Thesis (MSc(Med)(Pharmacy))--University of Limpopo, 2012. / ABSTRACT South Africa, 80% of the population is dependent on the vernment to provide for their health care needs, mainly ugh primary health care facilities. In the health objectives of the National Drug Policy, the government of South Africa outlines its commitment to ensuring availability and accessibility of medicines which are effective, affordable, safe and of good quality in all sectors of the health care system ( N a t ion a IDe par t men t of He a It h, 1 996) . In o rd e r to assess the availability of d ru g s and identify ch a II en g e s w hi c h . ex is tin the Emf u Ie n i sub - d is t r i c t wi t hi nth e Sedibeng district, a questionnaire was administered to 21 primary health care facility managers/store managers, fo u r Community Health Centre managers and five transport officers in the district. In addition, a document review process was conducted to verify aspects of th e facility managers' and store managers' responses. Bin cards and primary health care order files were also examined in conjunction with a checklist to establish whether stock control systems were in place. There was a 100% response with all primary health care centres and community health care centres completing th e questionnaires. It was established that drugs at primary and community health care clinics were procured from the Sedibeng district pharmacy. In each of these clin ics there were specific individuals responsible for medicine supply management. Only four primary health care clinics had full-time pharmacist assistants employed, and 14 clinics were visited by the assistants on a weekly/bi-weekly basis. There were no employees that have received training in drug supply management in the last 12 months in 88% of the clinics interviewed. Nineteen clinics claimed that the storage area was not large e n 0 ugh to s tor e a II the s toe k f or a m 0 nth's sup ply and 0 n I yon e clinic had a secure delivery area for their medication. It was established that 24 facilities received stock by two specific procedures namely; that the number of boxes were checked and the driver's note was then signed, and stock received was checked against the invoice. Of the interviewed cl i nics, 20% admitted that the re-order level had not been calculated for all tracer items in the store. Standard Operating Procedures, Standard Treatment Guidelines and the Essential Drugs List were also not available at all facilities. The results indicate inadequacies and weaknesses in procurement, quantification, stock control, storage and record keeping. It clearly demonstrates that inadequately-trained staff was a ma j 0 reo n t rib uti n g fa c tor to d rug s h 0 r tag e s. The r e was a I a c k 0 f monitoring and evaluation by th e district pharmacy as pharmacists did not manage to visit all the clinics each month. Most of the inadequacies and weaknesses can be addressed at facility level with pro per supervision, in-service training, mentoring and support of staff and the reinforcement of drug supply management training. Regular supervisory visits together with updating the monitoring too I in terms of th e problems identified will improve th e management of drugs and ultimately decrease the number of out of stocks where problems have been identified at primary health care level.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Pharmaceutical Affairs Johannesburg, 2003 / Tshwane is one of three metropolitan municipalities in Gauteng Province and a cross border district with North West Province. Tshwane has a complex Drug Supply Management system. Gauteng Provincial Authority (GPA), North West Provincial Authority (NWPA) and City of Tshwane Metropolitan Municipality (CTMM) play significant roles. This has resulted in duplication of duties and inefficient use of resources. The aim of the study was to describe the current Drug Supply Management System in Tshwane, identify any weaknesses plus the factors responsible for the observed weaknesses and formulate recommendations for improvement. / IT2018

M.P.H., Faculty of Health Sciences, University of the Witwatersrand, 2011

El sistema de abastecimiento público de medicamentos juega un rol importante en la provisión de servicios de salud de calidad, por ello requiere que su gestión sea eficaz y eficiente. El artículo analiza la situación actual del abastecimiento público de medicamentos en el Perú y los principales problemas que enfrenta y sus oportunidades. En concordancia con las políticas de modernización de la gestión pública y la reforma del sector salud, se propone implementar el modelo de demanda continua en la gestión de inventarios, nuevas estrategias de compra y la integración de la gestión almacenamiento y distribución de medicamentos entre las entidades públicas que proveen servicios de salud. / The public sector drug supply management system plays an important role in providing quality health services, which is why it requires effective and efficient management. The article analyzes the current public sector drug supply in Peru, the key problems it faces and its opportunities. Pursuant to public management modernization policies and reforms to the health sector, it proposes implementation of a continuous demand model of inventory management, new purchasing strategies and the integration of storage management and drug distribution among the public entities that provide health services.

Antimicrobials are unique drugs in that they target "infectious" or "transferable" diseases. There is considerable evidence linking increasing antimicrobial use withincreasing resistance. Resistant bacteria do not know the boundaries, either between countries or within a society between hospital and primary care. Inappropriate prescribing of antimicrobials in hospitals therefore has consequences for whole communities and problems may spread both nationally and internationally. The gathering of reliable measurements of antibiotic use in hospitals employing standardised methods is essential to building an evidence base and highlighting inconsistencies at national and international levels. In this study, after data processing, validating and record linkage, a method forelectronic conversion of drug supply data to the ATC/DDD classification and forlongitudinal analysis was established for Tayside and then for a set of Europeanhospitals. Time series analysis and interrupted time series analysis were described and used for longitudinal surveillance and interventional study of antimicrobial use. This thesis explores issues concerning the evolution and management of hospital antimicrobial use using a wide range of methods. A series of drug utilisation research studies were implemented as the basis of research methods that, in combination of previously described methods, provided novel studies. No single measure can currently capture all of the aspects of hospital antibiotic use. However, a combination of detailed, point prevalence data from individual patients with longitudinal analysis of total consumption can provide meaningful data for comparison between hospitals and for analysis of the relationship between use and outcome. Additionally, there is a need to apply standard processes and novel methods to produce more meaningful surveillances. Longitudinal and point prevalence surveillances together with an explanation ofvariations in hospital characteristics are used to produce a set of coherent measurements of hospital antimicrobial use. Administrative data for longitudinal surveys requires continuous quality control.Whereas drug utilisation researchers and clinicians should target a set of indicators for interventional studies, large studies at national or international level need central data processing by country to identify targets for evaluation and for interventional studies. Support from experts in other fields is needed to address any shortcomings that may be experienced during continuous antibiotic drug utilisation monitoring at national and international levels.

Η αγορά του φαρμάκου, παρά τις ρυθμίσεις για την ομαλή λειτουργία της που επιβάλλονται για τη διασφάλιση της φύσης του φαρμάκου ως κοινωνικό αγαθό, είναι ενταγμένη στην πραγματική οικονομία και απόλυτα ευαίσθητη στις διακυμάνσεις της ζήτησης. Το πρώτο βήμα για τον προγραμματισμό όλων των αλυσίδων και στην περίπτωσή μας της εφοδιαστικής αλυσίδας του φαρμάκου, είναι η χρήση μεθόδων πρόβλεψης της ζήτησης έτσι ώστε οι υποθέσεις σχετικά με την ποσότητα των φαρμάκων που θα αγοράσουν οι πελάτες-ασθενείς, να είναι όσο το δυνατόν ακριβέστερες. Η παρούσα διπλωματική εργασία έχει σκοπό να διερευνήσει τη χρήση μεθόδων πρόβλεψης στην εφοδιαστική αλυσίδα του φαρμάκου στην Ελλάδα. Οι επιμέρους στόχοι της έρευνας είναι να μελετηθεί σε επίπεδο φαρμακαποθήκης και φαρμακείου: α) Ποιες είναι οι γνώσεις και η γνώμη των υπεύθυνων προμηθειών σε σχέση με τη χρήση μεθόδων πρόβλεψης της ζήτησης. Ποιοι είναι οι λόγοι που εμποδίζουν κάποιους να κάνουν χρήση προβλέψεων και ποια είναι τα κριτήρια με βάση τα οποία γίνεται η επιλογή των μεθόδων, β) Ποια είναι τα πλεονεκτήματα και μειονεκτήματα που προκύπτουν από τη χρήση μεθόδων πρόβλεψης, γ) Εάν υπάρχει συνεργασία των δύο κρίκων. Ποιοι είναι οι λόγοι που την εμποδίζουν, ποια τα οφέλη από τη συνεργατική πρόγνωση της ζήτησης και ποιες οι αιτίες του φαινομένου της «μεγέθυνσης» της ζήτησης και δ) Πώς επηρεάζεται η άποψη των υπεύθυνων προμηθειών σε σχέση με τη χρήση μεθόδων πρόβλεψης της ζήτησης ανάλογα με τα δημογραφικά χαρακτηριστικά τους. Αρχικά, διεξήχθη βιβλιογραφική ανασκόπηση που εστίασε κυρίως σε μελέτες της ξένης βιβλιογραφίας σχετικά με το θέμα της χρήσης προβλέψεων ζήτησης των φαρμάκων σε επίπεδο χονδρικής και λιανικής διανομής. Στη συνέχεια, βάσει των ευρημάτων της βιβλιογραφικής ανασκόπησης και των συνεντεύξεων με υπεύθυνους αγορών σε φαρμακαποθήκες και σε φαρμακεία, δημιουργήθηκαν δύο ερωτηματολόγια, τα οποία συμπληρώθηκαν από 38 και 64 συμμετέχοντες, αντίστοιχα. Τα πρωτογενή στοιχεία που συλλέχθηκαν αναλύθηκαν στη συνέχεια με τη βοήθεια του στατιστικού προγράμματος SPSS. Από τις αναλύσεις των απαντήσεων της έρευνας σε φαρμακαποθήκες, διαπιστώσαμε ότι το 59,4% των ερωτηθέντων θεωρεί αναγκαία τη χρήση μεθόδων πρόβλεψης της ζήτησης κατά τη σύνταξη της παραγγελίας, οι 7 στους 10 συμμετέχοντες δήλωσαν ότι δεν έχουν χρησιμοποιήσει κάποια μέθοδο πρόβλεψης στο παρελθόν και σχεδόν το 83% των ερωτώμενων ήταν θετικοί σε μια μελλοντική χρήση προβλέψεων. Οι λόγοι άρνησης χρήσης των προβλέψεων φαίνεται να είναι κυρίως η άγνοια των πλεονεκτημάτων που προσφέρει η πρόβλεψη και η έλλειψη εμπιστοσύνης σχετικά με τη χρήση των μεθόδων αυτών η οποία οφείλεται στο φόβο ότι θα υπάρχουν σημαντικές επιπτώσεις από μια ανακριβή και λανθασμένη πρόβλεψη. Επιπρόσθετα, η έρευνα έδειξε ότι οι 9 στους 10 συμμετέχοντες θεωρούν αναγκαία τη συνεργασία φαρμακείου-φαρμακαποθήκης για την καλύτερη διαχείριση της ζήτησης. Παρόλα αυτά οι 6 στους 10 συμμετέχοντες δήλωσαν ότι έχουν συνεργαστεί στο παρελθόν με κάποιο φαρμακείο για να πετύχουν καλύτερη πρόβλεψη της ζήτησης, ενώ οι 9 στους 10 δήλωσαν θετικοί σε μια μελλοντική συνεργασία. Οι λόγοι άρνησης της συμμαχίας αποθήκη-φαρμακείο φαίνεται να είναι ο φόβος ότι θα υπάρχει απόκρυψη σημαντικών πληροφοριών από το φαρμακείο και το γεγονός ότι οι αποθήκες θεωρούν ότι οι πελάτες τους (φαρμακεία) δεν ενδιαφέρονται για μια τέτοιου είδους συνεργασία. Από τις αναλύσεις των απαντήσεων των υπεύθυνων των φαρμακείων, διαπιστώσαμε ότι το 75% του δείγματος γνωρίζει ότι τα συστήματα μηχανοργάνωσης δίνουν τη δυνατότητα πρόβλεψης των πωλήσεων και της ζήτησης των φαρμάκων, αλλά παρόλα αυτά μόλις το 18,8% των ερωτηθέντων φαίνεται να χρησιμοποιεί αποκλειστικά τις δυνατότητες των μηχανογραφικών συστημάτων κατά τη σύνταξη της παραγγελίας προς τους προμηθευτές, ενώ το 75% στηρίζεται μόνο στις πωλήσεις της ημέρας και στην εμπειρία και κρίση του για να συντάξει τις παραγγελίες των φαρμάκων, χωρίς να χρησιμοποιεί κάποια μέθοδο πρόβλεψης. Σχεδόν οι 6 στους 10 θεωρούν αναγκαία τη χρήση μεθόδων πρόβλεψης της ζήτησης κατά τη σύνταξη της παραγγελίας, αλλά το 73,4% των συμμετεχόντων δήλωσαν ότι δεν έχουν χρησιμοποιήσει κάποια μέθοδο πρόβλεψης στο παρελθόν. Παρόλα αυτά, σχεδόν όλοι (82,8%) ήταν θετικοί σε μια μελλοντική χρήση προβλέψεων. Οι λόγοι άρνησης χρήσης των προβλέψεων φαίνεται να είναι κυρίως η άγνοια των πλεονεκτημάτων που προσφέρει η πρόβλεψη και η επιφυλακτικότητα σχετικά με τη χρήση των μεθόδων αυτών, η οποία οφείλεται στο φόβο ότι θα υπάρχουν σημαντικές επιπτώσεις από μια ανακριβή και λανθασμένη πρόβλεψη. Από την ανάλυση των απαντήσεων φαίνεται ότι οι 9 στους 10 συμμετέχοντες θεωρούν αναγκαία τη συνεργασία φαρμακείου-φαρμακαποθήκης προκειμένου να επιτευχθεί καλύτερη διαχείριση της ζήτησης. Ωστόσο, οι 7 στους 10 ερωτώμενους δήλωσαν ότι δεν έχουν συνεργαστεί στο παρελθόν με κάποια φαρμακαποθήκη για να πετύχουν καλύτερη πρόβλεψη της ζήτησης, ενώ οι 9 στους 10 δήλωσαν θετικοί σε μια μελλοντική συνεργασία. Οι λόγοι άρνησης της συμμαχίας αποθήκη-φαρμακείο, σύμφωνα με τα αποτελέσματα της έρευνας, φαίνεται να είναι όλοι σχεδόν εξίσου σημαντικοί και εκείνος που κυριάρχησε ελαφρώς είναι η έλλειψη εμπιστοσύνης προς τη φαρμακαποθήκη. Με τη συνεργατική πρόγνωση της ζήτησης, βελτιώνεται η ακρίβεια της πρόβλεψης χάρη στο μερισμό των γνώσεων σχετικά με την καταναλωτική συμπεριφορά, με αποτέλεσμα να προβλέπονται πολύ ακριβέστερα οι ανάγκες των καταναλωτών-ασθενών που είναι οι άμεσοι και έμμεσοι υποστηρικτές των επιχειρήσεων του κάθε κρίκου του καναλιού διανομής φαρμάκου. Για αυτό προτείνεται η συνεργασία των φαρμακαποθηκών με τα φαρμακεία, τις φαρμακευτικές εταιρίες και φαρμακοβιομηχανίες, μέσω της κοινοποίησης των προβλέψεων. Οι κοινές προβλέψεις θα συνδυάζουν τις διαφέρουσες οπτικές όλων των εταίρων για πιο αξιόπιστες μελλοντικές προβλέψεις. Επίσης μία πρόταση είναι η καθιέρωση συστήματος συλλογής μονάδων, υποχρεωτικά μέσα από την παρακολούθηση σεμιναρίων μετεκπαίδευσης, τα οποία θα περιλαμβάνουν την εκπαίδευση σε συστήματα προσομοίωσης εξειδικευμένων λογισμικών διακίνησης φαρμακευτικών προϊόντων. Μέσα από διαδραστικά σεμινάρια οι αρμόδιοι στον τομέα της προμήθειας των φαρμάκων θα ενημερώνονται σχετικά με βασικά θέματα διαχείρισης των αποθεμάτων που εφαρμόζονται στο χώρο του φαρμάκου και αφορούν τα συγκριτικά πλεονεκτήματα της ενοποιημένης εφοδιαστικής αλυσίδας, με στόχο να καταπολεμηθούν οι φόβοι που μετριάζουν τη χρήση προβλέψεων γενικότερα και συγκεκριμένα τη συνεργασία των δυο κρίκων της αλυσίδας. / The drug market, despite any arrangements imposed to promote accessibility to pharmaceuticals as a social good, is integrated into the real economy and is quite sensitive to fluctuations in demand. The first step during planning in all chains, and in our case in the drug supply chain, is the use of demand-forecasting methods. This research aims to explore the use of demand-forecasting methods for medication at the pharmacy and the pharmaceutical warehouse in Greece. The specific objectives of this research is to study: a) How familiar is the supply manager and what is their opinion in relation to the use of demand-forecasting methods. What are the reasons that prevent some people from putting in use forecasting methods and what are the criteria for selecting such methods, b) What are the advantages and disadvantages of using forecasting methods, c) Whether there is cooperation between the two parts of the supply chain. What are the causes of the phenomenon of "bullwhip effect", are there any means to prevent it and what are the benefits of collaborative demand-forecasting and finally d) Is there any correlation between the opinion of supply managers on the use of demand-forecasting methods and their demographic characteristics. Initially, a literature review was conducted that focused mainly on studies of foreign literature on the topic of demand-forecasting for drugs at wholesale and retail distribution. Then, based on the findings of the literature review and interviews with supply managers of pharmaceutical wholesalers and pharmacies, two questionnaires were created, which were completed by 38 and 64 participants, respectively. The original data collected was then analyzed using the statistical program SPSS. The analysis of responses from research in pharmaceutical warehouses, indicated that 59.4% of respondents consider it necessary to use demand-forecasting methods for the drug order, 7 out of 10 participants said that they had not previously used any and almost 83% of respondents were positive towards a future use. The reasons for refusing to use forecasting methods seem to be mainly ignorance of the benefits and lack of confidence in their efficacy, propelled by the fear that there will be significant losses from a possible inaccurate or totally incorrect forecast. Additionally, the survey showed that 9 out of 10 participants adhere to the necessity for cooperation between the pharmaceutical warehouse and the pharmacy, in order to more efficiently manage demand. However, only 6 out of 10 participants said they had collaborated in the past with a pharmacy to achieve this goal, while 9 out of 10 felt positive towards a future collaboration. The main reasons for avoiding an alliance between their warehouse and a pharmacy seem to be 1) the fear that their counterpart will not disclose important information and 2) the fact that they were under the impression their customers (pharmacies) were not interested in such a cooperation. From the analysis of the responses of supply managers in pharmacies, we found that 75% were aware that software systems enable forecast of sales and demand for drugs, but only 18.8% of respondents seem to exclusively use the capabilities of computer systems for the order to suppliers, while 75% rely only on daily sales plus their experience and judgment to compose orders for medicines, without using a forecasting method. Nearly 6 in 10 felt the need to use methods of demand-forecasting in the orders, but 73.4% of respondents indicated that they have not used a forecasting method previously. Nevertheless, more than 4 in 5 (82.8%) were positive towards a future use of software-assisted forecasts. The reasons for being reluctant to use the forecasting methods seem to be mainly the ignorance of the benefits and the fear that there will be significant losses from a possible inaccurate or totally incorrect forecast. From the analysis of the responses it appears that 9 out of 10 participants felt the need for cooperation between the pharmacy and the pharmaceutical warehouse, in order to achieve better management of demand. However, 7 out of 10 respondents stated that they have not collaborated in the past with a pharmaceutical wholesaler to achieve better demand forecasting, while 9 out of 10 felt positive towards a future collaboration. The reasons for avoiding an alliance with a wholesaler varied within the survey results, almost all being equally important, with one that dominated slightly being the lack of trust in the pharmaceutical wholesaler. As a general conclusion it has been shown that the use of collaborative forecasting of demand is improving the forecast accuracy thanks to the sharing of knowledge on consumer behaviour, leading to accurate predictions of the consumer/patient’s needs, who are after all the direct or indirect business supporters of each link in the drug distribution chain. It is proposed that a communication channel between pharmacies, wholesalers and manufacturers should be established for the exchange of forecasts. The resulting common forecast should combine the different perspectives for more accurate predictions of the demand. Another proposal is the introduction of incentives for attending interactive seminars on inventory management and training on specialised software. Through such activities individuals responsible for putting out orders or production managers could become updated to the latest inventory management techniques applied in the pharmaceutical field and become aware of the comparative advantages of the integrated supply chain. This would hopefully counter fears that mitigate the use of forecasting methods in general and specifically the cooperative forecasting between the members of the supply chain.

Made available in DSpace on 2014-12-17T14:27:25Z (GMT). No. of bitstreams: 1 AlanDB_DISSERT.pdf: 1096689 bytes, checksum: 2f58fb4a7d1ef283d240f8976f77dd49 (MD5) Previous issue date: 2013-09-20 / In Brazil, social rights have always been considered secondary legal categories, whose implementation could wait for the pending of political decisions. At the end of the Second World War, International Law emphasizes the protection of human beings, raising his dignity as a legal pillar of the legal orders and one of the main foundations of Constitutions. At the post-positivism Constitutionalism, the realization of social rights receives special attention with the assumption of supremacy and normativity of the Constitutions, while the judiciary participates in the realization of democracy, not only as applicator of laws, but also as the guardian of constitutionality of the acts and administrative omissions, creatively contributing to the constitutional achievement, filling gaps and normative state omissions. In this aspect, the supply of medicines, whose costs can not be supported by the individual, keep a close connection with the right to life, health and dignity of the human being, as the subject of numerous lawsuits directed against the Public Administration. Such phenomenon has caused intense debate regarding judicial activism and legitimacy of these decisions, particularly on the need to define what are the limits and possibilities considering the principle of separation of powers and the principle of reserve of the possible; bieng this the problematic developed in this research. Thus, this research aims to verify the legitimacy of judicial decisions that determines to the Public Administration the compulsory providing of medicine to those who can not afford the cost of their treatment, as well as, contribute to the dogmatic constructions of parameters to be observed by judicial interference. Regarding the methodology, this research has an investigative and descriptive caracter and an theoretical approach based on bibliographical data collection (judicial and doutrine decisions) that received qualitative treatment and dialectical approach. As a result, it is known that the judicial decision that determines the supply of medicines to those individuals who can not afford them with their own resources is legitimate and complies with the democratic principle, not violating the principle of separation of powers and the reserve of the possible, since the judicial decison is not stripped with an uniform and reasonable criteria, failing to contain high burden of subjectivism and witch signifies a possible exacerbation of functions by the judiciary, suffering, in this case, of requirement of legal certainty. It is concluded that the Court decision that determines the government the providing of medicine to those who can not afford the cost of treatment should be based on parameters such as: the protection of human dignity and the minimum existencial principle, the inafastable jurisdiction principle; compliance critique of the possible reserve principle; subsidiarity of judicial intervention; proportionality (quantitative and qualitative) in the content of the decision; the questioning about the reasons for non-delivery of the drug through administrative via; and, finally, the attention not to turn the judiciary into a mere production factor of the pharmaceutical industry, contributing to the cartelization of the right to health / No Brasil, os direitos sociais sempre foram considerados categorias jur?dicas secund?rias, cuja concretiza??o poderia aguardar o tr?mite das decis?es pol?ticas. Com o fim da 2? Guerra Mundial, o Direito Internacional enfatiza a prote??o da pessoa humana, elevando a sua dignidade como pilar dos ordenamentos jur?dicos e um dos principais fundamentos das Constitui??es. No Constitucionalismo p?spositivista, a concretiza??o dos direitos sociais recebe especial aten??o com a assun??o de supremacia e normatividade das Constitui??es, ao mesmo tempo em que o Judici?rio participa da realiza??o da democracia, como aplicador das leis, mas tamb?m como guardi?o da constitucionalidade dos atos e omiss?es administrativas, contribuindo criativamente com a concretiza??o constitucional, suprindo lacunas normativas e omiss?es estatais. Nesse aspecto, o fornecimento de medicamentos, cujos custos n?o podem ser suportados pelo indiv?duo, guarda estreita liga??o com o direito ? vida, ? sa?de e a dignidade da pessoa humana, sendo objeto de numerosas a??es judiciais dirigidas contra a Administra??o P?blica. Tal fen?meno provocou intenso debate quanto ao ativismo judicial e ? legitimidade dessas decis?es, sobretudo pela necessidade de se definirem quais os seus limites e possibilidades, ? luz do princ?pio da separa??o de poderes e da reserva do poss?vel; sendo esta a problem?tica desenvolvida na presente investiga??o. Diante disso, a presente pesquisa objetiva verificar a legitimidade das decis?es judiciais que determinam ? Administra??o P?blica o fornecimento compuls?rio de medicamentos ?queles que n?o podem arcar com os custos de seu tratamento, assim como contribuir com a constru??o dogm?tica de par?metros a serem observados nessas esp?cies de interfer?ncia judicial. Quanto ? metodologia, a presente pesquisa tem car?ter investigativo e descritivo, de enfoque te?rico, alicer?ada em coleta de dados bibliogr?ficos (doutrina e decis?es judiciais) que receberam tratamento qualitativo e abordagem dial?tica. Como resultados, tem-se que a decis?o judicial que determina o fornecimento de medicamentos ?queles indiv?duos que n?o podem adquiri-los com seus pr?prios recursos ? leg?tima e respeita o princ?pio democr?tico, n?o violando o princ?pio da separa??o de poderes e a reserva do poss?vel, desde que n?o despojada de crit?rios razo?veis e uniformes, sob pena de conter alta carga de subjetivismo e significar uma poss?vel exacerba??o de fun??es por parte do Judici?rio, padecendo do requisito da seguran?a jur?dica. Conclui-se que a decis?o judicial que determina ? Administra??o P?blica o fornecimento de medicamentos ?queles que n?o podem arcar com os custos de seu tratamento deve se pautar em par?metros tais como: prote??o ? dignidade da pessoa humana e ao m?nimo existencial; a inafastabilidade da jurisdi??o; a observ?ncia cr?tica da reserva do poss?vel; a subsidiariedade da interven??o judicial; a proporcionalidade (quantitativa e qualitativa) no conte?do da decis?o; o questionamento quanto aos motivos do n?ofornecimento do medicamento pela via administrativa; e, finalmente, a aten??o para que o Judici?rio n?o se transforme em mero fator produtivo da ind?stria farmac?utica, contribuindo para a carteliza??o do direito ? sa?de

Made available in DSpace on 2016-04-26T20:23:42Z (GMT). No. of bitstreams: 1 Silvia Melo da Matta.pdf: 5962606 bytes, checksum: 344a5c9d448572efc6b103b9d5649b65 (MD5) Previous issue date: 2015-06-03 / The aim of this research is to discuss the recent role of the Judiciary, through the analysis of the decisions of the Supreme Court on public policies of drug supplies, after public audience number 4. This investigation addresses the concrete effects of Judiciary performance over the Executive. Our starting point was the analysis of the historical evolution of the rights to health, both within national and international law, and its recognition as human rights. From this perspective, it seems that all rights entail costs to be implemented, but resources are insufficient and limited. From these premises as well as the principle of proportionality, we inquire if the interpretation of the article 196 of the Constitution by the Supreme Court is adequate in individual cases where there is a claim to supply the drug. The research approached judicialization consequences within the Public Administration by studying eleven res judicata of the Brazilian Constitutional Court. The Judiciary and the Executive branches should pursue a dialogue: the need for analysis of technical and collective aspects by the former and continuous improvement by the latter / O objetivo deste trabalho é trazer à discussão o recente papel do Poder Judiciário, por meio da análise das decisões do Supremo Tribunal Federal, perante as políticas de medicamentos, após a audiência pública nº4. Trata-se de uma investigação sobre os efeitos concretos da atuação deste Poder sobre o Poder Executivo. Partimos da análise da evolução histórica do direito à saúde, tanto no plano internacional, como no nacional, e do seu reconhecimento como um direito humano. Nessa perspectiva, verifica-se que todos os direitos possuem seus custos para serem implementados, no entanto, os recursos são escassos e limitados. A partir dessa premissa e do princípio da proporcionalidade propusemos uma interpretação ao art.196 da Constituição Federal e analisamos se a interpretação dada pelo Supremo Tribunal Federal é adequada aos casos individuais, quando há pedido para o fornecimento de medicamentos. Pesquisamos no âmbito da Administração Pública os custos e as consequências da judicialização por meio de onze julgados da Corte Constitucional brasileira. O Poder Judiciário e o Poder Executivo devem manter um diálogo, visto que existe a necessidade de análise de aspectos técnicos e coletivos pelo primeiro e o contínuo aperfeiçoamento do tema pelo segundo

Submitted by Leoná Rodrigues (leonarodrigues@id.uff.br) on 2017-07-26T19:44:34Z No. of bitstreams: 1 O Poder Judiciário - Gisele Alcantara.pdf: 353836 bytes, checksum: 26282fb72b88cc797098182c141a0786 (MD5) / Approved for entry into archive by Biblioteca da Faculdade de Direito (bfd@ndc.uff.br) on 2017-08-17T15:15:51Z (GMT) No. of bitstreams: 1 O Poder Judiciário - Gisele Alcantara.pdf: 353836 bytes, checksum: 26282fb72b88cc797098182c141a0786 (MD5) / Made available in DSpace on 2017-08-17T15:15:51Z (GMT). No. of bitstreams: 1 O Poder Judiciário - Gisele Alcantara.pdf: 353836 bytes, checksum: 26282fb72b88cc797098182c141a0786 (MD5) / Versa sobre a atuação do Poder Judiciário na concretização do direito à saúde no Brasil, no campo específico das demandas individuais de fornecimento de medicamentos pelo Estado, ante a perspectiva da escassez dos recursos orçamentários. Partindo da análise das bases jusfilosóficas que norteiam o papel ativo do Poder Judiciário na concretização dos direitos fundamentais, assim como do estudo dos fundamentos e da configuração constitucional da saúde como direito social tutelado pela ordem constitucional de 1988, promove a análise do fenômeno gerado pela proliferação do número de demandas de saúde no Brasil nos últimos anos. Reconhecido tal fenômeno e analisados os impactos e reações que produz, promove uma análise do principal instrumento de racionalização e uniformização da análise judicial no campo do fornecimento de medicamentos: os parâmetros delineados pelo Ministro Gilmar Mendes nos autos da Suspensão de Tutela Antecipada nº 175. Avaliado tal critério e reconhecido que, malgrado sua abrangência, ele não privilegia uma análise aprofundada acerca da escassez dos recursos orçamentários, propõe então, com suporte na Teoria dos Jogos, uma reflexão acerca da macrojustiça envolvida nestas demandas, apresentando, então, o problema do custo dos direitos e os seus reflexos na alocação de recursos escassos na área de saúde. Ante esta perspectiva, propõe então o estudo e avaliação de alguns parâmetros de racionalização propostos pela doutrina e que contemplam a questão da escassez, apontando o critério da “comprovação da hipossuficiência”, proposto por Guilherme Beux Nassif Azem, como o mais adequado para complementar o delineamento proposto por Gilmar Mendes na STA 175, colaborando, assim, para uma mais completa racionalização do problema da chamada “judicialização excessiva” no campo das demandas individuais de fornecimento de medicamentos. / The study argues on the role of Judiciary in concretizing the right to health in Brazil, specifically for State individual demands of drug supplies, considering the scarce budget resources prospect. From the analysis of legal philosophy thought bases that form and guide the active role of Judiciary in the implementation of fundamental rights, as well as the study of foundations and constitutional configuration of health as social right protected by the 1988 constitutional order, it analyses the phenomenon that the increase on demand has generated in the last years. Identifying such phenomenon and arguing on the impacts and reactions it has produced, the study analyzes the main instrument of rationalization and standardization of judicial review in the field of medicine supply: the parameters the Minister Gilmar Mendes outlined in the case of suspension of advance claim rights nº 175. Evaluating this criterion and recognizing that, despite its comprehensiveness, it does not take into account an in depth analysis of the scarcity of budgetary resources, the study proposes from the Theory of Games an account of macrojustice involved in these demands, then presents the problem of rights costs and their reflections in the allocation of scarce resources in public health. Faced with such prospect, it puts forward for consideration the study and evaluation of some rationalization parameters proposed by the doctrine that address the issue of scarcity, pointing to Guilherme Azem Beux Nassif´s criterion of ": hiposufficiency comprobation" as the most suited to complement the design proposed by Gilmar Mendes in STA 175, contributing thus to a more complete rationalization of the so-called "excessive judicialization" of individual demands in the field of drug supply

全民健保的實施改變了傳統的藥品通路，使得藥品市場逐漸集中於醫院，而醫療院所為因應總額支付的政策，降低營運成本，因而有逐漸結盟經營的趨勢。為滿足市場導向的藥品供應鏈需求，本研究探討自全民健保1995年實施後，藥品通路的變革對藥品供應鏈所造成的影響，並藉由個案探討以及理論分析，探討藥品供應鏈e化之趨勢，以歸納出一個藥品供應鏈e化可行模式，供政府機關、醫療院所、藥商及物流商在藥品供應鏈之流程中作為參考。 本研究認為藥品供應鏈應從分散管理改為集中管理，並藉由具有公信力的中央健保局，配合資訊科技協助藥品供應鏈e化，以讓藥品資訊可以有效的流通被利用。透過以以中央健保局為中心的藥品供應鏈模式，可以讓各個產業專業分工的成效更明顯，其具有下列益處： 一、以量制價統一配銷 二、降低醫療院所藥品存貨 三、簡化健保給付流程 四、藥品資訊有效利用 五、幫助醫藥分類落實 　　此外，本研究亦針對此模式下之藥品供應鏈提出初步實施規劃如下： 一、從公立體系醫院興辦 二、選擇量大且較常使用的健保給付藥品 三、彈性的配送頻率 四、資訊流與金流的整合 五、由中央健保局協助資訊商建立藥品供應鏈e化平台 透過本研究所提出之藥品供應鏈之e化模式及流程，本研究期望能加速藥品供應鏈集中管理之機制形成，以幫助醫藥產業降低藥品流通的成本並落實醫藥分業。 / This paper examines the condition of Taiwanese National Health Insurance (NHI) and brings up the idea of the centralizd management. Since Taiwan put the NHI into practice, Drug Price Black-Hole of the NHI has estimated about 20 billion every year under the fee-for-service payment system (FFS) and pricing drug with brand. Therefore, we collect the papers and some cases to discuss the situation of the Drug Supply Chain in Taiwan. We would like to understand how to descrease the drug cost in purchasing and distributing by this paper. This paper makes use of Value Chain, Diamond Theory, New Value Curve to analyze the Drug Supply Chain in Taiwan and proposes the model and process to direct the industry how to developing the Drug Supply Chain by certralized management. The Drug Supply Chain of certralized management can provide some benefit as following: 1. Purchase jointly to reach economies of scale 2. Simplify the reporting process 3. Effectively use the information of the drugs 4. Utilize the distributed process by jointly delivery 5. Help the separation profession of pharmacy from medicine to implement Besides, this paper proposes the initial plan about the Drug Supply Chain of certralized management as following: 1.Begin with governmental hospitals. 2. Select large amount of the drugs of NHI. 3. Provide flexible frequency of distribution. 4. Intergrate the information flow and cash flow. 5. Bureau of National Health Insurance (BNHI) supports the Internet Servie provider (ISP) to build the platform of the Drug Supply Chain. Our main goal is to adapt this kind of model to help NHI overcome financial crisis by jointly purchasing and distributing, simplifying the process of reporting and help the separation profession of pharmacy from medicine.