Thesis (Ph.D.)--University of British Columbia, 1999. / Title from PDF t.p. (viewed Sept. 22, 2005). Includes bibliographical references and index. Issued also in microfiche. Issued also in print.

Originally presented as the author's Thesis (doctoral)--Universität Bremen, 2005/2006. / Includes bibliographical references (p. 421-460) and index.

Esta dissertação examina em que medida as políticas nacionais para o controle do câncer no Brasil organizam o processo de trabalho na alta complexidade oncológica (ACO), por meio dos recursos humanos em saúde (RHS) oncologistas clínicos, radioterapeutas e físicos médicos vinculados às Redes Estaduais de ACO, a partir das definições estabelecidas pela Portaria SAS/MS N. 741/2005. Trata-se de um estudo de caso exploratório. Nele foi realizado um sucinto panorama da oncologia dentro da conjuntura histórica da saúde; apresentadas as três portarias ministeriais direcionadas ao controle câncer no País, e exemplificado, através de relato técnico e referencial teórico baseado nas três dimensões que permeiam os RHS propostas por Pierantoni: estrutural, gerencial e regulatória, de como aconteceu a divulgação das políticas para o controle do câncer no país, e os primeiros desenhos estaduais das redes de serviços de saúde de ACO. Algumas situações observadas sinalizam que, enquanto alguns dos instrumentos existentes na área da oncologia ainda são poucos utilizados pelos gestores no seu processo de planejamento e gestão, outros precisam ser aprimorados. O estudo de caso foi sobre a Rede de Atenção Oncológica do Município do Rio de Janeiro de 2008, composta por hospitais federais, estaduais, municipais, universitários e filantrópicos, todos na gestão municipal. No plano das análises destacam-se três elementos: a caracterização desses serviços de saúde; os parâmetros de cobertura assistencial e produção ambulatorial de quimioterapia e radioterapia e o número e carga horária dos RHS. O Cadastro Nacional de Estabelecimentos de Saúde do Departamento de Informação do SUS (DATASUS) e o Sistema de Informação Ambulatorial são utilizados como fontes de dados por representarem um banco de dados que podem contribuir para a gestão da área oncológica, ampliando, assim, sua utilidade para o SUS. Por fim, os achados possibilitam uma reflexão tanto pela ótica da gestão do trabalho quanto da gestão da educação em saúde, de como está se configurando a alta complexidade oncológica e quais os atuais limites e possibilidades para incluir o dimensionamento das categorias profissionais estudadas nos instrumentos normativos ministeriais. / This dissertation examines at which level the national policies for cancer control in Brazil organize the work process in oncological high complexity, through human resources in health (HRH) - clinical oncologists, radiotherapists and medical physicists - bound to the State oncological high complexity network, from the definitions established by the SAS/MS Order # 741/2005. It is an exploratory case study, which brings a brief overview of Oncology in the historical context of health. The three ministerial resolutions directed to the control of cancer in the country are presented and, through technical report and theoretical referential based on the three dimensions that permeate the HRH proposed by Pierantoni (structural, management and regulatory), exemplify how the dissemination of the cancer control policies in the country and the first State sketches of the oncological high complexity network came to be. Some situations encountered indicate that while some of the instruments in the area of oncology are still little used by the managers in their planning and management process, others need to be improved. The case study was on the Oncological Care Network in Rio de Janeiro 2008, composed of federal, state, municipal, university and philanthropic hospitals, all under municipal management. In terms of analysis, three elements stand out: the characterization of these health services, the parameters of care coverage and ambulatorial production of chemotherapy and radiotherapy and the number and workload hours of the human resources in health. The National Registry of Health Facilities of the SUS Information Department (DATASUS) and the Ambulatorial Information System are used as data sources, as they represent a data bank that may contribute to the management of the oncological area, this way widening its utility to the SUS. Finally, the findings allow a reflection from both the perspectives of work management and management education in health, on how is the oncological cancer care configuring itself and what are the actual limits and possibilities to have the dimensioning of the studied professional categories included in the ministerial normative instruments.

Esta dissertação examina em que medida as políticas nacionais para o controle do câncer no Brasil organizam o processo de trabalho na alta complexidade oncológica (ACO), por meio dos recursos humanos em saúde (RHS) oncologistas clínicos, radioterapeutas e físicos médicos vinculados às Redes Estaduais de ACO, a partir das definições estabelecidas pela Portaria SAS/MS N. 741/2005. Trata-se de um estudo de caso exploratório. Nele foi realizado um sucinto panorama da oncologia dentro da conjuntura histórica da saúde; apresentadas as três portarias ministeriais direcionadas ao controle câncer no País, e exemplificado, através de relato técnico e referencial teórico baseado nas três dimensões que permeiam os RHS propostas por Pierantoni: estrutural, gerencial e regulatória, de como aconteceu a divulgação das políticas para o controle do câncer no país, e os primeiros desenhos estaduais das redes de serviços de saúde de ACO. Algumas situações observadas sinalizam que, enquanto alguns dos instrumentos existentes na área da oncologia ainda são poucos utilizados pelos gestores no seu processo de planejamento e gestão, outros precisam ser aprimorados. O estudo de caso foi sobre a Rede de Atenção Oncológica do Município do Rio de Janeiro de 2008, composta por hospitais federais, estaduais, municipais, universitários e filantrópicos, todos na gestão municipal. No plano das análises destacam-se três elementos: a caracterização desses serviços de saúde; os parâmetros de cobertura assistencial e produção ambulatorial de quimioterapia e radioterapia e o número e carga horária dos RHS. O Cadastro Nacional de Estabelecimentos de Saúde do Departamento de Informação do SUS (DATASUS) e o Sistema de Informação Ambulatorial são utilizados como fontes de dados por representarem um banco de dados que podem contribuir para a gestão da área oncológica, ampliando, assim, sua utilidade para o SUS. Por fim, os achados possibilitam uma reflexão tanto pela ótica da gestão do trabalho quanto da gestão da educação em saúde, de como está se configurando a alta complexidade oncológica e quais os atuais limites e possibilidades para incluir o dimensionamento das categorias profissionais estudadas nos instrumentos normativos ministeriais. / This dissertation examines at which level the national policies for cancer control in Brazil organize the work process in oncological high complexity, through human resources in health (HRH) - clinical oncologists, radiotherapists and medical physicists - bound to the State oncological high complexity network, from the definitions established by the SAS/MS Order # 741/2005. It is an exploratory case study, which brings a brief overview of Oncology in the historical context of health. The three ministerial resolutions directed to the control of cancer in the country are presented and, through technical report and theoretical referential based on the three dimensions that permeate the HRH proposed by Pierantoni (structural, management and regulatory), exemplify how the dissemination of the cancer control policies in the country and the first State sketches of the oncological high complexity network came to be. Some situations encountered indicate that while some of the instruments in the area of oncology are still little used by the managers in their planning and management process, others need to be improved. The case study was on the Oncological Care Network in Rio de Janeiro 2008, composed of federal, state, municipal, university and philanthropic hospitals, all under municipal management. In terms of analysis, three elements stand out: the characterization of these health services, the parameters of care coverage and ambulatorial production of chemotherapy and radiotherapy and the number and workload hours of the human resources in health. The National Registry of Health Facilities of the SUS Information Department (DATASUS) and the Ambulatorial Information System are used as data sources, as they represent a data bank that may contribute to the management of the oncological area, this way widening its utility to the SUS. Finally, the findings allow a reflection from both the perspectives of work management and management education in health, on how is the oncological cancer care configuring itself and what are the actual limits and possibilities to have the dimensioning of the studied professional categories included in the ministerial normative instruments.

The background variables, GDP per capita, marketization, industrialization and urbanization are used to control different levels of development across provinces. The role of the state is measured in the following ways. First, financial capacity, administrative capacity and coercive capacity are used to measure the role of state capacity in BMI extension. The study examines whether there is a difference in choosing different agencies to collect social insurance premiums: one is local taxation agency and the other is social insurance agency. Third, the performance of BMI is measured through the deposit rates of BMI funding which reflects governments' ability to manage the BMI program. In the current policy, employers are charged largely the social insurance fees. So their willingness and capabilities to pay will affect BMI coverage. The study investigates two kinds of employers: loss making State-Owned-Enterprises (SOE hereafter) and Foreign Invested Enterprises (FIE hereafter). On the employee's part, the percent of informal employment in total urban employment is used to measure the effect of adverse employment conditions on BMI coverage. Trade union density is used to estimate the labor organization strength. / The complicated process of extending coverage is related to three major stakeholders: state, employers and employees. These three stake-holders influence BMI progress. Also, the background factors (such as the economic growth) should be taken into account for the regional variations in development level. Since BMI is a typical social policy field, this study reviews major theories about social policy development: logic of industrialism, power resource theory and state-centered approach and so on. These theories help organize pieces of phenomena into a unified framework and testable hypotheses are also derived. / The contributions of this study can be twofold. First, from the theoretical aspect, this research tests several welfare state development theories using Chinese data. In this way, it does not only expand the scope conditions of theories, but also improves our understanding of the social policy development in China, an outlier of traditional western democracies. Second, this study tests some controversial issues on BMI development and the research findings provide knowledge support for the policy practice in the real world. / The low coverage of social health insurance is one of the causes of the problems in Chinese health care system which is criticized for the rising health cost, large share of out-of-pocket payments and health inequality issue. The Basic Medical Insurance for Urban Employees (BMI hereafter) was chosen as the subject of my investigation. It was established in 1998 for the working population and till now it has not achieved universal coverage yet. The Basic Medical Insurance for Urban Residents (BMI-R hereafter) was started in 2007 and it is still in pilot stage, therefore data are still inadequate. In rural areas, the New Cooperative Medical Scheme (NCMS hereafter) achieved almost full coverage in 2008. Thus extending coverage is not issue at concern for NCMS. Besides, the NCMS data at province level are quite limited. Considering the stages of policy development and data access, BMI-R and NCMS are not included in this study. / The proportion of winning lawsuit in labor disputes is used to measure the function of labor protection system. This study adopts the panel method. Data is ranging from the year 1999 to 2005 and the unit of analysis is province/year. They were collected from various official statistics and constructed into a panel database which can trace the development of BMI from its origin to most recent situation. / The research question is what are the determinants of BMI's coverage? It is originated from some puzzling observations: the NCMS achieved full coverage in four years and it is a voluntary participation insurance program. On the contrary, why the mandatory BMI did not reach universal coverage after almost ten years' development? Besides, the progress of BMI across different provinces varied greatly. Given the policy designing and starting points are rather similar, how can we explain these variations? / The research yields several interesting results. First, the roles of financial capacity and administrative capacity in BMI development are supported by data, especially the social insurance agency. Second, results show that using local taxation to collect social insurance premiums has better effects in extending coverage than the alternative approach. This result will give an end to the decade-long debate on choice of social insurance premiums collection agencies. Third, the deposit rates of BMI funding are negatively related with BMI coverage. It implies that governments should improve the performance of BMI so as to attract more people to enroll in this program. Fourth, the union density in the private sector is positively related with BMI coverage. This result disagrees with the conventional wisdom that the Chinese trade unions are useless. It implies that strengthening the organization of employees (even through the official channel) can protect the rights of employees in some degree. / 劉軍強. / Adviser: Cheek-Kie Wong. / Source: Dissertation Abstracts International, Volume: 73-03, Section: A, page: . / Thesis (Ph.D.)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 198-222) / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [201-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Liu Junqiang.

Taking into account of the colonial nature of modern Hong Kong, this author is to examine how the TWGHs as a medical space gradually developed from one that used only Chinese medicine into one in which Chinese medicine and western medicine coexisted. However, it finally became a western style hospital using only western medicine in the inpatient services in the 1940s, along with the growing hegemony of western medicine that was underpinned by colonial power. The multidimensional relationships among different agents in the process of transformation of medical services in the TWGHs constitutes another important theme of this thesis. These relationships touched upon a series of significant interactions between colonial government and Chinese community, colonial authorities and the Tung Wah Board of Directors, Chinese and western medical practitioners, Chinese community and the Tung Wah authorities, and so on. / The implantation, dissemination and expansion of modern western medicine, as an important part of western learning that infiltrated into the Orient, exerted profound impacts on Chinese traditional medical patterns and Chinese medical ideas and practices. As the center for exchange between Chinese and Western Culture, Hong Kong became a significant space for the spread and practice of western medicine. A wide range of western medical services and activities were delivered and developed by the colonial government, western missionaries, benevolent societies, and private practitioners in order to promote the development and popularization of western medicine among the Chinese community, including the establishment of hospitals, dispensaries and clinics, the opening of medical schools and training of western doctors, and the promotion of public health education. / This thesis also points out that the early intense prejudice and resistance against western medicine is not necessarily and cannot be entirely attributed to the underlying difference in the concept and practice of healing and sickness in the two different medical systems. Instead, I argue that a number of technical and practical factors in the delivery of western medical services provided by different agencies greatly affected and determined the choices and uses of the Chinese population. At the same time, the gradual recognition and reception of western medicine among the Chinese was not only the passive result of the compulsory western medical system developed by the colonial government, but also an active realization of the real efficiency and value of western medicine among the indigenous population and their consent and acceptance of its ideology and cultural value, to a great extent. / This thesis examines the confrontation and interaction between Chinese medicine and Western medicine, and the diverse and complicated Chinese attitudes towards western medicine by studying the history of the introduction of western medicine into Hong Kong and the case of transformation of Chinese and western medical services in the Tung Wah Group of Hospitals (TWGHs) during the period between 1894 and 1941. The history of the TWGHs dates back to the opening of the Tung Wah Hospital in 1870. Originally intended for the accommodation and treatment of those Chinese who had strong fears and prejudices against western medicine, the Tung Wah Hospital was founded to provide treatment only by Chinese doctors using Chinese medicine. The bubonic plague of 1894 in Hong Kong marked an important turning point in the history of medical services of the Tung Wah Hospital. Since then, western medicine was formally introduced into the Tung Wah Hospital in 1897. / 楊祥銀. / Adviser: Hon-ming Yip. / Source: Dissertation Abstracts International, Volume: 69-02, Section: A, page: 0715. / Thesis (doctoral)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (p. 279-306). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / School code: 1307. / Yang Xiangyin.

Os Centros de Saúde do Rio de Janeiro são analisados enquanto uma organização estruturada para desempenhar, na área da saúde, parte das funções do aparato burocrático do Estado brasileiro. Seu papel institucional vincula-se à emergência de novos problemas sanitários numa sociedade em processo de urbanização e de consolidação de um Estado nacional. Ao longo de usa trajetória histórica passou por situações distintas, no que se refere ao seu papel no Sistema de Saúde, articuladas a determinantes de natureza técnica e política. Enquanto fenômeno burocrático, esta organização sobreviveu às diversas conjunturas históricas interpondo resistências, que se manifestaram, principalmente, pela lentidão com que eram processadas as mudanças internas propostas. / The Health Centers in the city of Rio de Janeiro are analyzed as organizations that have been structured to execute parto of the bureaucratic duties petaining to the brazilian State, as far as health care is concerned. Their role, as institutions, is related to the solution of new problems, in their sanitary aspects, that are emerging in a society in processo f increasing urbanization and inside a process of organizing a National State. Along the course of their history, these organization have overcome various distinctive situations, dependind on technical and political determinants. As bureaucratic phenomena, this organization have survived many historical conjuntures, presenting itself as resistant to the proposed changes, mainly by slow ways of implementing these propositions.

Os Centros de Saúde do Rio de Janeiro são analisados enquanto uma organização estruturada para desempenhar, na área da saúde, parte das funções do aparato burocrático do Estado brasileiro. Seu papel institucional vincula-se à emergência de novos problemas sanitários numa sociedade em processo de urbanização e de consolidação de um Estado nacional. Ao longo de usa trajetória histórica passou por situações distintas, no que se refere ao seu papel no Sistema de Saúde, articuladas a determinantes de natureza técnica e política. Enquanto fenômeno burocrático, esta organização sobreviveu às diversas conjunturas históricas interpondo resistências, que se manifestaram, principalmente, pela lentidão com que eram processadas as mudanças internas propostas. / The Health Centers in the city of Rio de Janeiro are analyzed as organizations that have been structured to execute parto of the bureaucratic duties petaining to the brazilian State, as far as health care is concerned. Their role, as institutions, is related to the solution of new problems, in their sanitary aspects, that are emerging in a society in processo f increasing urbanization and inside a process of organizing a National State. Along the course of their history, these organization have overcome various distinctive situations, dependind on technical and political determinants. As bureaucratic phenomena, this organization have survived many historical conjuntures, presenting itself as resistant to the proposed changes, mainly by slow ways of implementing these propositions.