de rue sont généralement les plus privilégiées. Les structures de soins sont sollicitées que lorsque la maladie devient très grave. Nos résultats montrent également qu’il est difficile d’attribuer à un facteur le rôle déterminant des recours thérapeutiques, car les comportements sont à la fois déterminés par les caractéristiques socio-démographiques de l’individu, de sa famille et par des paramètres contextuels, mais aussi par les caractéristiques de l’épisode morbide, par la connaissance du système de soins environnant et les attitudes vis-à-vis du système de soins. Néanmoins, nous pouvons dire qu’à Abidjan, les pratiques citadines du recours aux soins sont tributaires de la capacité économique des ménages avec le risque accru de marginaliser les personnes les plus vulnérables. / The city of Abidjan is located in the South of the Ivory Coast. It is the economic capital since 1983 and the first city of the country. It concentrates human potential and health of dense care supply modern and diversified divided on weak physical distance, giving the impression that everything is approachable. In effect, the State Of the Ivory Coast approved important investments to construct and equip services of health care since the emergence of the city at the beginning of last century to ameliorate the access to health care of abidjanais. However, in spite of a considerable increase among health facilities and among their availability, the rates of uses and company of the services of modern health care in the spaces of the city of Abidjan remain weak and the indicators of health remain very worrying and the needs in care of health are important. On top of that, the space and demographic speeded up growth which knows the city draw away quick changes in her territorial organization preventing the public authorities made responsible with planning for following the rhythm of its urban growth. They did not always manage to equip new urban spaces with timely urban services and to integrate new citizens at the various origins. This thesis allows to be studying, how, in a considered context as privileged, settle the problems of access and health care seeking in the services of modern health. To accomplish this plan, this study, from the combination of spatial analysis, statistics, and field work, analyses the socio- spatial inequality of access to the services of health to head with the problem of accessibility in care, so physical, cultural, material that social. It also measures the adequacy of health care supply at the Needs in care of health of populations to identify zones and populations discriminated for the access to health care. And finally, this study analyses the city practices in the use of health care, as well as the determinants that hinder or facilitate access to health care in the city of Abidjan. Study results show that the services of health exist, they are dense and manifold, but they did not leave again where there are most needs in care of health. In our study, they also underline a predominance of the taking care at home of morbid episodes notably across self-medication and a reduction of the use of the services of modern care. The seeking in structures of health care becomes rare in the space where the needs in care of health are the most important. Self-medication or street medicine are the most favouring in general. Structures of health care are solicited that when illness becomes very serious. Our results also show that it is difficult to allocate to a factor the role determining therapeutic seeking, because behaviours are determined at the same time by the socio-demographic characteristics of the individual, his family and by contextual parameters, but also by the characteristics of morbid episode, by the knowledge of the ambient the health care system and attitudes in relation to the health care system. However, we can say that in Abidjan, the city practices of health care seeking are dependent on the economic capacity of household with risk augmented to marginalize the most vulnerable persons.

O advento da Constituição Federal de 1988, que positivou a saúde como direito social de todos dependente de políticas de Estado (art. 196, CF) e criou o Sistema Único de Saúde (SUS) para garantir ações e serviços assistenciais universais, igualitários e integrais (art. 198, CF), propiciou, em pouco tempo, o incremento da judicialização da saúde no Brasil, em dimensões preocupantes, sobretudo por conta do significativo impacto orçamentário gerado. Mas a ingerência do Poder Judiciário nas políticas públicas de saúde, que ocorre principalmente em ações civis individuais de medicamentos e produtos de interesse à saúde, aguarda ainda uma crítica mais definitiva, que ultrapasse posicionamentos meramente teóricos e avalie o fenômeno empiricamente. O presente estudo desenvolve, em primeiro lugar, uma análise da CF e da legislação sanitária, inclusive a Lei Orgânica da Saúde (Lei 8.080/90) e os novos marcos legais da integralidade (Lei 12.401/11, Lei 12.466/11, Decreto 7.508/11 e LC 141/12), para identificar o regime jurídico-constitucional do SUS e o conteúdo material do direito à saúde, que corresponde ao que foi denominado integralidade sistêmica ou regulada (análise jurídica). Em seguida, o estudo faz uma pesquisa retrospectiva das ações judiciais de medicamentos, insumos terapêuticos e produtos de interesse à saúde, registradas no sistema informatizado do CODES (Coordenação de Demandas Estratégicas do SUS) da Secretaria de Estado da Saúde de São Paulo, durante o período de 2010 a 2014, objetivando constatar as suas principais características, buscando compreender o fenômeno enquanto realidade prática (análise fenomenológica). Em conclusão, verificou-se que, em regra, as ordens judiciais determinam escolha de marca comercial, medicamentos não previstos nos protocolos clínicos e nas relações de medicamentos, sem registro na Anvisa, importados e experimentais, e mesmo sem qualquer relação com as atividades assistenciais do SUS, frequentemente com base em prescrições médicas irregulares e privadas, gerando grande impacto orçamentário e desorganização das atividades administrativas. O confronto com o regime jurídico-constitucional do SUS e a legislação demonstra que o Poder Judiciário descumpre, em bloco, o ordenamento jurídico sanitário, uma ruptura do Estado Democrático de Direito que coloca em risco o projeto constitucional do SUS. Algumas sugestões de enfrentamento do problema são apresentadas / The advent of the Federal Constitution of 1988, which stated health as a social right for everyone dependent on government policies (art. 196, CF) and created the Unified Health System (\"SUS\") to ensure universal, egalitarian and integral assistance services and actions (art. 198, CF), provided, in a short time, the increased judicialization of health in Brazil, in alarming proportions, particularly due to significant budget impact generated. But the interference of the Judiciary in public health policies, which occurs primarily in individual civil actions of drugs and supplies, still awaiting a more definitive critical, going beyond merely theoretical positions and assess the phenomenon empirically. This study develops, first, an analysis of CF and health legislation, including the Organic Law of Health (Law 8.080/90) and the new legal frameworks of integrality (Law 12.401/11, Law 12.466/11, Decree 7.508/11 and LC 141/12), to identify the legal and constitutional arrangements of the \"SUS\" and the material content of the right to health, which corresponds to what is called systemic or regulated integrality (legal analysis). Then, the study makes a retrospective survey of judicial decisions concerning medications, therapeutic supplies and health-related products, recorded in the computerized system CODES (Coordination Strategic Demands of SUS) of the Secretariat of Health for the State of São Paulo, during the period from 2010 to 2014, aiming to realize its main features, trying to understand the phenomenon as a practical reality (phenomenological analysis). In conclusion, the study found that, as a rule, the court orders determine the choice of trade mark, medications not covered in the clinical protocols and relationships of drugs, without registration at ANVISA, imported and experimental, and even unrelated to the welfare activities of the \"SUS\", often based on rough and private medical prescriptions, generating large budget impact and disruption of administrative activities. The confrontation with the legal and constitutional arrangements of the \"SUS\" and the legislation shows that the Judiciary violates, as a whole, the health law, a breach of the Democratic State of Law that endangers the constitutional SUS project. Some suggestions of trouble confrontation are presented

Background Close, continuous and efficient collaboration between different professions and sectors of care is necessary to provide patient-centered care for individuals with mental disorders. The lack of structured collaboration between in- and outpatient care constitutes a limitation of the German health care system. Since 2012, a new law in Germany (§64b Social code book (SGB) V) has enabled the establishment of cross-sectoral and patient-centered treatment models in psychiatry. Such model projects follow a capitation budget, i.e. a total per patient budget of inpatient and outpatient care in psychiatric clinics. Providers are able to choose the treatment form and adapt the treatment to the needs of the patients. The present study (EVA64) will investigate the effectiveness, costs and efficiency of almost all model projects established in Germany between 2013 and 2016. Methods/design A health insurance data-based controlled cohort study is used. Data from up to 89 statutory health insurance (SHI) funds, i.e. 79% of all SHI funds in Germany (May 2017), on inpatient and outpatient care, pharmaceutical and non-pharmaceutical treatments and sick leave for a period of 7 years will be analyzed. All patients insured by any of the participating SHI funds and treated in one of the model hospitals for any of 16 pre-defined mental disorders will be compared with patients in routine care. Sick leave (primary outcome), utilization of inpatient care (primary outcome), utilization of outpatient care, continuity of contacts in (psychiatric) care, physician and hospital hopping, re-admission rate, comorbidity, mortality, disease progression, and guideline adherence will be analyzed. Cost and effectivity of model and routine care will be estimated using cost-effectiveness analyses. Up to 10 control hospitals for each of the 18 model hospitals will be selected according to a pre-defined algorithm. Discussion The evaluation of complex interventions is an important main task of health services research and constitutes the basis of evidence-guided advancement in health care. The study will yield important new evidence to guide the future provision of routine care for mentally ill patients in Germany and possibly beyond. Trial registration This study was registered in the database “Health Services Research Germany” (trial number: VVfD_EVA64_15_003713).

6 Abstract The health care concerning the pregnancy and delivery at foreign women from non-EU nations in the Czech Republic The thesis is devoted to health care that is provided in the Czech Republic for foreign women from countries outside the EU, in connection with pregnancy and childbirth. In the first part of my thesis there is described health care in the Czech Republic in general. It contains an overview of legislation on health care, described the healthcare system in the Czech Republic, public health insurance and there are also summarized the legal rights to health care of migrants from "third countries" with a focus on pregnancy and childbirth. The second part focuses on migration issues, describes the current status and historical facts about migration in the CR and describes the legislative regulation of migration in the Czech Republic, mainly focusing on foreigners from non-EU countries. In the empirical part of the thesis used a qualitative method of data processing and analysis based on interviews with twelve women in labour from non-EU countries. Interviews present their experience with maternal health care, which was provided to them in the Czech Republic and explaining their orientation in the health care system. The thesis summarizes possibilities and range of the health insurance for...