A crise capitalista pela qual o mundo passa atualmente, com o desmonte dos estados de bem-estar social europeus, nos acende o alerta para analisar com maior profundidade o nosso País e tentar compreender os rumos das suas políticas sociais, notadamente do SUS. Se é verdade que o horizonte estratégico da Reforma Sanitária Brasileira se rebaixou à mera reforma administrativa mas que resultaria no SUS hoje percebemos que mesmo este foi rebaixado ao SUS Possível. São analisadas algumas limitações/escolhas feitas no âmbito teórico e de estratégia política que não sendo os únicos elementos contribuíram para o afastamento dos objetivos estratégicos, entre elas o chamado Dilema Reformista. A partir do resgate de referenciais teóricos do setor saúde e da literatura marxista na qual se baseiam, fundamentalmente gramsciana, construir-se-á uma interpretação crítica do processo à luz dos seus resultados históricos, condicionados pelas arenas políticas internacionais e pela disputa de projetos políticos no Brasil. Apresenta-se a hipótese de que a conformação de um sistema de saúde híbrido, no qual o setor privado mantém o público aprisionado pela sua lógica de acumulação ao que chamamos de Minotauro da saúde guarda relações com as estratégias políticas adotadas, logicamente condicionadas pela dominância do capital financeiro e pelos limites estruturais do Estado Brasileiro. / The capitalist crisis that the world is currently undergoing, with the dismantling of the European welfare-state alerts us to analyze more deeply our country and try to understand the trajectory of its social policies, notably the SUS. If it is true that the strategic horizon of the Brazilian Health Reform is downgraded to mere administrative reform - but that would result in the SUS - today we realize that even this was downgraded to \"SUS as possible.\" Some limitations/choices made in the theoretical framework and political strategy are analyzed - not being the only elements - contributed to the removal of strategic objectives, including the so-called Dilemma Reformer. From the rescue of theoretical health sector benchmarks and Marxist literature in which they are based, fundamentally Gramsci, will be built-critical interpretation under the light of the process of its historical results, conditioned by the internationals policies arenas and the dispute of political projects in Brazil. It presents the hypothesis that the formation of a hybrid health system in which the private sector keeps the public sector trapped by its accumulation logic - to what we call health Minotaur - keep relations with the political strategies adopted, logically conditioned by dominance of finance capital and the structural limits of the Brazilian State.

A crise capitalista pela qual o mundo passa atualmente, com o desmonte dos estados de bem-estar social europeus, nos acende o alerta para analisar com maior profundidade o nosso País e tentar compreender os rumos das suas políticas sociais, notadamente do SUS. Se é verdade que o horizonte estratégico da Reforma Sanitária Brasileira se rebaixou à mera reforma administrativa mas que resultaria no SUS hoje percebemos que mesmo este foi rebaixado ao SUS Possível. São analisadas algumas limitações/escolhas feitas no âmbito teórico e de estratégia política que não sendo os únicos elementos contribuíram para o afastamento dos objetivos estratégicos, entre elas o chamado Dilema Reformista. A partir do resgate de referenciais teóricos do setor saúde e da literatura marxista na qual se baseiam, fundamentalmente gramsciana, construir-se-á uma interpretação crítica do processo à luz dos seus resultados históricos, condicionados pelas arenas políticas internacionais e pela disputa de projetos políticos no Brasil. Apresenta-se a hipótese de que a conformação de um sistema de saúde híbrido, no qual o setor privado mantém o público aprisionado pela sua lógica de acumulação ao que chamamos de Minotauro da saúde guarda relações com as estratégias políticas adotadas, logicamente condicionadas pela dominância do capital financeiro e pelos limites estruturais do Estado Brasileiro. / The capitalist crisis that the world is currently undergoing, with the dismantling of the European welfare-state alerts us to analyze more deeply our country and try to understand the trajectory of its social policies, notably the SUS. If it is true that the strategic horizon of the Brazilian Health Reform is downgraded to mere administrative reform - but that would result in the SUS - today we realize that even this was downgraded to \"SUS as possible.\" Some limitations/choices made in the theoretical framework and political strategy are analyzed - not being the only elements - contributed to the removal of strategic objectives, including the so-called Dilemma Reformer. From the rescue of theoretical health sector benchmarks and Marxist literature in which they are based, fundamentally Gramsci, will be built-critical interpretation under the light of the process of its historical results, conditioned by the internationals policies arenas and the dispute of political projects in Brazil. It presents the hypothesis that the formation of a hybrid health system in which the private sector keeps the public sector trapped by its accumulation logic - to what we call health Minotaur - keep relations with the political strategies adopted, logically conditioned by dominance of finance capital and the structural limits of the Brazilian State.

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.

Title from second page of PDF document. Includes bibliographical references (p. 228-234).

A presente dissertação analisa a implementação do Processo Transexualizador no âmbito do Sistema Único de Saúde (SUS), à luz do ideário do Movimento de Reforma Sanitária e de uma perspectiva histórica da política de saúde pública brasileira, detendo-se nas particularidades do Estado do Rio de Janeiro. Discutem-se alguns aspectos da transexualidade relacionados à esfera pública e à efetiva materialização dos direitos da população LGBT, em particular o acesso à saúde de pessoas transexuais. O recorte temporal compreende o período de 1970, quando se iniciam as primeiras cirurgias de transgenitalização no Brasil, a 2008, ano das portarias que instituíram o referido processo. Como instrumentos e técnicas de investigação qualitativa, foram privilegiados o trabalho de campo e a entrevista semiestruturada, tendo sido entrevistados(as) profissionais que atuaram em instituições de saúde que dispunham de programas voltados especificamente à população transexual no Estado do Rio de Janeiro e usuários(as) atendidos(as) por estas instituições. Diante do cenário de discriminação e estigma, muitas vezes fruto do desconhecimento e de informações deturpadas sobre transexualidade, pretende-se conferir maior visibilidade às demandas por direitos de pessoas transexuais, evidenciando a complexidade de tais demandas, bem como as fragilidades do modelo de atenção à saúde subjacente aos mencionados programas. Pretende-se, ainda, contribuir para o fomento da produção acadêmica do Serviço Social, relativamente limitada nesta área. / This dissertation examines the implementation of the sex reassignment process in the Unified Health System (SUS), from the ideals of the Health Reform Movement and a historical perspective of the Brazilian public health policy, focusing on the particularities of the State of Rio de Janeiro. Some aspects of transsexuality related to the state's sphere and to the effective realization of the rights of the LGBT population are discussed, particularly the access to health care for transsexual people. The time frame covers the period from 1970, when the first reassignment surgeries were started in Brazil, and 2008, when such process was officially instituted. The applied methodology favored, as tools and techniques of qualitative research, were fieldwork and semi structured interview with professionals who have worked in the health institutions that had programs geared specifically to transsexual population in the State of Rio de Janeiro and users of health services of these programs. In this scenario of discrimination and stigma, often the result of ignorance and misrepresented information about transsexuality, it is intended to give greater visibility to the health demands of transsexuals, showing the complexity of such demands as well as the weaknesses of the model of healthcare behind the aforementioned programs. It is also intended to contribute to the fomentation of academic production of Social Work, which is relatively limited in this area.

Made available in DSpace on 2014-12-17T15:46:24Z (GMT). No. of bitstreams: 1 MonicaMRN_DISSERT.pdf: 2365239 bytes, checksum: ee4f78ae549113c89a3d87843b87b283 (MD5) Previous issue date: 2011-09-29 / This study aimed to analyze the work of social workers at the Hospital Universit?rio Onofre Lopes (HUOL), with the analytical approach the contracting process with the HUOL with the National Health System (SUS), which is set from 2004. Thus, this study sought in times of state reform, restructuring and tension between enlargement / reduction of social and labor rights, understanding the limits and possibilities of social work in HUOL, analyzing how these determinations bounce in the practice of social workers included in the collective process of health work. From a theoretical and methodological historical and dialectical materialism, we conducted literature search, in which developed book report and readings of texts, articles, books that focus on the central categories of the study, namely: Work, Social Work, Health, Health Reform , Project ethical and professional politician. Operationalized also a documentary research, on the Brazilian Public Health Policy, (SUS) and of the Education, as well as research field in which we conducted interviews with 11 social workers, employees packed the HUOL. We conclude that social workers did not participate in the discussion process of contracting the HUOL with the Municipal Health Secretariat of Natal, RN, manager of health and full resetting of user access, via reference setting - counter-referral services provided by the hospital brought the main demands on Social Work guidance regarding the functionality of SUS, and the social intervention in the struggle to guarantee such access. However, the data show that the expansion of demands that require the intervention of the social worker at HUOL is not associated with quantitative growth of these professionals need. Such conditions inflect the possibilities of materialization of the professional ethical-political project, even though that these professionals worry and seek the intellectual improvement, quality of service and to guarantee the social rights of users in the professional practice everyday / Esta pesquisa buscou analisar o trabalho dos assistentes sociais, no Hospital Universit?rio Onofre Lopes (HUOL), tendo como recorte anal?tico o processo de contratualiza??o do HUOL com o Sistema ?nico de Sa?de (SUS), que se configurou, a partir de 2004. Assim, este estudo procurou apreender os limites e possibilidades do trabalho do assistente social no HUOL, analisando como as determina??es deste tempo de reforma do Estado, reestrutura??o e tens?o entre amplia??o/redu??o dos direitos sociais e trabalhistas, rebatem no exerc?cio profissional dos assistentes sociais inseridos no processo coletivo de trabalho em sa?de. A partir de um referencial te?rico-metodol?gico materialista hist?rico e dial?tico, realizamos pesquisa bibliogr?fica, na qual desenvolvemos leituras e fichamentos de textos, artigos, livros, que enfocassem as categorias centrais do estudo, quais sejam: Trabalho, Servi?o Social, Sa?de, Reforma Sanit?ria, Projeto ?tico-pol?tico profissional. Operacionalizamos, tamb?m, uma pesquisa documental, acerca da Pol?tica de Sa?de P?blica, SUS e de Educa??o, bem como pesquisa de campo, na qual realizamos entrevistas com 11 assistentes sociais, lotadas no quadro de pessoal do HUOL. Conclu?mos que as assistentes sociais n?o participaram do processo de discuss?o da contratualiza??o do HUOL, com a Secretaria Municipal de Sa?de de Natal, RN, gestor pleno de sa?de e que a redefini??o do acesso dos usu?rios, via regula??o de refer?ncia contra refer?ncia aos servi?os disponibilizados pelo hospital trouxe como principais demandas ao Servi?o Social as orienta??es a respeito da funcionalidade do SUS, bem como a interven??o do assistente social na luta pela garantia deste acesso. Por?m, os dados mostram que a amplia??o das demandas que requerem a interven??o do assistente social do HUOL est? comprometida em virtude da redu??o desses profissionais, fato que se agravou nos ?ltimos dezesseis anos. Tais condi??es inflexionam as possibilidades de materializa??o do projeto ?tico-pol?tico profissional, mesmo que estas profissionais se preocupem e busquem o aprimoramento intelectual, a qualidade do servi?o prestado e a garantia dos direitos sociais dos usu?rios

A presente dissertação analisa a implementação do Processo Transexualizador no âmbito do Sistema Único de Saúde (SUS), à luz do ideário do Movimento de Reforma Sanitária e de uma perspectiva histórica da política de saúde pública brasileira, detendo-se nas particularidades do Estado do Rio de Janeiro. Discutem-se alguns aspectos da transexualidade relacionados à esfera pública e à efetiva materialização dos direitos da população LGBT, em particular o acesso à saúde de pessoas transexuais. O recorte temporal compreende o período de 1970, quando se iniciam as primeiras cirurgias de transgenitalização no Brasil, a 2008, ano das portarias que instituíram o referido processo. Como instrumentos e técnicas de investigação qualitativa, foram privilegiados o trabalho de campo e a entrevista semiestruturada, tendo sido entrevistados(as) profissionais que atuaram em instituições de saúde que dispunham de programas voltados especificamente à população transexual no Estado do Rio de Janeiro e usuários(as) atendidos(as) por estas instituições. Diante do cenário de discriminação e estigma, muitas vezes fruto do desconhecimento e de informações deturpadas sobre transexualidade, pretende-se conferir maior visibilidade às demandas por direitos de pessoas transexuais, evidenciando a complexidade de tais demandas, bem como as fragilidades do modelo de atenção à saúde subjacente aos mencionados programas. Pretende-se, ainda, contribuir para o fomento da produção acadêmica do Serviço Social, relativamente limitada nesta área. / This dissertation examines the implementation of the sex reassignment process in the Unified Health System (SUS), from the ideals of the Health Reform Movement and a historical perspective of the Brazilian public health policy, focusing on the particularities of the State of Rio de Janeiro. Some aspects of transsexuality related to the state's sphere and to the effective realization of the rights of the LGBT population are discussed, particularly the access to health care for transsexual people. The time frame covers the period from 1970, when the first reassignment surgeries were started in Brazil, and 2008, when such process was officially instituted. The applied methodology favored, as tools and techniques of qualitative research, were fieldwork and semi structured interview with professionals who have worked in the health institutions that had programs geared specifically to transsexual population in the State of Rio de Janeiro and users of health services of these programs. In this scenario of discrimination and stigma, often the result of ignorance and misrepresented information about transsexuality, it is intended to give greater visibility to the health demands of transsexuals, showing the complexity of such demands as well as the weaknesses of the model of healthcare behind the aforementioned programs. It is also intended to contribute to the fomentation of academic production of Social Work, which is relatively limited in this area.

Inhabitants´ Opinions to the Health Service Problems in the Czech Republic The diploma thesis {\clqq}Inhabitants´ Opinions to the Health Service Problems in the Czech Republic`` deals with the problems of the Czech health service. The theoretic part treats of the definitions of the main terms, legislative framework, state health service policy, public health insurance, public finances reform and first of all treats of the new Act on Public Budget Stabilization n. 261/2007 Law Code, effective from January 1st, 2008. Recently there have been discussed the Czech health service problems within the context of publication of the health service reform. The implementation of the regulation fees evokes the atmosphere of disagreement and fear from financial non-capacity in the inhabitants resulting from the fees implementation on particular items of health care. It is necessary to realize that there have been health service problems all the time. But this situation doesn´t apply to the Czech Republic solely. Quite a number of states have to solve the problems and shortcomings of the health service system. To point out these problems, to find out the cause but first of all to find the ways to deal and eliminate problems should be the main objective of the state. The Czech health service needs badly the alternation. It has to tackle the 21st century challenges and at the same time to continue in european tradition which is based on the availibility of health care for all our inhabitants. There are no doubts that population ageing, new medical procedures, services quality requirements and the possibility of co-determination will lead to the significant changes of financing and organization of the health service all over the world. (18) The aim of the diploma thesis is to survey the ideas applying to the health service problems in the Czech Republic by the inhabitants over 18 years old living in Nachod region. In the framework of quantitative research there were used the questioning method (questionnaire) and the method of document analysis (the technique of secondary data analysis). The diploma thesis {\clqq}Inhabitants´Opinion to the Health Service Problems in the Czech Republic`` tries to illustrate comprehensive aspect of the general public to the Czech health service and challenge to study this problem.

Mental health has been receiving increasing amounts of attention in recent years. Despite this, there are still many barriers to receiving mental health care in all parts of the world. Post-conflict countries have the dual challenge of increased mental health problems among their populations and trying to respond to these problems with low resources as their economies are often destroyed by the effects of war. This research studies the implementation of Rwanda’s post-genocide mental health policy to assess the challenges and best practises of implementing mental health reform in a low-resource, post-conflict country. The thesis found that the implementation of Rwanda’s mental health policy has relied on policies of rapid decentralization and integration to increase accessibility to mental health care. Decentralization has ensured that mental health services are available at every level and relies on a referral system. Mental health care is integrated into the general healthcare system by training generalists in hospitals and health centres to respond to mental health issues, therefore making these services available at nearly all health institutions. These policies were viewed positively by stakeholders, but there were still many gaps and challenges in the implementation of Rwanda’s mental health policy. One of the major challenges was stigma acting as a barrier to accessing services while one of the largest gaps was that the implementation relies too much on institutionalized, individualized, and Westernized care, which participants pointed out is not always suitable in the Rwandan context. Recommendations included an increase in sensitization campaigns, shifting towards community-based mental health care, expanding personnel and services, as well as increasing funding. The analysis, relying on complexity theory, found that many of the gaps are missed by the government because of a lack of collaboration with local organizations and service providers working in the domain.

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation.