Introduction: Persistent health inequalities are the focus for much public health policy activity. Understanding the policy response to public health problems, the role of evidence, and the roles and strategies of different actors may help explain this persistence. Research suggests that policy actors often access knowledge through interpersonal relations, but current perspectives in the literature do not analyse relational aspects of finding evidence and influencing policy. Identifying powerful and influential actors (in terms of personal characteristics, strategies, and network properties) offers a method of exploring the policy process and evidence use. Methods: Network data were gathered from a public health policy community in a large urban area in the UK (n = 152, response rate 80%), collecting relational data on perceived power, influence, and sources of evidence about public health policy. Hubs and Authorities analyses were used to identify powerful and influential actors, to test whether powerful and influential actors were also sources of information; and betweenness and Gould-Fernandez brokerage were used to explore the importance of structural position in policy networks. These data were analysed in conjunction with qualitative data from semi-structured interviews (n = 24) carried out with a purposive subsample of network actors. Characteristics of powerful and influential actors, the use of evidence in the policy process, and roles and strategies used to influence policy were analysed using a framework approach, and combined with network data. Results: The most influential actors were mid-level managers in the NHS and local authorities, and to a lesser extent, public health professionals. These actors occupied advantageous positions within the networks, and used strategies (ranging from providing policy content, to finding evidence, to presenting policy options to decision-makers) to influence the policy process. Powerful actors were also sources of information for one another, but providing information did not predict power. Experts, academics and professionals in public health were represented in the networks, but were usually more peripheral and played fewer roles in the policy process. This study presents empirical evidence to support the suggestion that recognition of network structure assists individuals to be influential, and proposes a framework to categorise their activities. Conclusions: In order to influence policy, actors need good relationships with other influential actors, and the skills to exploit these relationships. The relational approach is useful for both identifying powerful and influential people (potential evidence-users) and for exploring how evidence and information reaches them. Identifying powerful and influential actors and describing their strategies for influencing policy provides a new focus for researchers in evidence-based policy, and for those wishing to influence policy. For academics and researchers, this study demonstrates the importance of directly creating ties with decision-makers

In the aftermath of World War II, the Liberal Democratic Party of Japan followed Germany’s blueprint in fashioning a universal health coverage system. Comparisons to Germany’s welfare state during this same time period reveal markedly different social and mental health policy practices, as Germany’s Christian Democratic Union and Social Democratic Party cooperated toward progressive policies while the Liberal Democratic Party largely neglected social welfare expansion. The effect of these practices is reflected in budgetary provisions, institutionalization practices, and mental health epidemiology. This research finds that a favorable economic climate allowed the Liberal Democratic Party to politically isolate the Social Democratic Party and focus on economic productivity as opposed to welfare expansion. In contrast, West Germany’s competition with East Germany forced cooperation of its two largest political parties to balance economic policy and social progress, which is today reflected in mental health outcomes and policies markedly more favorable than those of Japan.

Made available in DSpace on 2015-07-22T20:49:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-02-22 / Esta dissertação teve como objetivo descrever e analisar quantitativamente e qualitativamente a produção legislativa que trata da questão da saúde, em tramitação, nos anos de 2007 e 2008, no Congresso Nacional. Foi realizado um estudo descritivoexploratório com corte transversal e abordagem quantitativa e qualitativa. O material de análise do estudo foi constituído por 112 projetos de lei em tramitação na Comissão de Seguridade Social e Família (Câmara dos Deputados) e 32 projetos de lei na Comissão de Assuntos Sociais (Senado Federal), relacionados à saúde, com data de apresentação entre janeiro de 2007 a dezembro de 2008. A pesquisa teve duas fases distintas: na primeira fase foi realizada uma pesquisa quantitativa através da estratificação, classificação e análise dos Projetos de Lei. Na segunda fase houve uma abordagem qualitativa através de um questionário com perguntas fechadas a um grupo de profissionais que atuavam no sistema de saúde, com a finalidade de avaliar a relevância, viabilidade, alinhamento estratégico e impacto dos projetos selecionados. Ao final da pesquisa, os seguintes resultados foram obtidos: das 144 proposições, 57,6% dos PL’s selecionados foram apresentados no ano de 2007 e 42,4% em 2008. O PT (12,5%) foi o partido político que mais apresentou PL's seguido do PMDB (11,1%) e PSDB (10,4%). Apenas 25,7% dos parlamentares que apresentaram PL's relacionados à saúde são da área da saúde. Um ano após a coleta de material de análise do estudo, foi verificado que a maioria (93,7%) dos PL's continuava em tramitação, 4,9% foram arquivados e apenas 1,4% foram transformados em Norma Jurídica. Quanto ao foco de atenção dos projetos de lei relacionados à saúde, mais da metade (57,7%) dos PL's estava relacionada com o Sistema Público de Saúde e apenas 4,2% se referem à natureza orçamentária (financiamento da saúde). Em relação aos resultados do questionário aplicado, 78,1% dos respondentes encontravam-se insatisfeito/muito insatisfeito com o Poder Legislativo e 41,8% dos respondentes classificaram o Sistema Público de Saúde como ruim/péssimo. Já no Sistema Privado de Saúde, apenas 9,6% o consideraram ruim/péssimo. Quanto aos critérios avaliativos dos projetos de lei, mais da metade (51,5%) dos respondentes declararam que não entenderam no PL a forma de viabilizar (Viabilidade) o proposto, 40,6% responderam que não existe relevância nos projetos de lei apresentados, 52,7% responderam que não existe alinhamento estratégico às prioridades e às políticas de saúde do país e 52,5% disseram que a recusa do projeto de lei não traria impactos negativos e/ou seria prejudicial para a sociedade brasileira. Quando simulado uma consulta pública, mais da metade (54,4%) respondeu que aprovaria o projeto de lei que analisou, 30,1% reprovariam e 10,1% se abstiveram da escolha. Por meio dos dados deste estudo, pôde-se perceber que a produção legislativa, no âmbito da saúde, é baixa; os parlamentares com formação acadêmica na área da saúde produzem pouco (25% da amostra) e a transformação dos projetos de lei em Norma Jurídica é mínima (apenas 1,4% da amostra). Outro aspecto importante verificado foi o alto índice de insatisfação com o Poder Legislativo e com o Sistema de Saúde Público Brasileiro, além da baixa qualidade da produção legislativa no Congresso Nacional. / This dissertation had the objective to describe and analyse qualitatively and quantitatively the legislative production which deals with health, at the National Congress, happening in 2007 and 2008. It was done a descriptive-exploratory study with transverse cut and quantitative and qualitative approach. The material of analysis from the study was constituted by 112 draft bills which were performed at Social Security and family (House of representatives) and 32 draft bills at the Social Subjects (Federal Senate), related to health, which were performed from January 2007 to December 2008. The research had two distinctive phases, at the first phase there was a quantitative research through stratification, classification and analysis of the draft bills. At the second phase there was a qualitative approach made through a questionnaire containing closed questions to a specific group of professionals who performed in the Health System and the objective was to analyse the relevance, viability, strategic balance and impact of the selected projects. At the end of the study, the following results were found; from the 144 possibilities, 57,6% of the draft bills selected were presented in 2007 and 42,4% in 2008. The Labour Party, PT, was the one which most presented draft bills (12,5%) followed by PMDB (11,1%) and PSDB (10,4%). Only 25,7% of the Members of the Congress who presented draft bills deal with Health Policy. After a year of gathering the material to analyse the study, was verified that the majority of the draft bills (93,7%) were still being done, 4,9% were filed and only 1,4% were transformed in juridical norm. Considering the aim of the draft bills related to health, more than a half (57,7%) of the draft bills are related to the SUS ( Public Health Care ) and only 4,2% are related to quotation (financing for health). Considering the result of the applied questionnaire, 78,1% from the questioned people were dissatisfied, very dissatisfied with the Legislative Power and 41,8% classified as bad, extremely bad; at the private Health System only 9,6% considered bad, extremely bad. In relation to the criteria of the draft bills, more than a half (51,5%) from the questioned people declared that they did not understand, in the draft bills, the way of making viable what was proposed, 40,6% answered that there is no relevance; 52,7% answered there is not strategic balance from the draft bills to the priorities and the health policies of the country and 52,5% answered that the refusal of the draft bills would not bring negative impacts or would be prejudicial to the Brazilian society. Through a public enquire, more than a half (54,4%) answered they would approve the draft bill they analysed; 30,1% would not approve and 10,1% did not answer. Through the data of this study we can perceive that the Legislative production, related to health, is low; the members of the congress with academic graduation in the health area has a low output (25% of the amount) and the draft bills which become juridical norm is minimal (only 1,4% of the amount). It is important to point out the high rate of insatisfaction with the Legislative Power, with the Health Public Brazilian System and the low quality of the legislative production at the National Congress. / TEDE / BV UNIFESP: Teses e dissertações

Health is deemed central to a nation’s development. Accordingly, health care reform and expansion are key policy priorities in developing countries. Many such nations are now testing various methods of funding and delivering health care to local disadvantaged populations. Similarly, India launched the Rashtriya Swasthya Bima Yojana (RSBY) national health insurance programme for low-income groups in 2008. The RSBY intends preventing catastrophic health-related expenditure by improving recipients’ access to hospital-based care. This thesis is an in-depth qualitative evaluation of the RSBY in Delhi state. It examines the RSBY’s effectiveness in fulfilling its goals and meeting local health care needs. Walt and Gilson’s (1994) actors-content-process-context model informs the research design and an actor-centred “responsive” (Stake 1975) or “constructivist” approach guides data analysis. Three research questions are examined: (i). Why was a health insurance programme launched and why now? Why was this model favoured over alternate methods of service expansion? (ii). Is the RSBY delivered as intended? If not, why? (iii) How does the RSBY affect patients’ access to services? The findings are based on documentary sources, observation of implementation sites and activities and 164 semi-structured interviews with RSBY policymakers, insurers, NGOs, doctors, and patients. The results show improved access to curative and surgical care for RSBY patients. However, RSBY’s focus on hospitalisation and omission of primary and outpatient services had undesired negative effects. The lack of ambulatory facilities led RSBY patients to self-medicate or use dubious quality informal providers. By only allowing inpatient care, the RSBY also seemingly encouraged the substitution of outpatient care with costlier hospitalisations. In effect, the RSBY’s design contributed to cost increases and poor patient outcomes. While more funds and human resources were needed to improve RSBY implementation, the performance of frontline agencies could potentially improve through more stable, longer-term contracts. Similarly, modifying RSBY’s monetary incentives for doctors may lead to better service delivery by them. By evaluating the RSBY’s strong points and shortcomings, this thesis provides key lessons on strengthening policy design and health service delivery in developing countries. Thereby, it makes a broader contribution to understanding the determinants of successful policymaking.

This thesis seeks to contribute to the knowledge base about social policy in the United States, using long-term care (LTC) financing policy reform as an illustrative example. Specifically, this thesis explores LTC financing reform efforts during three U.S. Presidential administrations: Bill Clinton (1993-2001), George W. Bush (2001-2009), and Barack Obama (2009-2010). Within this historical framework, the LTC provisions of the Health Security Act of 1993, the development of the Community Living Assistant Services and Supports or 'CLASS' Act during the Bush Administration, and the legislative success of the CLASS Act as a part of the Patient Protection and Affordable Care Act of 2010 provide comparable cases to compare the drivers of social policy. Drawing on the explanatory frameworks of the welfare state such as ideology, historical institutionalism, and an actor-centered approach to policy analysis, this thesis argues that successful path-departing legislation is difficult to achieve due, in part, to the presumed high costs of social programs and the complex institutional framework of the American political system. Policy outcomes result from the interaction between the complex processes and dynamics of the political system through which policy change (or the failure to change) actually occurs. The fact that the CLASS Act was politically successful, yet administratively inoperable as designed, reinforces the argument that social policy outcomes in the United States are reflective of a complex, enduring struggle of competing ideologies. This continual struggle, coupled with a heightened concern over cost control and fiscal austerity, helps to ensure that policies which are legislatively successful within the institutional architecture of the American political system are unlikely to produce major expansions of the welfare state. Social change is therefore highly difficult to achieve, even in the face of significant unmet social needs. Comprehensive reform of U.S. LTC financing arrangements will remain an elusive goal for the foreseeable future. Instead, incremental, highly pro-market solutions are likely to be the types of policies promoted in the years of ahead.

Made available in DSpace on 2016-04-25T20:21:08Z (GMT). No. of bitstreams: 1 Luiz Otavio dos Santos Pereira.pdf: 961275 bytes, checksum: 142b625726925eca0fc0b979f53de0a8 (MD5) Previous issue date: 2014-04-10 / This dissertation proposes an analysis of the Health Policy for Indigenous People of Brazil, in the period between 1986 and 2013, with basis in the theories of policy studies developed by the Political Science, in special the ACF( Advocacy Coalition Framework) developed by Jenkins-Smith and Sabatier. We observe that this policy born due to an amplest context of transformations of citizenship nature, that compels to a new way to formulate policies that handle with diversity, that start to conciliate the principle of equality with the respect to difference. And we demonstrate how the Brazilian State search in this policy the conciliation between the health right and the cultural rights, with mean, between the principles of universalism and particularism, dealing with the unavoidable set of dilemmas that this matter causes. However, we highlight that in this health policy occur an uncommon frequency of discontinuities. We identify that between the consolidation of the ideational basis of this policy in 1986 and the present period of 2013; occur an sequence of institutional reconfigurations and restructuration of the attention model. The four main changes are: in 1991, when the responsibility of the indigenous health was transferred to FUNASA( National Foundation of Health); in1994, when occur the partial return of the indigenous health to FUNAI( National Foundation of Indian); in 1999, with the Arouca s Law that give back the integrity of the indigenous health responsibility to FUNASA; in 2008, when was create the Especial Secretary of Indigenous Health. This research propose to answer what was the factors that causes the general picture of the institutional instability and the identified changes; and adopt as main hypothesis that the sources of the changes and consequentially of the instability, was the competition between the coalitions that structure themselves around of a divergent set of ideas, that constitute the normative basis of the health policy for indigenous peoples. That way shows with are the coalitions, how they born, around of what ideas they are structured, how they interact, and how make changes in the policy health to indigenous peoples, using the opportunity structure, that opens the possibilities to break the stability and change the status quo / Essa dissertação propõe uma análise da Política de Saúde para as Populações Indígenas no Brasil, do período entre 1986 e 2013, tendo como base as teorias de políticas públicas desenvolvidas pela Ciência Política, em particular o ACF( Advocacy Coalition Framework) desenvolvido por Jenkins-Smith e Sabatier. Observamos que essa política pública nasce devido a um contexto mais amplo de transformações da natureza da cidadania, que compele a uma nova forma de se formular políticas públicas que lidam com a diversidade, que passa a conciliar o principio da igualdade com o respeito a diferença. E demonstramos como o Estado brasileiro busca nessa política a conciliação entre o direito à saúde e os direitos culturais, ou seja, entre o universalismo e o particularismo, tratando dos dilemas inevitáveis que esta questão acarreta. No entanto, destacamos que na política de saúde indígena ocorre uma frequência incomum de descontinuidades. Identificamos que, entre a consolidação da base ideológica dessa política pública em 1986 e o atual momento de 2013, ocorre uma série de reconfigurações institucionais e reestruturações do modelo de atenção. As quatro principais mudanças foram: em 1991, quando responsabilidade da saúde indígena é transferida para a FUNASA (Fundação Nacional de Saúde); em 1994, quando ocorre o retorno parcial da saúde indígena para a FUNAI(Fundação Nacional do Índio);em 1999, com a Lei Arouca que devolve a integralidade da responsabilidade da saúde indígena para a FUNASA; e em 2008, quando é criada a Secretaria Especial de Saúde Indígena. Essa pesquisa propõe responder quais foram os fatores que causaram o quadro geral de instabilidade institucional e das mudanças identificadas; adota como hipótese central que a causa das mudanças, e consequentemente, da instabilidade, foi a disputa entre as coalizões que se estruturam em torno de um conjunto de divergentes ideias que formam a base normativa da política de saúde indígena. Assim demonstramos quais são as coalizões, como nascem, em torno de quais ideias se estruturam, como interagem e causam mudanças na política de saúde indígena, usando a estrutura de oportunidade que possibilita a ruptura da estabilidade e mudança do status quo

香港醫療衛生發展的論述，通常至1941年便停止，然後由1945年重新探討，跳過了二次大戰期間的日治時代。雖然有大量關於英軍回憶、遊擊隊、一些口述歷史等的研究書籍，但這時期仍未得到充分的關注，尤其在社會發展方面。本文以《香港日報》為主要材料，嘗試析述被忽略的日治醫療衛生史。 / 有關戰前香港醫療衛生的史觀，主要有「殖民醫學」與「殖民現代性」兩套理論。前者認為殖民力量將西醫強加於本地社會；後者則強調殖民統治帶來的正面作用，和殖民地有其獨特形式的現代性。直至日治前夕，香港的中西醫仍較為對等，中醫在民間有極大支持；西醫在政府政策上享有優勢。然而戰後出現的卻是另一景象，無論民間或政府皆接受西醫為主流醫學，中醫則潛藏於民間繼續傳承。這不代表中醫已被淘汰，只是西醫的發展已蓋過中醫，其中原因須追溯日治期間。日治政府承接英國殖民政府推行西醫，社會上有大量西醫常識流通，藥物使用習慣講求科學，日治時期的這些因素都為西醫在戰後普及做準備。 / 本文為過往研究所忽略作補充，藉此重新思考「日治歷史」的意義。誠然這段歷史是傷痛的，但也不可主觀地跳過而不作討論，日治時期是連接香港二戰前後的發展。醫療衛生正是其中一個脈絡，本研究將就此提出新視角。 / The analyses on Hong Kong medical and hygienic history often split into two time slots, one from the beginning as the British colony until 1941 and the other from 1945 to the present, mostly overlooking the period of Japanese occupation from 1942 to 1945. Although there are plenty of books for general readers, for examples, memoirs of British troops and Chinese guerillas, and oral history records about the Japanese occupation in Hong Kong, this period has not yet received due academic treatment. This dissertation, therefore, studies the neglected medical history of Hong Kong under the Japanese occupation using Honkon Nippō (Hong Kong News) as the main reference. / Approaches to the discussion on prewar Hong Kong medical history apparently depend on two theories, namely the “colonial medicine and the “colonial modernity. The former perspective believes that colonial powers forced colonized societies to follow the European modernity, while the latter stresses the positive effects brought by colonizers and formations of own unique modernity among colonies. Before the Japanese occupation, both traditional Chinese medicine (TCM) and Western medicine (WM) enjoyed fair status, with the TCM gaining overwhelming support from the Hong Kong society and the latter receiving administrative advantages from the colonial government. After the WWII, however, both the Hong Kong society and the government recognized the WM to be the mainstream therapy, and thus, the TCM was only praciticed at the bottom level of society without official acknowledgement. Nevertheless, this did not represent the elimination of the TCM and merely revealed the development of WM surpassing the TCM. The reason should be traced back to the period of Japanese occupation when the government sustained the policy of the British colonial government to spread the WM, causing circulation of a large amount of medical knowledge in the society and a trend of scientific drug using. All these factors benefited to the popularization of WM in Hong Kong society after WWII. / This study fills in a missing link of previous research and rethinks the implication of the “history of Japanese occupation. Indeed, the history is painful but one should not subjectively omit it because this period connected the development of Hong Kong between prewar and postwar era. This study sheds new light on medical history as well as history of Japanese occupation. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / Detailed summary in vernacular field only. / 李威成. / "2012年8月". / "2012 nian 8 yue". / Thesis (M.Phil.)--Chinese University of Hong Kong, 2012. / Includes bibliographical references (leaves 193-201). / Abstract in Chinese and English. / Li Weicheng. / 論文摘要 --- p.i / Abstract of thesis entitled --- p.ii / 鳴謝 --- p.iii / 圖表目錄 --- p.vi / Chapter 第一章 --- 導論 --- p.1 / Chapter 第一節 --- 研究動機與目的 --- p.1 / Chapter 第二節 --- 文獻回顧 --- p.5 / Chapter 第三節 --- 研究方法 --- p.12 / Chapter 第四節 --- 論文架構 --- p.17 / Chapter 第五節 --- 研究意義 --- p.19 / Chapter 第二章 --- 戰前香港的醫療衛生發展 --- p.20 / Chapter 第一節 --- 殖民地政府的醫療衛生事業沿革 --- p.21 / Chapter 第二節 --- 民間的醫療衛生常識 --- p.29 / Chapter 第三節 --- 戰前香港醫療衛生與日本人 --- p.37 / Chapter 第四節 --- 《香港日報》的創辦與發展 --- p.43 / Chapter 第五節 --- 小結 --- p.49 / Chapter 第三章 --- 日治香港政府的醫療衛生概觀 --- p.51 / Chapter 第一節 --- 日治政府醫療管理與醫生註冊 --- p.52 / Chapter 第二節 --- 疾病控制與防疫運動 --- p.67 / Chapter 第三節 --- 環境衛生與糞便處理 --- p.76 / Chapter 第四節 --- 區制、戶籍登記與醫療衛生制度 --- p.87 / Chapter 第五節 --- 小結 --- p.97 / Chapter 第四章 --- 從《香港日報》看日治時期醫療衛生常識的傳播 --- p.99 / Chapter 第一節 --- 副刊專欄與醫藥新知 --- p.100 / Chapter 第二節 --- 公共衛生資訊的提供 --- p.116 / Chapter 第三節 --- 小結 --- p.133 / Chapter 第五章 --- 從《香港日報》看日治時期治療藥物的供應 --- p.135 / Chapter 第一節 --- 《香港日報》中的藥物廣告 --- p.136 / Chapter 第二節 --- 流通市面的藥物 --- p.155 / Chapter 第三節 --- 贈醫所及個人醫師的角色 --- p.165 / Chapter 第四節 --- 小結 --- p.173 / Chapter 第六章 --- 總結日治時期的影響──香港醫療的延續與前進 --- p.175 / Chapter 第一節 --- 醫療體制的過渡 --- p.175 / Chapter 第二節 --- 從日治醫療史看日治歷史性質 --- p.187 / Chapter 附錄(一) --- 日治期間各分區新舊名稱轉換、區長副區長及區會員數目表列 --- p.191 / Chapter 附錄(二) --- 香督令第二十一號(1942年)[節錄] --- p.192 / Chapter 附錄(三) --- 香督令第十六號(1944年) --- p.193 / 參考書目 --- p.194

Made available in DSpace on 2016-04-26T14:54:40Z (GMT). No. of bitstreams: 1 Luiz Otavio dos Santos Pereira.pdf: 961275 bytes, checksum: 142b625726925eca0fc0b979f53de0a8 (MD5) Previous issue date: 2014-04-10 / This dissertation proposes an analysis of the Health Policy for Indigenous People of Brazil, in the period between 1986 and 2013, with basis in the theories of policy studies developed by the Political Science, in special the ACF( Advocacy Coalition Framework) developed by Jenkins-Smith and Sabatier. We observe that this policy born due to an amplest context of transformations of citizenship nature, that compels to a new way to formulate policies that handle with diversity, that start to conciliate the principle of equality with the respect to difference. And we demonstrate how the Brazilian State search in this policy the conciliation between the health right and the cultural rights, with mean, between the principles of universalism and particularism, dealing with the unavoidable set of dilemmas that this matter causes. However, we highlight that in this health policy occur an uncommon frequency of discontinuities. We identify that between the consolidation of the ideational basis of this policy in 1986 and the present period of 2013; occur an sequence of institutional reconfigurations and restructuration of the attention model. The four main changes are: in 1991, when the responsibility of the indigenous health was transferred to FUNASA( National Foundation of Health); in1994, when occur the partial return of the indigenous health to FUNAI( National Foundation of Indian); in 1999, with the Arouca s Law that give back the integrity of the indigenous health responsibility to FUNASA; in 2008, when was create the Especial Secretary of Indigenous Health. This research propose to answer what was the factors that causes the general picture of the institutional instability and the identified changes; and adopt as main hypothesis that the sources of the changes and consequentially of the instability, was the competition between the coalitions that structure themselves around of a divergent set of ideas, that constitute the normative basis of the health policy for indigenous peoples. That way shows with are the coalitions, how they born, around of what ideas they are structured, how they interact, and how make changes in the policy health to indigenous peoples, using the opportunity structure, that opens the possibilities to break the stability and change the status quo / Essa dissertação propõe uma análise da Política de Saúde para as Populações Indígenas no Brasil, do período entre 1986 e 2013, tendo como base as teorias de políticas públicas desenvolvidas pela Ciência Política, em particular o ACF( Advocacy Coalition Framework) desenvolvido por Jenkins-Smith e Sabatier. Observamos que essa política pública nasce devido a um contexto mais amplo de transformações da natureza da cidadania, que compele a uma nova forma de se formular políticas públicas que lidam com a diversidade, que passa a conciliar o principio da igualdade com o respeito a diferença. E demonstramos como o Estado brasileiro busca nessa política a conciliação entre o direito à saúde e os direitos culturais, ou seja, entre o universalismo e o particularismo, tratando dos dilemas inevitáveis que esta questão acarreta. No entanto, destacamos que na política de saúde indígena ocorre uma frequência incomum de descontinuidades. Identificamos que, entre a consolidação da base ideológica dessa política pública em 1986 e o atual momento de 2013, ocorre uma série de reconfigurações institucionais e reestruturações do modelo de atenção. As quatro principais mudanças foram: em 1991, quando responsabilidade da saúde indígena é transferida para a FUNASA (Fundação Nacional de Saúde); em 1994, quando ocorre o retorno parcial da saúde indígena para a FUNAI(Fundação Nacional do Índio);em 1999, com a Lei Arouca que devolve a integralidade da responsabilidade da saúde indígena para a FUNASA; e em 2008, quando é criada a Secretaria Especial de Saúde Indígena. Essa pesquisa propõe responder quais foram os fatores que causaram o quadro geral de instabilidade institucional e das mudanças identificadas; adota como hipótese central que a causa das mudanças, e consequentemente, da instabilidade, foi a disputa entre as coalizões que se estruturam em torno de um conjunto de divergentes ideias que formam a base normativa da política de saúde indígena. Assim demonstramos quais são as coalizões, como nascem, em torno de quais ideias se estruturam, como interagem e causam mudanças na política de saúde indígena, usando a estrutura de oportunidade que possibilita a ruptura da estabilidade e mudança do status quo

This thesis aims to analyze the inner dynamics as well as the outcomes of the health sector restructuring process in Turkey, by focusing on Neo-Liberal transformation, New Public Management practices and European Integration process. The thesis argues that health reform process along with other public sector reforms have been initiated by Neo-Liberalism as the new face of institutional and structural arrangements during 1980s. Within that process, it is underlined that New Public Management approach with its commitment to private sector methodology and techniques reflected the underlying philosophy and basic premises of Neo-Liberalism which dominated the health sector restructuring process in Turkey, as well as in Eastern Europe since 1990s. Often characterized with the notion of &ldquo / efficiency&rdquo / , the New Public Management techniques and methodologies claimed to bring a more efficiently working health system. In order to refute this claim, the health sector reforms that have been exercised in the past two decades in Turkey as well as in Eastern Europe are analyzed within a historical context. It is also argued that while the Neo-Liberal policies and policy initiatives proposed by International Monetary Fund and World Bank had a direct effect on health sector restructuring process, the role of the European Union has been indirect with regard to organization and service provision. Therefore, the main objective of this thesis is to analyze the outcomes of the health reforms carried out in Turkey in a multidisciplinary manner in order to reveal its political, economic,social and administrative implications in terms of service providers and service takers.

published_or_final_version / Public Administration / Master / Master of Public Administration