Thesis (M.P.H.M.)--Mahidol University, 1999.

Made available in DSpace on 2014-06-11T19:29:36Z (GMT). No. of bitstreams: 0 Previous issue date: 2001Bitstream added on 2014-06-13T19:17:54Z : No. of bitstreams: 1 oikawa_lt_me_botfm.pdf: 261151 bytes, checksum: c62a888e2773e9ae391eae8670076b39 (MD5) / A condição da acessibilidade aos serviços básicos de atenção à saúde envolve um conjunto de variáveis, tais como: distância entre a moradia e o serviço de saúde, a capacidade de oferta do serviço, a receptividade do funcionário para com o usuário, o intervalo de tempo entre o agendamento e a obtenção da ação de saúde requerida pelo usuário, a necessidade do usuário, entre outras. Como estas variáveis se apresentam e se relacionam entre si, merece ser conhecido, analisado e disponibilizado a todos aqueles que se interessam pelo bom funcionamento do sistema de saúde. O presente trabalho reúne informações que contextualizam teórica e conjunturalmente o objeto de estudo, qual seja, acessibilidade à rede pública de atenção básica à saúde de Botucatu, que aqui é estudada analisando-se o Centro de Saúde “Dr. Sebastião de Almeida Pinto”. Para o desenvolvimento deste estudo, realizaram-se 269 entrevistas domiciliares entre moradores da área de abrangência do Centro de Saúde. Também foram coletadas opiniões dos membros da equipe deste serviço estudado através de questionário. Os resultados obtidos indicam, entre outros aspectos, que dos moradores entrevistados na área de abrangência do serviço estudado, 69,5% (IC 90% 64,9% – 74,1%) são usuários e 30,5% (25,9% - 35,1%) não são usuários. Quanto às características demográficas dos moradores entrevistados, tanto usuários, quanto não usuários se concentram na faixa etária compreendida entre 20 e 50 anos de idade. Em relação ao sexo, entre os usuários, a clientela é majoritariamente feminina 84,5% (80,2% - 88,8%), ao passo que entre os não usuários, a distribuição do sexo é mais... / The accessibility to primary health care comprises a set of variables such as: distance between the house of the user and the health service, service offer, receptivity of the employee towards the user, the time spent between setting the appointment and the assistance required by the user and his necessities. How these variables occur and relate to one another is not only worth being studied and analyzed but it should also be provided to those interested in the appropriate management of the health system. This research gathers information which contextualize in theory and in practice the object of study that is, accessibility to public health service in Botucatu, which is studied through the evaluation of the Health Center “Dr. Sebastião de Almeida Pinto”. Two hundred and sixty nine interviews were made in the houses of the population of the area assisted by the Health Center and the opinion of the staff of this service was heard through questionnaires. The results show that among the dwellers of this area 69,5% (CI 90% 64,9% – 74,1%) are users, and 30,5% (25,9% - 35,1%) are non users. As to demographic characteristics, users as well as non-users, the age ranges from 20 to 50 years old. As to gender, among the users, the clientele is mostly female 84,5% (80,2% - 88,8%) but among the non-users sex distribution is more balanced 40,2% (31,4% - 49,1%) men and 59,8% (50,9% - 68,6%) women. Considering the relationship to the Health Center mainly the... (Complete abstract click electronic access below)

The subject of this thesis describes system of health service financing in the Czech Republic in connection to the actual situation. After introducing current problems there is an analysis of reformative efforts of system stabilization. The final part of the thesis is focused on the evaluation of reformative attempts and it is compared with selected health services in the Europe.

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Yes / Bryan McIntosh, senior lecturer in health management and organisational behaviour at the University of Bradford, explores the role of partnerships in the health service.

This thesis argues that the creation of the NHS inadvertently created an institution that is fundamental to current British national identity. The NHS exemplifies the core values of the UK, in a way that previous national institutions – the Church, the monarchy, and the Empire – could not due to the societal makeup of the country. The NHS was created for all citizens, regardless of class, and the democratic nature of the institution embodies the ideals at the heart of the nation. The institution pushed the UK to become faithful to its founding ideals of fraternity, community, democracy, and it allowed Britons to have another world-renowned institution. Furthermore, the NHS's creation coincided with one of the last great eras the UK clings to – World War II – therefore, the NHS continually pulls from that the achievements of that period and connects itself to the national pride after victory. / Master of Arts / This thesis argues that the creation of the NHS inadvertently created an institution that is fundamental to current British national identity. The NHS exemplifies the core values of the UK, in a way that previous national institutions – the Church, the monarchy, and the Empire – could not due to the societal makeup of the country. The NHS was created for all citizens, regardless of class, and the democratic nature of the institution embodies the ideals at the heart of the nation. The institution pushed the UK to become faithful to its founding ideals of fraternity, community, democracy, and it allowed Britons to have another world-renowned institution. Furthermore, the NHS's creation coincided with one of the last great eras the UK clings to – World War II – therefore, the NHS continually pulls from that the achievements of that period and connects itself to the national pride after victory.

The goal of this master thesis is the analysis of trends in public and private expenditures on health care in the Czech republic, which have a tendency to develop above possibility o public budget in the context of long-term sustainability. This create pressure on the increase of share of private expenditures. In this thesis will be attention also focus on the proportion of public and private expenditures in total expenditures with evaluation of consequences for availability of needed health care for citizen in social deprivation. Part of the thesis will be focus on elasticity of demand for health care in view of the sensitivity, that have citizen in social deprivation to the increase of private expeditures on health care. The thesis will include quest to find a possibility of financing health care from private resources and describe prices of health care in the public system of health service.

It is widely accepted that the home environment may act as a socio-geographic focus of both disease transmission and of learned health behaviour. Households also appear to be units of convergence for factors identified in the literature as relating to the utilization of health services. This thesis is devoted to an examination of the role of the home environment, as well as of personal characteristics and accessibility, in the utilization of health services in Grenada, West Indies. The theoretical framework that informs this work is a holistic systems-orientated Socio-Ecological Model of Utilization. The empirical analysis draws upon the results of a detailed household survey conducted in five communities on the western portion of the island. Visits to homes containing children less than eight years of age isolated socio-demographic characteristics and information pertaining to residential mobility, household physical and behavioural environment, accessibility, self-reported morbidity and self-reported utilization. Records of patient visits over the previous two years for non-trauma events were abstracted from the medical records of area clinics, hospitals and physicians attending to the sample communities. Bivariate analyses between components of variables were conducted at both household and individual service use levels. These indicated that 1) service utilization was highly clustered around "high user" households and individuals; 2) considerable discrepancies emerged between self-reported and actual utilization; 3) the complexity of relationships between elements of the home environment was highlighted; and 4) there was a consistency with which certain elements of the home environment were statistically associated with health service use across a wide spectrum of illnesses. These observations were further confirmed in multivariate analyses, in which a small number of variables were able to retrospectively predict the presence or absence of service use by both adults and children with a high degree of model specificity and sensitivity. The implications of this work for development and health care planning in Grenada is discussed. The meaningful application of this work in Grenada is seen to hinge upon the extent to which relevant variables are amenable to change or act as proxy variables whose underlying nature of association with utilization remains to be adequately explored. A number of suggestions are advanced concerning the manner in which the study of health service utilization might be approached in the future. / Thesis / Master of Arts (MA)

Utilizando-se a análise de conteúdo identificaram-se os marcos referenciais (nos níveis nacional e internacional) que orientaram a formação da defesa sanitária animal no Estado de São Paulo, desde a criação da Secretaria de Agricultura de São Paulo aos dias atuais. Descreveu-se o modelo atual de defesa animal, tendo como enfoque as dimensões organizacional, procedimental e operacional, precedida de uma recuperação histórica da sua formação. A defesa animal ocupou diferentes posições na estrutura organizacional da Secretaria, em função dos diferentes objetivos dos diferentes grupos governantes. Passou, de coadjuvante nos projetos de melhoramento animal, a instrumento dos controles legais. Este papel passou a ter maior nitidez, a partir de 1969, com a implantação da Campanha de Combate à Febre Aftosa. Consolidou-se, a partir da década de 1990, com a nova agenda do comércio internacional, do acordo constitutivo da Organização Mundial do Comércio e dos acordos e instrumentos jurídicos conexos que o compõem, especialmente com a adoção do Acordo sobre Aplicação de Medidas Sanitárias e Fitossanitárias. Constatou-se que as estratégias e políticas estabelecidas nos programas de defesa estão baseadas no marco referencial da epidemiologia tradicional. Este enfoque impede que se caracterizem e interpretem o papel que a organização sócio-econômica da produção possui na determinação dos problemas produtivos. A estreita aproximação entre os objetivos da defesa animal em São Paulo e os conteúdos das normas internacionais, coloca em segundo plano as prioridades internas. A base legal que define a organização da defesa não favorece a partilha do poder, no âmbito do próprio serviço, quando, contraditoriamente, espera-se de uma organização pública moderna: flexibilidade, interatividade, capacidade gerencial, visão estratégica e a prática de conceitos de qualidade. Apesar da grande quantidade de oferta de canais de participação e de integração com a sociedade não se evidenciam indicadores de efetividade. As regras estabelecidas para relações de convênio ou parceria mostram-se excessivamente burocratizadas, geralmente mais adequadas a relações com grandes grupos econômicos. Ao longo do período estudado, persiste o discurso sobre a execução de programas de Educação Sanitária, entretanto, os instrumentos e métodos descritos na base legal de atuação da defesa não privilegiam a abordagem educativa. / Using the content analysis, reference points, that have oriented the formation of the animal health service in São Paulo State, have been identified at national and international levels, since the creation starting of the Department of Agriculture of São Paulo until today. Preceded by a historical recovery of the animal health service build-up, the current model was described based on organizational, procedural and operational dimensions. Throughout the years, according to the different aims of several government groups, this service has played different roles in the Department of Agriculture?s organizational structure. The animal health service, from mere complementary technical support for the animal improvement projects, became an active agent in the control of animal diseases, especially since 1969, with the establishment of foot-and-mouth-disease control campaigns. This new role was consolidated, from the 1990´s on due to the new shedule in international trade and the constitutive agreement of the World Trade Organization and its the agreements and legal instruments mainly the adoption of the Sanitary and Phytosanitary Measures Agreement (SPS). It was noticed that established strategies and policies of animal health programs are based on traditional epidemiology reference points. This approach doesn?t allow characterization and interpretation of the role of social economic organization of production has in determining productive problems. The close relation between the aims of São Paulo animal health service and the contents of international health standards leads internal priorities to a second role. The legal basis which defines the animal health service organization doesn\'t promote power in its own service, as it is expected, on the other hand, a modern public organization with flexibility, interactivity, managing capacity, strategic vision and the quality concepts practices. Despite the great offer of participation channels and integration with civil society, there is no evidence of effectiveness. The rules established for pact relations or partnerships turned out to be excessively bureaucratic, generally more suitable for agreements among large corporations. The animal health service, in theory, has a permanent focus on sanitary education; however, tools and methods described in the legal basis of action of the animal health service, don\'t emphasize educational approach.

Utilizando-se a análise de conteúdo identificaram-se os marcos referenciais (nos níveis nacional e internacional) que orientaram a formação da defesa sanitária animal no Estado de São Paulo, desde a criação da Secretaria de Agricultura de São Paulo aos dias atuais. Descreveu-se o modelo atual de defesa animal, tendo como enfoque as dimensões organizacional, procedimental e operacional, precedida de uma recuperação histórica da sua formação. A defesa animal ocupou diferentes posições na estrutura organizacional da Secretaria, em função dos diferentes objetivos dos diferentes grupos governantes. Passou, de coadjuvante nos projetos de melhoramento animal, a instrumento dos controles legais. Este papel passou a ter maior nitidez, a partir de 1969, com a implantação da Campanha de Combate à Febre Aftosa. Consolidou-se, a partir da década de 1990, com a nova agenda do comércio internacional, do acordo constitutivo da Organização Mundial do Comércio e dos acordos e instrumentos jurídicos conexos que o compõem, especialmente com a adoção do Acordo sobre Aplicação de Medidas Sanitárias e Fitossanitárias. Constatou-se que as estratégias e políticas estabelecidas nos programas de defesa estão baseadas no marco referencial da epidemiologia tradicional. Este enfoque impede que se caracterizem e interpretem o papel que a organização sócio-econômica da produção possui na determinação dos problemas produtivos. A estreita aproximação entre os objetivos da defesa animal em São Paulo e os conteúdos das normas internacionais, coloca em segundo plano as prioridades internas. A base legal que define a organização da defesa não favorece a partilha do poder, no âmbito do próprio serviço, quando, contraditoriamente, espera-se de uma organização pública moderna: flexibilidade, interatividade, capacidade gerencial, visão estratégica e a prática de conceitos de qualidade. Apesar da grande quantidade de oferta de canais de participação e de integração com a sociedade não se evidenciam indicadores de efetividade. As regras estabelecidas para relações de convênio ou parceria mostram-se excessivamente burocratizadas, geralmente mais adequadas a relações com grandes grupos econômicos. Ao longo do período estudado, persiste o discurso sobre a execução de programas de Educação Sanitária, entretanto, os instrumentos e métodos descritos na base legal de atuação da defesa não privilegiam a abordagem educativa. / Using the content analysis, reference points, that have oriented the formation of the animal health service in São Paulo State, have been identified at national and international levels, since the creation starting of the Department of Agriculture of São Paulo until today. Preceded by a historical recovery of the animal health service build-up, the current model was described based on organizational, procedural and operational dimensions. Throughout the years, according to the different aims of several government groups, this service has played different roles in the Department of Agriculture?s organizational structure. The animal health service, from mere complementary technical support for the animal improvement projects, became an active agent in the control of animal diseases, especially since 1969, with the establishment of foot-and-mouth-disease control campaigns. This new role was consolidated, from the 1990´s on due to the new shedule in international trade and the constitutive agreement of the World Trade Organization and its the agreements and legal instruments mainly the adoption of the Sanitary and Phytosanitary Measures Agreement (SPS). It was noticed that established strategies and policies of animal health programs are based on traditional epidemiology reference points. This approach doesn?t allow characterization and interpretation of the role of social economic organization of production has in determining productive problems. The close relation between the aims of São Paulo animal health service and the contents of international health standards leads internal priorities to a second role. The legal basis which defines the animal health service organization doesn\'t promote power in its own service, as it is expected, on the other hand, a modern public organization with flexibility, interactivity, managing capacity, strategic vision and the quality concepts practices. Despite the great offer of participation channels and integration with civil society, there is no evidence of effectiveness. The rules established for pact relations or partnerships turned out to be excessively bureaucratic, generally more suitable for agreements among large corporations. The animal health service, in theory, has a permanent focus on sanitary education; however, tools and methods described in the legal basis of action of the animal health service, don\'t emphasize educational approach.