Introducão - A Terapia Renal Substitutiva (TRS) é utilizada por uma quantidade elevada de pacientes de forma contínua, demandando montantes financeiros crescentes do Sistema Único de Saúde (SUS). Objetivo - explorar e compreender, a partir das contribuições da Economia Política da Saúde (EPS), os processos econômicos, políticos e sociais envolvidos na oferta da Terapia Renal Substitutiva (TRS) no estado de São Paulo. Métodos - a partir do referencial teórico da Economia Política da Saúde (EPS), foi realizado estudo de caso sobre a Terapia Renal Substitutiva (TRS) no estado de São Paulo mediante a investigação da dimensão industrial, da política e a de proteção social. Com relação à dimensão industrial, foram construídos indicadores com base em dados secundários relacionados às Autorizações para Procedimentos de Alta Complexidade, ao Sistema de Gerenciamento da Tabela de Procedimentos, Medicamentos, Órteses, Próteses e Meios Auxiliares de Locomoção do SUS e ao Cadastro Nacional de Estabelecimentos de Saúde. A escala da análise foram as 17 redes Regionais de Atenção Saúde em São Paulo. Com relação à dimensão política e social, foram realizadas entrevistas com atores-chaves. Procedeu-se inicialmente à leitura livre da entrevista; na sequência, foram identificados os núcleos temáticos de interesse da pesquisa. Resultados - Na dimensão industrial, foi constatado que, apesar do elevado gasto, a tecnologia na diálise apresenta somente inovações incrementais. A oferta de máquinas, em 2017, por 10000 habitantes, foi superior à do ano de 2008 em todas as regiões de saúde. O gasto para a diálise cresceu no período de 2008 a 2017. Houve crescimento de 37% na produção de procedimentos dialíticos ao longo de 2008 a 2017. Com relação aos turnos, 92% das clínicas operam com menos do que três turnos de atividade, tendo capacidade ociosa. A participação dos prestadores de serviços é de 2% para os prestadores de serviços municipais, 9% para os estaduais, 53% para os privados lucrativos e 35% para os privados sem fins lucrativos (filantrópicos). O custo é de 75% com filtros hemodialisadores importados, tendo elevado impacto no financiamento do SUS. Com a abertura do mercado da saúde ao capital estrangeiro, sancionada pelo governo através da Lei 13.097/2015, identificou-se a compra de clínicas privadas de diálise por empresas estrangeiras que pertencem à cadeia produtiva da diálise, em uma estrutura de mercado oligopolista. Com relação à dimensão política, não se observou a configuração de um conjunto de políticas públicas para o segmento. Por fim, com relação à dimensão de proteção social, há um acesso desigual aos serviços. Conclusões - Verificou-se que a diálise está inserida em um cenário de extrema dependência produtiva para sua operacionalização, sendo que todos os insumos e equipamentos são importados. É notória a presença de empresas multinacionais no segmento da diálise, com maior poder de barganha na composição dos preços dos produtos ofertados ao segmento, delineando-se um processo inflacionário e um forte impacto nos gastos. O SUS financia esta área da saúde; seria importante a indução do parque produtivo nacional para a produção de filtros, no entanto, esse movimento ainda não foi concretizado. Para complementar, as multinacionais começam a adquirir as clínicas, em um processo de liquidação dos serviços de diálise, o que pode ter implicações futuras no acesso aos pacientes SUS dependentes. / Introduction - Renal Replacement Therapy (TRS) is used by a large number of patients in continuous treatment, demanding increasing amounts of the Unified Health System (SUS). Objective - to explore and understand, from the contributions of the Political Economy of Health (EPS), the economic, political and social processes involved in the supply of Renal Replacement Therapy (TRS) in the state of. Methods - A case study on Renal Replacement Therapy (TRS) in the state of São Paulo was carried out using the industrial, political and social protection research, based on the theoretical framework of the Political Economy of Health (EPS). Regarding the industrial dimension, indicators were built based on secondary data related to the Authorizations for High Complexity Procedures, the System of Management of the Table of Procedures, Medications, Orthoses, Prostheses and Auxiliary Locomotion of SUS and to the National Registry of Establishments The scale of the analysis was the 17 Regional Health Care Networks in São Paulo. With regard to the political and social dimension, interviews were conducted with key actors. The free reading of the interview was initially done, in the sequence identified the thematic nuclei of interest of the research. Results - In the industrial dimension, it was observed that despite the high expenditure, dialysis technology presents only incremental innovations. The supply of machines in 2017 per 10,000 inhabitants was higher than in 2008 in all health regions. Dialysis expenditures increased from 2008 to 2017. There was a 37% increase in the production of dialysis procedures from 2008 to 2017. With regard to shifts, 92% of the clinics operate with less than three shifts of activity, taking idle capacity. The share of service providers is 2% for municipal service providers, 9% for state service providers, 53% for profitable private firms and 35% for private non-profit organizations (philanthropic). The cost is 75% with imported hemodialysis filters, having a high impact on the financing of SUS. With the opening of the health market to foreign capital, sanctioned by the government through Law 13.097 / 2015, it was identified the purchase of private dialysis clinics by foreign companies that belong to the dialysis production chain, in an oligopolistic market structure. Regarding the political dimension, the configuration of a set of public policies for the segment was not observed. Finally, with regard to the social protection dimension, there is an unequal access to services. Conclusions - It was verified that dialysis is inserted in a scenario of extreme dependence on production for its operationalization, and all inputs and equipment are imported. The presence of multinational companies in the dialysis segment is notorious, with a greater bargaining power in the composition of the prices of the products offered to the segment, outlining an inflationary process and a strong impact on expenses. The SUS finances this area of health, it would be important to induce the national productive park for the production of filters, but, however, this movement has not yet materialized. In addition, multinationals are beginning to acquire the clinics in a process of settlement of dialysis services, which may have future implications for access to SUS dependent patients.

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The South African government intends to overhaul the entire public health system by introducing the National Health Insurance (NHI) system. The implementation of the NHI has created concerns amongst the majority of South African citizens who have a poor image of the quality of services provided by the public sector. One of the major questions that this study attempted to address was whether one of the largest clinics in Soweto could deliver quality healthcare in terms of the proposed NHI system. The study conducted is quantitative in nature and two-pronged. The first part of the study involved a survey conducted amongst staff members at the Soweto clinic to determine their awareness of the National HeaIth Insurance (NHI) and their knowledge of the National Core Standards (NCS). The second part of the study used an assessment questionnaire to determine compliance of the Soweto clinic to the six ministerial priority areas. The results of the survey conducted among the Soweto clinic’s staff members in all staff categories, showed that there is general awareness amongst staff members of National HeaIth Insurance and they have some knowledge of the NCS; however, more education on NHI and NCS is needed for staff working in specialised or isolated departments who are unaware of NHI and have no knowledge of the NCS. The Soweto clinic showed some advancement with regard to the vital measures compliance scores compared to those of the rest of the Gauteng province in the three priority areas. The Soweto clinic has, however, failed to comply under the other four ministerial priority areas, with ratings of less than 80%. This study has shown a disconnect between knowledge of the NCS and the NCS’s implementation by staff members, as staff members have failed to implement or comply with four of the ministerial priority areas, with sub-standard ratings of less than 80%. The Non-NHI clinic is still very far from ensuring the provision of basic quality health service for its clients and it is, thus, not ready to implement NHI. Recommendations from the study: - Managers must drive the quality improvement agenda for their facilities. - Awareness campaigns and more knowledge on NHI and quality improvement (NCS) must be communicated to all staff categories in the health establishments to ensure a deeper understanding of these concepts. - Workshops must be conducted for all staff members in the Soweto clinic, to support the creation of a culture of excellence, with emphasis in providing quality care to clients. Similar future studies need to be conducted on a large scale such as in the whole of Gauteng to determine staff at health establishments’ knowledge of the quality NCS. / MBA, North-West University, Potchefstroom Campus, 2015

The thesis is focused on health care funding in Czech Republic. Comparative analysis confront current Czech health care system with effective one used in Netherlands. First part explains importance of health care activities in welfare state as a public interest priority that influence national economy. Second part presents positive and negative aspects of each type of health care system used abroad. Summary of all these fund sources, type of compensations and health care providers characteristics shapes a hypotetical effective system that can be implemented into a practice of universal health insurance system with detailed considaration of historical, political, legal and social aspects of Czech Republic. According to all these analysis I aim to recommend healt care system improvements that would enhance health care quality.

This diploma thesis is called "Relations of Medical Staff and Their Patients." The first part of this diploma thesis deals with patients' rights, their genesis, and the legislative base. It also includes disordered patients, whose patient's rights should not be forgotten during their hospitalization. A large part of my thesis consists of psychological, economic, legal and organizational system limits of the realization of these rights. This means relationship between a doctor and his patient, the source of health care funding, above standard medical care and the privatization of hospitals. The final part of this thesis focuses on the interaction between health professionals in social work and the patients. This thesis is enriched by an interview with the leader of social workers of a hospital in Prague, discussing new patients' right: right on a social worker.