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Santrauka Magistro baigiamajame darbe „Ar Lietuvos valstybė pažeidžia žmogaus teises nesuteikdama asmenims nemokamo gydymo?“ nagrinėjama viena iš svarbiausių žmogaus teisių – teisė į sveikatos priežiūrą. Nemokamo gydymo tema mūsų šalyje yra kiek nauja, mažai nagrinėta, tačiau be galo aktuali, nes situacija Lietuvoje rodo, kad yra neatitikimų tarp to, kas įtvirtinta teisės aktuose ir praktikos gydymo įstaigose. Pirmoje darbo dalyje išsamiai apibrėžiama teisės į sveikatos priežiūrą samprata. Šiame skyriuje analizuojama sveikatos priežiūros samprata, „sveikatos“ sąvokos aiškinimas ir tikslai. Be to kalbama apie kokybiškų sveikatos priežiūros paslaugų teikimą Lietuvoje. Taip pat aprašomos pacientų teisės ir pareigos. Antroje darbo dalyje aptariama teisė į nemokamą gydymą tarptautiniu lygmeniu, kalbama apie skirtingas užsienio valstybių sistemas sveikatos priežiūros sektoriuje, požiūrį į žmogų ir jo teises. Taip pat analizuojama situacija Lietuvoje, ką reglamentuoja Lietuvos Respublikos Konstitucija ir kiti tarptautiniai teisės aktai. Trečioje darbo dalyje pateikiama privalomojo sveikatos draudimo samprata bei jo reikšmė. Akcentuojami privalomojo sveikatos draudimo privalumai ir trūkumai. Taip pat pateikiami atlikto tyrimo rezultatai, padėję atskleisti nagrinėjamos temos problematiką. Darbe nagrinėjama keturių pažangių pasaulio šalių - Australijos, Kanados, Lenkijos ir Vokietijos sveikatos priežiūros sistemos modeliai, plėtojimosi istorija bei teisinis reglamentavimas. Išsamiai... [toliau žr. visą tekstą] / Summary In the Master’s final thesis “Does Lithuania violate human rights by refusing to provide treatment for people free of charge?” are analyzed the obligation of the State, set by Article 53 of the Constitution of the Republic of Lithuania and problems in the health system. The right to free of charge treatment belongs to the group of social human rights. The implementation of this group of human rights usually depends on the economic situation of the state and, in particular, right to free charge treatment depends on the health protection policy of the state. Health care systems are criticized around a world. By reason of expensive medical technologies and medicine as such, require huge sums of money, which is scare. Patient’s needs and expectations for health care, health and quality of life are growing. Patients become more aware and demanding on health care. In these conditions health care quality helps to save resources and better meets patient’s needs and expectations. Globalization and privatization processes determine expansion of health care services and patient’s market. The Constitution was adopted by referendum on the 25th of October 1992. Since these days continues a period of biggest changes: a new system of social, economical, political relations was settled. The right of to free of charge health protection is established in Article 53 of the Constitution of the Republic of Lithuania, which determines that the state shall take care of people’s health and... [to full text]

Providing care services across several departments and care givers creates the complexity of the patient pathways, as it deals with different departments, policies, professionals, regulations and many more. One example of complex patient pathways (CPP) is one that exists in integrated care, which most literature relates to health and social care integration. The world population and demand for care services have increased. Therefore, necessary actions need to be taken in order to improve the services given to patients in maintaining their quality of life. As the complexity arises due to different needs of stakeholders, it creates many problems especially when it involves complex patient pathways (CPP). To reduce the problems, many researchers tried using several decision tools such as Discrete Event Simulation (DES), System Dynamic (SD), Markov Model and Tree Diagram. This also includes Direct Experimentation, one of techniques in Lean Thinking/Techniques, in their efforts to help simplify the system complexity and provide decision support tools. However, the CPP models were developed using a single tools which makes the models have some limitations and not capable in covering the entire needs and features of the CPP system. For example, lack of individual analysis, feedback loop as well as lack of experimentation prior to the real implementation. As a result, ineffective and inefficient decision making was made. The researcher also argues that by combining the DES and SD techniques, named the hybrid simulation, the CPP model would be enhanced and in turn will help to provide decision support tools and consequently, will reduce the problems in CPP to the minimum level. As there is no standard framework, a framework of a hybrid simulation for modelling the CPP system is proposed in this research. The researcher is much concerned with the framework development rather than the CPP model itself, as there is no standard model that can represent any type of CPP since it is different in term of its regulations, policies, governance and many more. The framework is developed based on several literatures, selected among developed framework/models that have used combinations of DES and SD techniques simultaneously, applied in a large system or in healthcare sectors. This is due to the condition of the CPP system which is a large healthcare system. The proposed framework is divided into three phases, which are Conceptual, Modelling and Models Communication Phase, and each phase is decomposed into several steps. To validate the suitability of the proposed framework that provides guidance in developing CPP models using hybrid simulation, the inductive research methodology will be used with the help of case studies as a research strategy. Two approaches are used to test the suitability of the framework – practical and theoretical. The practical approach involves developing a CPP model (within health and social care settings) assisted by the SD and DES simulation software which was based on several case studies in health and social care systems that used single modelling techniques. The theoretical approach involves applying several case studies within different care settings without developing the model. Four case studies with different areas and care settings have been selected and applied towards the framework. Based on suitability tests, the framework will be modified accordingly. As this framework provides guidance on how to develop CPP models using hybrid simulation, it is argued that it will be a benchmark to researchers and academicians, as well as decision and policy makers to develop a CPP model using hybrid simulation.

This article considers emergence in the context of systems of systems, examining the earlier proposed tri-layered architecture in some depth. In contrast with healthcare reform, a social media phenomenon, the emergence of topics in the Twitter user community, is shown not to satisfy a critical condition of the architecture. Nevertheless, detection of topic emergence is shown to offer insights into the design of Emergence Behavior Observers.

Class of 2006 Abstract / Objectives: To assess predictors of systolic blood pressure control in the Southern Arizona Veterans Affairs Health Care System. Methods: 6185 patients were followed over a 2 year period and predictors of blood pressure control were examined using univariate and multivariate analyses. Primary independent variables assessed were age, gender, race, antihypertensive medication class, and comorbidities. The primary dependent variable was systolic blood pressure. Results: Sixty percent of patients studied had controlled hypertension. Significant predictors of better blood pressure control were the presence of coronary artery disease, use of loop diuretics, not using miscellaneous antihypertensive agents, lower age, and not of Hispanic descent or not an African-American. Conclusions: Frequency of systolic blood pressure control was found to be higher than previously reported. In contrast, age, sex, and race were significant predictors of control as reported elsewhere. Lastly, coronary artery disease, loop diuretics, and miscellaneous antihypertensive agents were found to be the only other significant predictors of systolic blood pressure control. These results suggest that there is largely no difference between the major antihypertensive medications class with respect to blood pressure control.

The Diploma paper " The Health Care Providing System in Switzerland" describes the development, structure and typical aspects of health care providing system in Switzerland. The Diploma paper concentrates on identification of the key factors which helped Switzerland health care providing system to reach very high quality and also ensured large availability of the services. The work is divided into theoretical and practical part. Theoretical part describes Swiss Confederation and its health care providing system. The practical part offers the comparison with the system in Czech Republic. The finale part is devoted to the key factors which could be implemented into the Czech system and which would be helpful for its further development.

Student Number : 8910202A - MPH research report - School of Public Health - Faculty of Health Sciences / An increasing number of people are migrating to South African urban centers (GJMC, 2000). There are various reasons that can be attributed to this migration; including the hope of finding employment and better living conditions. Recent urban migrants find themselves faced with the basic problem of lack of shelter and, depending on the migrant’s situation, they may choose to live in indoor shacks within the city center, backyard shacks in the black townships or join the growing number of informal settlement dwellers (GJMC, 2000). The number of informal settlements continues to grow at an alarming rate in Johannesburg (CEROI, 2000). This poses unique health care challenges as well as presenting the health care system with unusual disease conditions associated with general lack of infrastructure and services (CEROI, 2000). It has been established that the proportion of HIV infected patients is higher in people living in informal settlements when compared to people living in private houses (SAHR, 2000). Thus, it is expected that more people will be presenting with HIV and AIDS related illnesses in an informal settlement health center as compared to well-developed residential areas. This study aimed at exploring the prescribing patterns of health care givers for patients attending a health center in an informal settlement as well as to determine the major disease patterns prevalent in the area. The study was carried out in Davidsonville and OR Tambo clinics as well as Bophelong and Hikhensile clinics in Ivory Park. The study covered regions five, one and two respectively according to Gauteng metropolitan services area classification (GJMC, 2000). The findings of the study will help the appropriate policy makers improve the Essential Drug List and inform public health officials in formulating strategies that may lead to health status improvement for people living in informal settlements.

This thesis address one of the most important topics for the human being; health. Specifically, the research is about the deficiencies of the health system in Mexico. This paper shows the importance, how the system works and its current situation in the country. The purpose of this research is, based on the Pareto principle (20% vs 80%), to find how to solve most problems with the least possible investment.   It was found that the common denominator in the problems was the process and flow of information of the patients; specifically, the health records. The researchers address the issue at first explaining in a deep way the health records to highlight their importance in the health care system. In order to corroborate this finding in the literature; The researchers designed an interview, which was applied to physicians from the two main health institutions in Mexico in order to collect the necessary information to develop the thesis.   Since the design of the research is qualitative; the necessary social context is given to be able to understand the analysis and the results; likewise, the authors explain in detail the methodology used.   In spite of other important factors that were found such as the lack of results despite the investment and deficiencies in the infrastructure; It was concluded that, in fact, most of the problems were derived from the problems of health records. These results are important because it gives a parameter of what must be corrected first in order to have the expected results and a better health system.

O SAMU brasileiro utiliza o modelo francês e opera com uma Central Única de Regulação Médica regionalizada, hierarquizada e descentralizada na composição das equipes de socorro e unidades móveis como USBs (Unidade de Suporte Básico) e USAs (Unidade de Suporte Avançado) que variam de acordo com o tipo de gravidade do caso. Na cidade de Ribeirão Preto, o serviço do SAMU, implantado em 1996, era municipal até 2012, porém seguindo as resoluções e portarias do Ministério da Saúde houve a necessidade da transição do SAMU Municipal para o SAMU Regional, com um único número (192) para os 26 municípios do Departamento Regional de Saúde de Ribeirão Preto (DRS XIII) sendo composto/constituído por 38 (trinta e oito) USBs sendo 01 USB para cada base descentralizada, 13 USB para Ribeirão Preto, 01 (uma) equipe de motolância e mais 03 (três) USAs (unidades de suporte avançado de vida) para cada base nos municípios polos microrregionais (Ribeirão Preto, Sertãozinho e Batatais). Com base nessas informações, este estudo visou caracterizar a estrutura e funcionamento do SAMU Municipal e sua Central de Regulação de Urgência e a transição para a regionalização nos seus aspectos estruturais, recursos humanos, tecnológicos e principalmente a viabilidade financeira, considerando o repasse tripartite (estado - união e município) insuficientes. Para a viabilidade financeira foi instituído o Consórcio CIS-AVH (consórcio intermunicipal de saúde - Aquífero guarani, Vale das cachoeiras e Horizonte verde). Os Consórcios Intermunicipais de Saúde (CISs) são importantíssimos instrumentos de cooperação e gestão entre municípios integrados, com 9interesses comuns definidos através do Plano Anual de Trabalho descritos pelos gestores municipais, conselhos e entidades públicas que estabelecem as prioridades e necessidades de determinado local e região. O objetivo foi criar soluções para problemas comuns, racionalizando a ação governamental a partir da realização conjunta de atividades de promoção, proteção e recuperação da saúde. Observa-se o fortalecimento da co-gestão compartilhada em saúde, em especial para os municípios de menor porte, cujas capacidades de investimento no setor são reduzidas em razão do limitado orçamentos disponível, as crescentes necessidades dos cidadãos, o avanço do aparato tecnológico e seus custos e principalmente o ganho por meio de editais de aquisição, compras ou contratação em escala seja de serviços, exames ou insumos. / The Brazilian SAMU uses the French model and operates with a regionalized, hierarchical and decentralized Single Regulated Medical Regulation Center in the composition of rescue teams and mobile units such as USBs (Basic Support Unit) and USAs (Advanced Support Unit) that vary according to with the type of severity of the event. In the city of Ribeirão Preto, the SAMU service, implemented in 1996, was municipal until 2012, but following the resolutions and ordinances of the Ministry of Health, there was a need to transition from SAMU Municipal to SAMU Regional, with a single number (192) for the 26 municipalities of the Regional Health Department of Ribeirão Preto (DRS XIII) consisting of 38 (thirty-eight) USBs, with 1 USB for each decentralized base, 13 USB for Ribeirão Preto, 01 (one) motolance team and more 03 (three) USAs (advanced life support units) for each base in the microregional poles municipalities (Ribeirão Preto, Sertãozinho and Batatais). Based on this information, this study aimed to characterize the structure and functioning of the Municipal SAMU and its Central Emergency Regulation and the transition to regionalization in its structural aspects, human resources, technological and mainly financial viability, considering the tripartite pass-through insufficient. (2013 to 2016). For the financial viability, the CIS-AVH Consortium (inter-municipal health consortium - Aquifer, Guaraní, Vale das cachoeiras and Horizonte verde) was instituted. The Intermunicipal Health Consortiums (CISs) are very important instruments of cooperation and 11management among integrated municipalities, with common interests defined through the Annual Work Plan described by municipal managers, councils and public entities that establish the priorities and needs of a given place and region. With the objective of creating a solution to common problems, rationalizing government action through joint activities to promote, protect and recover health. The strengthening of shared co-management in health is observed, especially for smaller municipalities, whose investment capacities in the sector are reduced due to the limited budgets available, the growing needs of the citizens, the advancement of the technological apparatus and its costs, and especially the gain through purchase, purchase or scale calls for services, examinations or inputs.

Este estudo teve como objetivo compreender e desvelar o sistema de referência e contra-referência, no contexto do Sistema Único de Saúde do município de Botucatu/SP/BR, a partir da experiência de enfermeiras que vivenciam essa prática. Para tanto, optei pela pesquisa qualitativa, modalidade do fenômeno situado, vertente metodológica da fenomenologia. Seguindo essa trajetória fenomenológica, cheguei às descrições das treze enfermeiras entrevistadas através da questão: \"Gostaria que você discorresse sobre a sua vivência e percepção em relação ao sistema de referência e contra-referência no Município de Botucatu\". Inicialmente, realizei um breve histórico do Sistema Único de Saúde no Brasil, contextualizando, a seguir, o sistema de referência e contra-referência, para depois explicitar os fundamentos metodológicos utilizados. A construção dos resultados deu-se a partir da análise e compreensão individual dos depoimentos (análise ideográfica) e, também, através da interpretação das convergências evidenciadas entre todos os depoimentos (análise nomotética). Evidenciei nessa análise treze temas, os quais foram reduzidos a três categorias: o funcionamento do sistema de referência e contra-referência, as possibilidades de encaminhamento e fatores estruturais do sistema local. As convergências obtidas permitiram vislumbrar um caminho que indica, enquanto essência deste estudo, que embora o sistema de referência e contra-referência no Município de Botucatu apresente problemas estruturais com precária organização, ocultando dificuldades de integração entre os serviços e, em alguns casos, desproporção demanda/oferta de serviços, existem reais possibilidades de melhoria do mesmo, uma vez que o Município conta com os três níveis de complexidade e, no momento, existe um fator de impulsão, que é o financiamento de propostas através do Programa UNI / This study aimed to understand and to care counter-reference and reference system upon the context of the Health Unique System in Botucatu-SP, Brazil from the nurses who experience this practice. I adopted a qualitative research, situated fenomena model, methodologically derived from phenomenology. Following this phenomenology course, I reached the descriptions from 13 nurses interviewed on the following question: \"I would like you to elucidate your experience and perception regarding counter-reference and reference system in Botucatu\". At first I performed a brief record about the Health Unique System in Brazil contextualizing as it follows counter-reference and reference system to explicit methodological basis afterwards. Results were obtained from analysis and individual comprehension from evidences (ideographic analysis) and also through the interpretation of the attested convergencies among all the evidences (nomothetic analysis). I attested 13 themes in this analysis, and they were reduced into 3 categories: counter-reference and reference system operation, guiding possiblities and local system structural factors. The convergencies allowed to glimpse at a way which indicates that although counter-reference and reference system in Botucatu show structural problems with scarce organization, hiding integrations difficulties among services, and in some cases, disproportion demand / supply, there are real betterment possibilities once the city has three complexity levels, and at the moment there is an impulsion factor, which is the proposals sponsoring through UNI Project