A assistência psiquiátrica a indivíduos com sofrimento psíquico, em seu campo político, passou por um longo processo de discussão e formulação de estratégias a fim de garantir condição de humanidade aos indivíduos assistidos. A Reforma Psiquiátrica brasileira, como ficou conhecida, ocorreu concomitante ao processo de Reforma Sanitária e formulou leis para a garantia da integralidade e do acesso universal à saúde em território nacional sob a responsabilidade das esferas governamentais. No município de Cascavel PR, o processo de formulação das políticas assistenciais para o indivíduo com transtorno mental se inicia na década de 90, porém só é efetivamente estruturado a partir de 2003 com o fechamento do Hospital Psiquiátrico São Marcos, que forçou o município a agilizar o processo de implantação da rede assistencial e de serviços complementares com moldes psicossociais. Com isso o município estrutura a assistência ao portador de transtorno mental através da implantação de ambulatório especializado, serviço de urgência e centros de atenção psicossocial para adultos, crianças e usuários de álcool e outras drogas, todos estruturados com suporte assistencial realizado pela Unidade Básica de Saúde (UBS). Em cada UBS foi nomeado um profissional de referência para o acompanhamento desses usuários e de seus familiares com o intuito de fortalecer o vínculo e manter a relação entre os serviços complementares e atenção primária. O presente estudo é centrado na pesquisa bibliográfica e de campo, com caráter qualitativo, cujo ponto de partida é a coleta de dados por meio de aplicação de questionário semi-estruturado com a finalidade de conhecer o processo de formulação das políticas municipais de atenção ao doente mental através do questionamento sobre as práticas assistenciais desenvolvidas pela atenção primária à saúde. A população é composta por 10 (dez) profissionais das UBS, referências em saúde mental, e 10 (dez) familiares de usuários com sofrimento mental, assistidos pela atenção básica, mas inseridos em algum dos serviços ofertados da rede assistencial de saúde mental. A análise dos dados se deu por meio de análise de conteúdo, com estruturação de dois grandes focos de análise para melhor compreensão dos conteúdos (Análise de Conteúdo de Bardin). O resultado apontou dados positivos em relação à política de saúde mental municipal uma vez que, embora com apontamentos divergentes entre profissionais e usuários, percebe-se a intenção em assegurar aos indivíduos em sofrimento psíquico uma gama de procedimentos que são, inclusive, orientados por portarias ministeriais. Em relação à assistência prestada pela atenção básica de saúde, há convergência em relação às ações desenvolvidas pelos profissionais da UBS, embora os profissionais afirmem o desenvolvimento de atividades que não são confirmadas pelos usuários. Em relação às dificuldades encontradas para efetivação do tratamento, tanto profissionais quanto usuários apontam que há muito a avançar no campo da saúde mental para que efetivamente seja prestada assistência de forma equânime e integral. / The psychiatric care to individuals with psychological distress, based on its political area, went through a long process of discussion and formulation of strategies to ensure human condition for assisted individuals. Psychiatric Reform in Brazil, as it was known, happened concomitantly with the Sanitary Reform and stated laws to guarantee the completeness and universal access to health in the country under the responsibility of the civil cabinet. In the city of Cascavel, Paraná State, the process of formulating welfare policies for individuals with mental illness has started in the 90s, but, it is only effectively structured up from 2003, when São Marcos Hospital was closed. This forced the municipality to expedite the implementing process concerning the care network and additional services with psychosocial patterns. Thus, the municipality structures assistance to the ones who were mentally ill through the implementation of an outpatient clinic, emergency department and psychosocial care centers for adults, children and users of alcohol and other drugs, all structured to support care conducted by the Basic Health Unit (BHU). In each BHU, it was designated a professional of reference for the monitoring of users and their families in order to strengthen the bond and keep the relationship among complementary services and primary care. This study is focused on literature and field research, with qualitative approach, whose starting point is the collection of data through the application of semi-structured questionnaire in order to know the process for formulation of municipal policies to mental patient care through the questioning of care practices developed by primary health care. The studied group was of ten (10) professionals from BHU, with good qualifications in mental health and 10 (ten) people from the families of users with mental illness, helped by basic assistance, but who made part of any of the services offered from the health care system in mental health. Data analysis was based on the content analysis, with the structure of two points of interest regarding the analysis for better understanding contents (Content Analysis of Bardin). The results showed positive data in relation to mental health policy in common council since, although there were some different notes among professionals and users, it can be observed the intention to ensure that individuals in psychic suffering have a range of procedures that are inclusive, guided by decrees ministry. Regarding the assistance provided by primary health care, there is convergence concerning the actions that were carried out by professionals from BHU, although they asserted the development of some activities that are not shared among users. Regarding the difficulties in effective treatment, both professional and users pointed out that there is much to advance in mental health area, so that effective assistance gets provided in an equal and integral way.

O presente estudo tem como objetivo a análise das tecnologias presentes no trabalho da Equipe Itinerante da Rede de Saúde Mental do município de Viamão/RS. Para realizar o presente estudo foi utilizado o referencial teórico do processo de trabalho em saúde, articulado ao debate sobre o modo psicossocial. O estudo é de abordagem qualitativa, do tipo estudo de caso. A coleta de dados ocorreu nos meses de julho, agosto e setembro, através da observação participante, com anotações em diários de campo, análise documental e por meio de uma entrevista semiestruturada. Os participantes do estudo são três profissionais da Equipe Itinerante de Saúde Mental. Para realizar a análise dos dados foi utilizada a análise de conteúdo, modalidade temática. A análise evidenciou três categorias, a saber: Elementos constituintes do trabalho da equipe itinerante – seu objeto e tecnologias; Organização do trabalho da equipe itinerante; e, Potencialidades e desafios do trabalho da equipe itinerante para a rede de atenção psicossocial. Em relação à primeira categoria, os resultados apontaram para a clareza do objeto de trabalho, sendo este o usuário. O papel da equipe é relativizado como sendo de apoiador das equipes de referência, responsáveis pela inserção dos usuários nos serviços de saúde e pela aproximação e resposta ao judiciário em relação à judicialização da saúde. Em relação às tecnologias de trabalho, são usadas as reuniões de equipe, as visitas domiciliares e outras tecnologias, como as Guias de Encaminhamentos. Na segunda categoria foram identificadas ações de desburocratização das atividades da equipe itinerante, avanços em articulações e intervenções em conjunto com os serviços de referência - com maior abertura dos serviços de saúde mental à equipe itinerante -, e a necessidade de melhores diálogos com o setor judiciário para repensar prazos processuais e sanar dúvidas dos trabalhadores. Na terceira categoria, em relação às potencialidades, os participantes destacam a criação de uma equipe para atuar com o judiciário, a autonomia no processo de trabalho e abertura para trabalho em conjunto com a atenção básica e o CAPS AD. Já em relação aos desafios, são destacadas: a dificuldade de encontrar o usuário em sua casa, a mediação de conflitos familiares e as questões relacionadas ao tráfico, à violência e ao preconceito da sociedade com o usuário. Deste modo, acredito que o estudo possa contribuir no processo de reforma psiquiátrica ao propor novos modos de cuidado no território a partir da criação de equipes itinerantes. / The present study aims the analysis of the technologies present in the work of an Itinerant Team from the Mental Health Network in the city of Viamão-RS. In order to carry out the present study, a theoretical benchmark of the process in health work was used, linked to the debate on psychosocial level. It is a qualitative approach study, similar to a case study. The data was collected in the months of July, August and September, through the participating observation with note taking in field diaries and through semi structured interview. The study participants are three professionals from the Itinerant Team of mental health. To analyze the data we used the content analysis, thematic review. The analysis highlighted three categories, which are: Elements members of the itinerant working team - their purpose and technologies; Organization of the itinerant working team and potentials and challenges of the itinerant working team for the network of psychosocial attention. Concerning the first category, results pointed out for the clearness of the working object, that is, the user. The role of the team is seen as a supporting one for the reference teams, responsible for introducing the users in the health services and approximation and response to the judicial power concerning the judicialization of health. Concerning the working technologies, we used the team meetings, the visits and the new technologies as Referral Guidelines. In the second category, debureaucratization actions of the itinerant team activities were identified as well as advances in connections and interventions with the reference services – with bigger access of mental health services for the itinerant team – and the need of better dialogues with the judicial power to rethink procedural deadlines and solve doubts of the workers. In the third category, concerning the potentials: the participants highlight the creation of a team to work with the judicial power, the autonomy in the working process and the opening of joint work with the basic attention and the CAPS AD. The challenges are highlighted concerning the difficulty to find the user at home, the mediation of family conflicts and the issues involving traffic, violence and prejudice from the society against the user. Thus, I believe this study can contribute in the process of psychiatric reform when it proposes new ways to care for in the territory based on the creation of itinerant teams. / El presente estudio tiene como objetivo el análisis de las tecnologías presentes en el trabajo del Grupo Itinerante de la Red de Salud Mental del municipio de Viamão-RS. Para realizar tal estudio fue utilizado el referencial teórico del proceso de trabajo en salud, articulado al debate sobre el modo psicosocial. El estudio es de abordaje cualitativo, tipo estudio de caso. La recolección de los datos ocurrió en los meses de julio, agosto y septiembre, a través de la observación participante con apuntes en diarios de campo y por medio de una entrevista semiestructurada. Los participantes del estudio fueron los tres profesionales que componen el Grupo Itinerante de la Red de Salud Mental del municipio de Viamão-RS. Para realizar el análisis de los datos fue utilizado el análisis de contenido modalidad temática. El análisis evidenció tres categorías, a saber: Elementos constituyentes del trabajo del grupo itinerante – su objeto y tecnologías; organización del trabajo del grupo itinerante y Potencialidades y desafíos del trabajo del grupo itinerante para la red de atención psicosocial. Sobre la primera categoría, los resultados señalaron la claridad del objeto de trabajo, siendo éste, el usuario. El papel del grupo es relativizado como siendo de apoyador de los grupos de referencia, responsables por la inserción de los usuarios en los servicios de salud y por la aproximación y respuesta al judiciario en relación a la judicialización de la salud. En relación a las tecnologías de trabajo, son usadas las reuniones de grupo, las visitas domiciliares y otras tecnologías, como las Guías de Encaminamientos. En la segunda categoría fueron identificadas acciones de desburocratización de las actividades del grupo itinerante, avances en articulaciones e intervenciones en conjunto con los servicios de referencia – con mayor apertura de los servicios de salud mental al grupo itinerante -, y la necesidad de mejores diálogos con el sector judiciario para repensar plazos procesuales y sanar dudas de los trabajadores. En la tercera categoría, en relación a las potencialidades, los participantes señalan la creación de un grupo para actuar con el judiciario, la autonomía en el proceso de trabajo y apertura para trabajo en conjunto con la atención básica y CAPS AD. Ya cuanto a los desafíos, son señalados: la dificultad de encontrar el usuario en su casa, la mediación de conflictos familiares y las cuestiones relacionadas al tráfico, violencia y prejuicio de la sociedad con el usuario. De este modo, creo que este estudio pueda contribuir en el proceso de reforma psiquiátrica al proponer nuevos modos de cuidado en el territorio a partir de la creación de grupos itinerantes.

Este trabalho se propôs a analisar limites e possibilidades da participação social na saúde por espaços não institucionalizados, a partir de alguns dos limites decorrentes da institucionalidade posta e do conjunto de práticas sociais, técnicas e sistêmicas na saúde. A discussão enfoca a rádio comunitária como espaço de emergência de conflitos e questões que perpassam dada realidade e suas relações sociais, de forma a poder contribuir com a participação social na saúde. Nesse sentido, optou-se pela realização de um estudo de caso em Heliópolis, São Paulo, SP, por um olhar para o território na sua diversidade de espaços e vivências, e também para os conflitos que lhe são próprios e relacionados às relações sociais daquele espaço constitutivas. A partir das práticas significantes relacionadas à produção simbólica e material de Heliópolis, do entrejogo entre práticas sociais e trajetórias individuais, e entre aquelas e contexto global, foi possível uma formulação teórica em relação ao objetivo da pesquisa. A organização da população de Heliópolis se deu em resistência à dominação exercida por grupos político-econômicos e à repressão do Estado, pela construção de laços sociais de solidariedade em processos de subjetivação de indivíduos, que resultou na constituição de uma comissão de moradores. Com a transformação progressiva da relação do Estado com aquele corpo social, a comissão torna-se associação e deixa de fazer enfrentamento direto por manifestações e ocupações, passando a atuar na forma projeto financiável pelo Estado ou pela iniciativa privada. Hoje, parte das necessidades sociais, as financiáveis, é tomada pelo todo, e as determinações econômicas e sociais decorrentes da divisão de classes impedem que ganhe centralidade, nas ações sociais, a luta de classes. No entanto, a Rádio Comunitária possui historicidade e legitimidade distintas das dos projetos financiáveis, e disto decorrem distintas formas de ação social. O espaço é de lazer e trabalho, de produção e divulgação culturais, e também de constituição de sujeitos políticos, pois nele se dá a formação de uma cadeia coletiva de ações em resistência a determinações políticas, econômicas e sociais. Da especificidade da relação entre forma e conteúdo na produção e expressão culturais decorre a emergência diferenciada de necessidades sociais, de modo que a rádio possibilita a expressão, articulação e mobilização de sujeitos em ação política diferenciada daquela que ocorre em espaços institucionalizados. A atuação pela rádio comunitária também possibilita a construção histórica de necessidades sociais em sua relação com a saúde, e tem função organizativa de demandas que permitem guiar a satisfação dessas necessidades pela reivindicação frente ao poder público e ao sistema de saúde. Na atuação deste com a rádio, gera-se demandas a que existem respostas sistêmicas previamente definidas. No entanto, a rádio é espaço que auxilia na construção de processos instituintes, o que em Heliópolis se expressa pelo combate à política de privatização da saúde São Paulo e às Organizações Sociais (OS), além da articulação de sujeitos em ações como a organização da coleta de lixo / This study aimed to analyze the limits and possibilities of social participation in health by non-institutionalized spheres, from some of the limits imposed by the institutions and the set of social practices, techniques and systemic health. This discussion focuses on Community Radio as a sphere of emergency of conflicts and issues that permeate the reality and its social relations, in order to contribute to social participation in health. Accordingly, we chose to carry out a case study in Heliópolis, São Paulo, SP, by a view on the area in its diversity of spheres and experiences, and also on the conflicts which are related to the social relations of that sphere constitutive. From the signifying practices related to material and symbolic production of Heliopolis, by working between social practices and individual trajectories, and between those and the global context, it made possible a theoretical formulation for the purpose of research. The popular organization in Heliopolis was built in resistance to the political-economic domination and the one exercised by the State, constructed from social bonds of solidarity in processes of constitution of political subjects, which resulted in the formation of a residents committee. With the gradual transformation of the relationship between the State and that social body, the committee became an association, making no more direct engagement by occupations and demonstrations nowadays. It starts acting by projects fundable by the state or by private enterprise. Today part of the social needs, the fundable ones, are taken by all, and the economic and social determinations that are consequences of the classes division prevent to gain centrality in the social actions the class-conflict. The Community Radio, however, has legitimacy and historicity distinct from those of fundable projects, and from this results different forms of social action. The sphere is for work and leisure, for cultural production and dissemination and also for constitution of political subjects, because on it takes the formation of collective actions in resistance to political, economic and social determinations. From the specificity of the relationship between form and content on the cultural production and expression follows the differentiated emergence of social needs, so that the radio enables the expression, articulation and mobilization of subjects in different political actions from the one that occurs in institutionalized spheres. The action by a Community Radio also makes possible the historical building of social needs in their relationship to health. The Community Radio has an organizational function of the demands that allows subjects to conduct the satisfaction of social needs by claiming against the government and the health system. The System action in the radio is characterized by the generation of demands in which answers are previously defined by the System. However, a Community Radio is a sphere that assists the construction of instituting processes, which are in Heliópolis expressed by the struggle against privatization of health in São Paulo and the organized system, providing political articulation of subjects, such as the organization of garbage collect

Durante séculos as pessoas com transtornos mentais sofreram pela exclusão social e espacial. No Brasil, apenas a partir da Reforma Psiquiátrica se iniciaram propostas de inclusão social do doente mental, que passa a ser tratado em serviços substitutivos aos hospitais psiquiátricos. Hoje em dia, o principal equipamento com a missão de articular a atenção em saúde mental na comunidade é o Centro de Atenção Psicossocial CAPS. Com o recente aumento de numero de CAPS no território brasileiro, as práticas de inclusão social têm se desenvolvido e as pessoas com transtornos mentais têm enfrentado o desafio de buscar formas de interação na comunidade em que vivem. Este trabalho investiga os avanços na inclusão social do usuário atendido em CAPS. A finalidade deste estudo foi identificar ações que possibilitem a inclusão social do usuário e colaborar com diretrizes para as políticas públicas de saúde mental. Para atingir esta finalidade os objetivos específicos foram: analisar a concepção de inclusão social expressa na representação social dos usuários de CAPS e pessoas da rede social dos usuários, identificar o cotidiano e a rede social de suporte dos usuários e analisar as estratégias existentes nos CAPS que auxiliam na construção do cotidiano e da inclusão social do usuário. Como referencial teórico de suporte para o desenvolvimento da pesquisa, foi utilizada a teoria sobre cotidiano de Ágnes Heller, que considera que as transformações sociais muitas vezes começam no nível microscópico. Nesta investigação optou-se por utilizar como referência as seguintes categorias analíticas: exclusão/inclusão social, Reabilitação Psicossocial e Representações Sociais. O estudo foi realizado em um CAPS da cidade de São Paulo e os sujeitos desta investigação foram pessoas com transtorno psíquico, usuários do CAPS e pessoas de sua rede sua social. Para a coleta de dados foram realizadas entrevistas semiestruturadas, e para a apuração dos dados foi utilizada a análise do discurso. A partir desta análise foram identificadas as seguintes categorias empíricas: processo de exclusão/inclusão social, redes sociais e cuidado em saúde mental. Como resultados foram encontradas dificuldades no processo de inclusão social como: a existência de concepções alinhadas ao modelo manicomial, estigma e preconceito, desvantagens de recursos materiais, dificuldade em exercer a cidadania, isolamento social, pouco contato social fora do CAPS, poucas oportunidades no contexto e falta de uma rede de atenção à saúde e rede intersetorial articulada. Os avanços encontrados no processo de inclusão social foram: concepções sobre inclusão social de que todos devem estar integrados na comunidade, experienciais de participação em espaços da cidade, aumento da rede social do usuário, contato com pessoas fora do CAPS, inclusão em grupos religiosos, apoio de associações e ONGs e o CAPS enquanto espaço de acolhimento, inclusão, pertencimento e cuidado à saúde. Percebe-se que o CAPS tem favorecido a inclusão social dos usuários, criando acessos e opções, projetando um novo paradigma em saúde mental no Brasil. Porém, mais do que avanços nas práticas em saúde mental esta pesquisa encontra diversos desafios a serem solucionados. Estes desafios não são postos apenas para o CAPS, mas para a sociedade. / For centuries, people with mental health issues suffered social and spatial exclusion. In Brazil, it was only after the psychiatric reform that the proposal of inclusion of the mental patients started with treatment in public services that substituted psychiatric hospitals. Currently the main service with the purpose of articulating mental health attention in the community is the Psychosocial Care Center (CAPS). With the recent increase in the number of CAPS in the Brazilian territory, the practice of social inclusion has developed and people with mental health problems have faced the challenge of finding new ways to interact in the community they live in. This work investigates the advances of social inclusion of CAPS users. The purpose of this study was to indentify actions that allow for the social inclusion of users and to help the design of mental health public policies. To achieve this goal the specific object of the study was: to analyze the conception of social inclusion expressed in the social representation of CAPS users and people in their social networks, to identify the everyday life and their support social networks, and to analyze the strategies existent in CAPS that help building everyday life and the social inclusion of users. As support theoretical reference for the development of the research Agnes Heller´s everyday life theory, that considers that often social transformation starts at the microscopic level, was used. In this research the chosen analytic categories for reference are: social exclusion/inclusion, psychosocial rehabilitation and social representations. The research was conducted in a CAPS in São Paulo city and the subjects were people with mental health problems, CAPS users and their social networks. For data collection semi-structured interviews were conducted and subjected to discourse analysis. Based on this analysis the following empirical categories were identified: social exclusion/inclusion process, social network and mental health care. As results difficulties in the social inclusion process were revealed, such as: the existence of conceptions aligned with the asylum model, stigma and prejudice, lack of material resources, difficulties in the exercise of citizenship, social isolation, lack of social interaction outside CAPS, lack of opportunities in the milieu, lack of support in the health care network and in the articulated multi-sector network. The advances found in the process of social inclusion were: conceptions about social inclusion that everyone should be integrated in the community, experiences of participation in spaces in the city, increase of the social network of users, contact with people outside CAPS, inclusion in religious groups, support of NGOs and the CAPS as a space of welcoming, inclusion, belonging and health care. Thus, the CAPS have favored the social inclusion of users, crating access and options, projecting a new paradigm in mental health in Brazil. Nevertheless, even more than advances in the mental health practices the research finds several challenges to be solved. These challenges are not faced just by the CAPS but by the society.

Socioeconomically deprived women are at greater risk of adverse pregnancy outcomes. To counteract this, attention tends to focus around access (equality) of services. Yet access may not equate with the meaningfulness (equity) of services for women from different socioeconomic backgrounds. Without understanding equity we are not in a position to plan appropriate and equitable care. This study aimed to determine pregnant women's perceptions of the current antenatal provision and to determine if women from the extremes of socioeconomic background perceived their antenatal care differently. Longitudinal interviews were undertaken with multiple, comparative antenatal case studies between January 2007 and April 2009. Cases were primigravida women from ‘least deprived’ (n=9) and ‘most deprived’ (n=12) geographical areas as identified by the Scottish Index of Multiple Deprivation (SIMD 2006). The data were analysed using case study replication analysis. Analysis of categorical data from the sample groups indicated they were less diverse than might have been expected in terms of age and education. However in the key variables of housing tenure, potential income and socioeconomic status based on area of residence, the groups were indicative of the SIMD target populations. The preliminary analysis showed that the sample groups considered the initial General Practitioner contact to be less than adequate and the subsequent utility of antenatal education to be based on self perceived relevance. The substantive analysis showed little difference in access to antenatal services between the ‘least’ and ‘most’ deprived groups but perception of care differed. A key difference concerned the level of ‘engagement’ (defined as personalisation and active involvement in care, power and relationships and health literacy). Using these concepts, engagement was present in most of the ‘least deprived’ group and almost none of the ‘most deprived’ group. In comparison with women from affluent areas, more deprived women described less evidence of: personal connection to their own care; shared decision making; and perceived value in relation to the written educational aspects of antenatal care. In terms of the preliminary analysis, the results suggest that utility of educational material may need to be reviewed to ensure it is relevant to specific needs. Without this relevance, key information may be missed. The substantive analysis suggests that for women from socioeconomically deprived areas, access may be a less useful indicator than engagement when assessing quality of antenatal services. The lack of engagement perceived by those who are most deprived suggests that equity of service has yet to be attained for those who are most in need. Future research needs to be directed to the potential reasons that may undermine equity and engagement in women from lower socioeconomic areas.

The thesis is dealing with financial aspects of the U.S. health care system. The main reasons are excessively high costs and less beneficial outputs of the system compared to other developed countries. The topic is more than up to date especially with regard to the latest changes in American health care and the neverending discussion about the necessity of further reforms aiming especially at fiscal sustainability of the system.The introduction is devoted to a brief description of basic models of health care system. It also introduces the approach of the United States to health care and provides an overview of the structure and participants of American health care. Moreover, the thesis provides details about the latest reform of the system. The main objective of the thesis is analysis of main factors that contributes to high growth of health care costs. Technological development, consolidation of markets and ineffective setting of health care reimbursement are identified as some of the main contributors to high cost in the U.S. health care system.

ObamaCare 2010: Political Aspects of U.S. Health-care Reform Katarína Dujčíková Abstract The enactment of the comprehensive health-care reform in March 2010 is one of major political achievements of the administration of the 44th president of the United States of America, a Democrat Barack Obama and the 111th Congress with the majority of Democrats in both chambers. Democratic politicians reacted to the need to answer three major problems of American health care system; rising cost, average quality and limited access to standard health care services for million Americans. The historical passage of health-care reform enacted despite unified opposition by Republicans was possible due to the rare combination of favorable conditions, or so-called window of opportunity and legislative tactic, which had to be adopted in order to diffuse opposition and secure enough votes from undecided congressmen. Compromises that had to be made necessarily altered an initial reform proposal. This diploma thesis has focused on two major aims. First, it examines in detail the legislative process of health-care reform, actions of its major players (public, congressional parties, president, and interest groups) as well as its result (the reform bills), which compares to the initial reform proposals of President Obama. The findings...

This study collects the views of 38 health policy leaders, answering one open-ended question in a 1-hour interview: What state-level reforms do you believe are necessary to implement a feasible model of universal health insurance in Oregon? Interviewees represented seven groups: state officials, insurers, purchasers, hospitals, physicians, public interest, and experts. About 370 coded arguments in the interview transcripts were condensed into 95 categorical topics. A code outline was constructed to present a dialogue among stakeholders in one comprehensive narrative. Topical sections include the cost imperative, politics, model systems, insurance, purchasing, delivery system, practice management, and finance. Summary results show the prevalence of group attention to each topic, group affinities, and proximity correlations of different arguments mentioned by individuals. The most common arguments related to problems of low-value care and delivery system reform. There was a generally felt imperative to control costs. Regarding universal health insurance, stakeholders were split between two main alternatives. One model, favored mostly by insurer and purchaser groups, supported the state-sponsored individual mandate. This plan, embodied in the current Oregon Action Plan to implement universal health insurance, involved managed competition for insurers and clinical governance over professional practice. A separate set of arguments, favored mostly by expert and physician groups, emphasized the need for a unified public system, or utility model, possibly with centralized funds and regional global budgets. The ability of the individual mandate plan to control costs or manage quality appears doubtful, which strengthens opposition. The utility model is more likely to work at cost control and governance, but it disrupts the status quo and its details are vague, which strengthens opposition. Neither model is endorsed by a majority of the stakeholders, and political success for either one alone is not promising. Possibly, a close analysis of the two models could find a way to combine them and generate unified support.

Human beings have two apparently conflicting fundamental rights. On the one hand, individuals have a right to health care as the United Nations declared in 1948. On the other hand, individuals have a right to liberty; that is, the freedom to make one's own health related choices, even poor ones. One goal of this essay is to show how to reconcile these two apparently conflicting core American values. This reconciliation is important, because a universal health care system that is fair and just must account for individual rights in tandem with attempts to address matters of social justice. In order for this reconciliation to occur, matters of individual responsibility, social responsibility, and social justice must be central to health care reform. / by Jennifer Lynn Mantoni. / Vita. / Thesis (M.A.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.

Text in Afrikaans / Drug dependent adolescents do not display a clear understanding regarding the value of social work intervention during the process of rehabilation, causing them to not utilize the profession of social work effectively during drug rehabilitation. This study aimed to explore and describe the nature and contribution of social work service delivery to drug dependent adolescents from their own perspective. A qualitative research approach, an explorative research design, and a snowball sampling technique were implemented. The sample consisted of drug dependent adolescents from the Western Cape. Semi-structured interviews were executed determining the participant’s perception of the nature and contribution of social work service delivery. Amongst others, the findings indicate that: • social workers are not sufficiently prepared, trained or committed to render effective, professional services to drug dependent adolescents; • social workers need to continuously revisit their knowledge, skill and attitude regarding this specialised field of service rendering. / Social Work / M.A. (Maatskaplike Werk)