A garantia do acesso dos usuários do Sistema Único de Saúde (SUS) em todos os níveis de atenção em tempo adequado e a criação de fluxos de assistência à saúde que opere de forma sincronizada são uns dos grandes desafios do SUS. O HCFMRP-USP oferta serviços de nível terciário dentro do sistema, sendo referência dentro de sua Regional de Saúde trabalha para otimizar suas vagas ofertadas aos Departamentos Regionais de Saúde e absorver o maior número possível de pacientes que necessitam de atendimento terciário. Objetivo: Avaliar o aproveitamento das vagas de consultas para novos pacientes ofertadas pelo HCFMRP - USP aos Departamentos Regionais de Saúde de sua região de abrangência, no período de 2006 a 2014. Metodologia: Foi realizado um estudo descritivo com dados secundários do banco de dados do HCFMRP-USP, a partir das informações do Serviço de Agendamento e Controle de Pacientes Ambulatoriais. Foram calculadas no período de 2006 até 2014, a Taxa de Agendamento, Taxa de Falta, Taxa de adequação da Referência e Taxa de Aproveitamento Global. Resultados: A taxa geral de agendamento foi 76%, a taxa de falta de pacientes novos teve a média de 17%, a Taxa média de Adequação da Referência foi de 92%. A taxa de aproveitamento global foi 57%, ano de 2014 das 37.830 vagas disponibilizadas pelo HCRP apenas 21.170 foram efetivamente aproveitadas. CONCLUSÕES: As iniciativas para o HCFMRP-USP se consolidar como um hospital terciário vem sendo gradativamente concretizadas, todas as taxas avaliadas tiveram uma melhora significativa se compararmos com o estudo anteriormente realizado que avaliou os anos de 2000-2005, mas ainda existem muitos desafios. Os gestores precisam avaliar os dados e buscarem mudanças em suas práticas de gestão, sendo necessários investimentos na formação recursos humanos e na integração entre gestores para que seja possível o integral aproveitamentos das vagas disponibilizadas. / Ensuring access of users of the Unified Health System (UHS) at all levels of care in a timely manner and the creation of health care flows that operate synchronously are one of the great challenges of UHS. The HCFMRP-USP offers tertiary services within the system, being a reference within its Regional Health activity to optimize their vacancies offered to the Regional Health Departments and the largest possible number of patients who need tertiary care. Objective: Evaluate the use of vacancies consultations for new patients offered by HCFMRP - USP to Regional Departments of Health within the respective coverage area in the period 2006-2014. Methodology: A descriptive study of secondary data from HCFMRP- USP database was conducted from information of the Scheduling and Ambulatory Patient Control Service. There were calculated in the period of 2006 until 2014: the Schedule Rate, Lack Rate, Adequacy Rate Reference and Global Utilization Rate. Results: The overall Schedule Rate was 76%, the Lack Rate of new patients had an average of 17%, the average Reference Adequacy Rate 92%. The Global Utilization Rate was 57%, in the year of 2014 37,830 vacancies provided by HCFMRP-USP only 21,170 were actually utilized. Conclusions: The initiatives for HCFMRP-USP consolidate as a tertiary hospital has been gradually implemented, all measured rates had a significant improvement when compared to the previously conducted study that evaluated the years 2000-2005, but there are still many challenges. Managers need to evaluate the data and seek changes in their management practices and the necessary investments in training human resources and integration of managers for the full exploitations of available vacancies is possible.

As Unidades de Atenção Primária à Saúde (APS) devem ser a principal porta de entrada para o Sistema Único de Saúde (SUS). O objetivo deste estudo foi analisar acesso dos usuários do SUS às unidades de APS a partir de três dimensões: disponibilidade, acessibilidade e aceitabilidade. Trata-se de um estudo de caso com múltiplas abordagens realizado na Região de Saúde de Barretos, São Paulo. A investigação foi pautada em três aspectos que influenciam o acesso: fatores do sistema de saúde, percepção dos gestores e dos usuários. As fontes de evidências utilizadas foram dados secundários, análise espacial das unidades de APS com auxílio de Sistema de Informação Geográfica (GIS), entrevista com gestores da pesquisa Política, Planejamento e Gestão das Regiões e Redes de Atenção à Saúde no Brasil e entrevista com usuários do Programa Nacional de Melhoria de Acesso e da Qualidade da Atenção Básica. Os principais achados na dimensão da disponibilidade foram que o número da unidade de APS está de acordo com o recomendado pelo Ministério da Saúde. De acordo com os gestores nas unidades, há falta de integração entre os serviços e os médicos, que estão centrados nos principais centros urbanos da região. Para os usuários, o tempo de espera está dentro das expectativas. Na acessibilidade, a distribuição geográfica das unidades está adequada na maior parte dos municípios, onde os usuários realizam o trajeto em até 10 minutos e consideram como sendo fácil ou muito fácil o acesso, mas a maioria dos gestores desconhecem critérios de distribuição geográfica dos recursos. Na aceitabilidade, grande parte dos usuários aceita o cuidado recebido pelos profissionais de saúde das unidades de APS. O acesso às unidades de APS na região de Barretos revelou resultados positivos, porém a maior parte não possui ocupação profissional. Nos achados, fica evidenciada a necessidade dos gestores públicos aprimorarem a gestão em alguns aspectos como introdução de sistema de informação para agendamento de consultas, ampliação do horário de atendimento, utilização de SIG, pois permite a identificação de áreas mais vulneráveis e aquelas que necessitam de investimentos - e a melhoria na comunicação para que a população entenda o papel das unidades de APS para a prevenção e promoção à saúde, as quais possam se efetivar como coordenadoras do cuidado das Redes de Atenção à Saúde (RAS). A APS fortalecida permite que o sistema se organize nos três níveis da atenção, obtenha melhor desempenho no planejamento das ações, otimize os recursos e contribua para a melhoria das condições de vida da população na região / The Units of Primary Health Care (PHC) must be the main gateway to the Unified Health System (SUS). This study aims to analyze the access from users to PHC through three dimensions: availability, accessibility and acceptability. This is a case study with multiple approaches which took place in the region of Barretos, São Paulo. The research was focused considering three aspects that can influence the access: health systems factors, the perception of health professionals and users. The sources of evidence used were secondary data, spatial analyses of the Primary Care Center (PCC) using the Geographic Information System (GIS), interviews with the managers from the research Regions and Health Care Network and with users of the National Program to Improve Access and Quality of Primary Care . The main findings in the dimension of availability were that the number of units of PCC is according to the recommendation from the Ministry of Health. According to the units managers, there is a lack of integration between the services and the phisicians that are located in the main urban areas. The waiting time for the users, for scheduling appointments, is according to their expectation. Concerning the accessibility, the geographic location of the units are adequate for users in most counties. Users take about ten minutes to arrive to the units. They consider the access to it to be easy or very easy, but managers dont know the geographical location criteria for the resources. Regarding acceptability most users accept the Health Care Services, in the PHC. The access to the units in Barretos region had positive results, therefore most of the users dont have a professional occupation. It was evident in the findings the need for public managers to improve some management aspects, like to implement a new information system for scheduling appointments, extension of operation hours to the users, the utilization of a GIS, which can identify the more vulnerable areas, the ones that needs financial investments and improvement in communication, so that the population understands the role of the PHC units to prevent, promote and protect health, which can be effective as coordinators for the care of the Health System Network. The robust PHC allows the organization of the system on three health care levels, achieving a better performance on planning its action, optimizing the resources and contributing to the a better well-being for the population on its region

A garantia do acesso dos usuários do Sistema Único de Saúde (SUS) em todos os níveis de atenção em tempo adequado e a criação de fluxos de assistência à saúde que opere de forma sincronizada são uns dos grandes desafios do SUS. O HCFMRP-USP oferta serviços de nível terciário dentro do sistema, sendo referência dentro de sua Regional de Saúde trabalha para otimizar suas vagas ofertadas aos Departamentos Regionais de Saúde e absorver o maior número possível de pacientes que necessitam de atendimento terciário. Objetivo: Avaliar o aproveitamento das vagas de consultas para novos pacientes ofertadas pelo HCFMRP - USP aos Departamentos Regionais de Saúde de sua região de abrangência, no período de 2006 a 2014. Metodologia: Foi realizado um estudo descritivo com dados secundários do banco de dados do HCFMRP-USP, a partir das informações do Serviço de Agendamento e Controle de Pacientes Ambulatoriais. Foram calculadas no período de 2006 até 2014, a Taxa de Agendamento, Taxa de Falta, Taxa de adequação da Referência e Taxa de Aproveitamento Global. Resultados: A taxa geral de agendamento foi 76%, a taxa de falta de pacientes novos teve a média de 17%, a Taxa média de Adequação da Referência foi de 92%. A taxa de aproveitamento global foi 57%, ano de 2014 das 37.830 vagas disponibilizadas pelo HCRP apenas 21.170 foram efetivamente aproveitadas. CONCLUSÕES: As iniciativas para o HCFMRP-USP se consolidar como um hospital terciário vem sendo gradativamente concretizadas, todas as taxas avaliadas tiveram uma melhora significativa se compararmos com o estudo anteriormente realizado que avaliou os anos de 2000-2005, mas ainda existem muitos desafios. Os gestores precisam avaliar os dados e buscarem mudanças em suas práticas de gestão, sendo necessários investimentos na formação recursos humanos e na integração entre gestores para que seja possível o integral aproveitamentos das vagas disponibilizadas. / Ensuring access of users of the Unified Health System (UHS) at all levels of care in a timely manner and the creation of health care flows that operate synchronously are one of the great challenges of UHS. The HCFMRP-USP offers tertiary services within the system, being a reference within its Regional Health activity to optimize their vacancies offered to the Regional Health Departments and the largest possible number of patients who need tertiary care. Objective: Evaluate the use of vacancies consultations for new patients offered by HCFMRP - USP to Regional Departments of Health within the respective coverage area in the period 2006-2014. Methodology: A descriptive study of secondary data from HCFMRP- USP database was conducted from information of the Scheduling and Ambulatory Patient Control Service. There were calculated in the period of 2006 until 2014: the Schedule Rate, Lack Rate, Adequacy Rate Reference and Global Utilization Rate. Results: The overall Schedule Rate was 76%, the Lack Rate of new patients had an average of 17%, the average Reference Adequacy Rate 92%. The Global Utilization Rate was 57%, in the year of 2014 37,830 vacancies provided by HCFMRP-USP only 21,170 were actually utilized. Conclusions: The initiatives for HCFMRP-USP consolidate as a tertiary hospital has been gradually implemented, all measured rates had a significant improvement when compared to the previously conducted study that evaluated the years 2000-2005, but there are still many challenges. Managers need to evaluate the data and seek changes in their management practices and the necessary investments in training human resources and integration of managers for the full exploitations of available vacancies is possible.

Thesis (M. Dev) -- University of Limpopo, 2013 / Refer to document

Thesis (LLM. (Labour Law)) -- University of Limpopo, 2013 / The South African government gazzetted the Green Paper introducing the NHI on 12 August 2012. This policy seeks to progressively realize the right of access to quality health care services for everyone. Those who cannot provide for themselves will be assisted by government at the expense of the elite. The NHI was first recommended by the Taylor Commission and it has been under the discussion since then. Since this announcement, there has been growing pressure for mandatory health insurance to be included in the development of a comprehensive social security system, as was envisaged by the Taylor Committee of Inquiry. This discussion was further debated at the 52nd conference of the African National Congress (ANC) in Polokwane in December 2007 where numerous resolutions were taken with regard to the NHI. The Freedom Charter of 1955 and also section 27 and 28 also provided some guidance.

Ongoing research in the fields of genetics and biotechnology hold the promise of improved diagnosis and treatment of genetic diseases, and potentially the development of individually tailored pharmaceuticals and gene therapies. Difficulty, however, arises in determining how these services are to be evaluated and integrated equitably into public health care systems such as Canada's. The current context is one of increasing fiscal restraint on the part of governments, limited financial resources being dedicated to health care, and rising costs for new health care services and technologies. This has led to increasing public debate in the last few years about how to reform public health care, and whether we should prohibit, permit or perhaps even encourage private purchase of health care services. In Canada, some of these concerns have crystallized around the issue of gene patents and commercial genetic testing, in particular as illustrated by the case of Myriad Genetics' patented BRACAnalysis test for hereditary breast and ovarian cancer. While most Canadians who currently access genetic services do so through the public health care system, for those with the means, private purchase is becoming an option. This situation raises serious concerns - about justice in access to health care; about continued access to safe and reliable genetic testing supported by unbiased patient information; and about the broader effects of commercialization for ongoing research and the Canadian public health care system. Commercial genetic testing presents a challenge to health care professionals, policy analysts, and academics concerned with the social, ethical and policy implications of new genetic technologies. Using the Myriad case as an exemplar, tools from moral philosophy, the social sciences, and health policy and law will be brought to bear on the larger issues of how as a society we should regulate commercial research and product development, and more coherently decide which services to cover under public health insurance and which to leave to private purchase. Generally, the thesis is concerned with the question of "how best to bring capital, morality, and knowledge into a productive and ethical relationship" (Rabinow 1999, 20).

Vertinant sveikatos priežiūros paslaugų kokybę, svarbu yra įvertinti kaip patys pacientai vertina įvairius sveikatos priežiūros paslaugų elementus – nuo sveikatos priežiūros organizavimo, prieinamumo iki pačių sveikatos priežiūros paslaugų, gydytojo ar slaugytojo vertinimo. Nemažiau svarbi ir mediko nuomonė, nes pacientas vertina daugiau subjektyviai, per savo lūkesčius, o medikas vertina daugiau objektyviai, geriau žinodamas sveikatos priežiūros sistemos ar naujų technologijų galimybes. Habilitacijos procedūrai teikiamų mokslo darbų apžvalgoje nagrinėta 21 mokslinė publikacija. Pacientų nuomonė apie sveikatos priežiūros paslaugas nagrinėta pagal respondentų socialines – demografines chrakteristikas, jų gyvenamąją vietą. Nagrinėta vyresnio amžiaus žmonių nuomonė apie sveikatos priežiūros paslaugas. Sveikatos priežiūros paslaugos įvertintos ir medikų požiūriu pagal darbo vietos chrakteristiką ir pagal sveikatos priežiūros įstaigos geografinę padėtį. Apžvalgoje nagrinėtas vairuotojų sveikatos tikrinimo tvarkos efektyvumas, informacinių technologijų poreikis Lietuvos asmens sveikatos priežiūros įstaigose. Pacientų įtraukimas į sveikatos priežiūros paslaugų vertinimą pateikia vertingą informaciją apie sveikatos priežiūros sistemos silpnąsias ir stipriąsias puses. Dauguma respondentų sveikatos priežiūros įstaigų darbą vertina teigiamai. Blogai sveikatos priežiūros įstaigų darbą vertina tik 5,1 % respondentų. Visų socialinių – demografinių grupių atstovai nurodo, kad... [toliau žr. visą tekstą] / Evaluation of the quality of health care services is important from the viewpoint of both providers as well as receivers of those services. Patient’s perspective includes the evaluation of all the parts of the process- from accessibility and other organizational issues to personal collaboration with physicians and nurses. On the other hand, the health care professionals evaluate the same services from inside the system, with better understanding the health care delivery process and possibilities of the system. 21 scientific publications have been included into the Habilitation thesis. Patients’ opinion concerning the health care services has been evaluated according to the patient’s social and demographic characteristics, their place of living and other variables. This also included evaluation of opinions of elderly patients concerning the services they receive. Evaluation of opinions of health care professionals has been made according to the characteristics of the institutions, their locality and specialty of respondents. Part of the materials is evaluation of efficiency of professional health checks of drivers, which is a common procedure in health care institutions. Evaluation of patient opinions about health care services provides important information for improvement of the quality of health care services. Majority of respondents evaluate health care services positively. 5,1% of respondents evaluate health care services as unsatisfactory. Respondents of all social... [to full text]

There is strong evidence from developing countries to support the hypothesis that physical accessibility of health services, particularly absolute distance from clinics, is a major determinant of health service utilization and health status. In South Africa, such evidence is very limited and as a result the relationship between absolute distance and health service utilization and health status is not fully understood. As an attempt to understand this relationship, a household survey of mothers with children aged 12-23 months was conducted in a rural district of KwaZulu-Natal province, South Africa. Maternal and child health (MCH) service utilisation and MCH status patterns were then compared at different absolute distances from PHC clinics. The find ings reveal that the study population is characterised by impoverished living conditions (86%), high functional illiteracy (67%), high fertility and unemployment rates . In comparison with other studies conducted previously in the same population, MCH service utilization rates are high. Based on mean distances of homesteads from PHC clinics in the entire study area before the Clinic Upgrading and Building Programme it has been concluded that the physical accessibility of fixed PHC clinics, when compared with the WHO recommendations, was suboptimal. When this assessment is based on clinic usage patterns, it is found that clinic usage decreased from 86.4% at 0-5 km to 79% at 6-10 km with a dramatic decrease to 37.8% at distances beyond 10 km. This decrease in usage at distances above 5 km translates into a considerable reduction in effective coverage of the target population by PHC clin ic services if it is considered that above 50% of the population live greater than 5 km from these clinics. An assessment of the effect of distance of homesteads from PHC clinics on specific MCH service utilization and MCH status has found very few or no significant differences between mothers and children living at 0-5 km, 6-10 km or > 10 km from these clinics. This observation is consistent even after adjustment for the effects of potential confounding. The fact that distance from clin ics has little or no effect on the indicators of MCH service utilization and MCH status is counter-intuitive. A few explanations can be provided. These include the fact that only 50% of the population, even in one of the most rural parts of South Africa access clinics on foot. Since the traditional assumption has been that this distance effect is a function of straight-line walking distances between homesteads and clinics, Euclidian distances alone may be a poor explanatory variable for health service utilization. Furthermore, if the hypothesis is valid that health status is a function of service utilization, it may also be a poor explanatory variable for health status of community members who are reliant on these services. Secondly, based on data from other sources, there is evidence that there have been steady declines in both mortality and fertility rates in the study population over the past 10-20 years suggesting that client communities are already benefiting quite substantially from health services in general and from MCH services in particular in spite of residual distance barriers. In other words, this distance effect on service utilization and health status may be more evident in populations with much higher background infant, child and maternal mortality rates. Thirdly, it is also possible that distance effect still exists, but that methodological limitations prevented this study from showing this effect. For instance, the fact that people use mobile clinics for some MCH services may have confounded the effect of distance from fixed clinics. It is also possible that people use different facilities for different services even though they are further away, and the assumption that all facilities have equal attraction for clients and that the only determinant of use is distance may be flawed. For example, it is evident from this and from other studies in South Africa that whereas most clients use fixed clinics for vaccinations, deliveries are now increasingly conducted at hospitals. Other methodological issues include the fact that certain health outcomes such as stunting are not an exclusive reflection of health service inputs, but are a function of social and economic determinants. Based on these findings, a number of recommendations are made. / Thesis (Ph.D.)-University of Natal, Durban, 2004.

But : La radiothérapie (RT) est disponible seulement dans les grandes villes au Québec. Les patients atteints de cancer vivant en zone rurale doivent voyager pour obtenir ces soins. Toute proportion gardée, moins de ces patients accèdent à la RT. L’accessibilité serait améliorée en instaurant de petits centres de RT qui dépendraient de la télémédecine (téléRT). Cette étude tente (1) de décrire un modèle (population visée et technologie) réaliste de téléRT; (2) d’en estimer les coûts, comparativement à la situation actuelle où les patients voyagent (itineRT). Méthode : (1) À l’aide de données probantes, le modèle de téléRT a été développé selon des critères de : faisabilité, sécurité, absence de transfert des patients et minimisation du personnel. (2) Les coûts ont été estimés du point de vue du payeur unique en utilisant une méthode publiée qui tient compte des coûts en capitaux, de la main d’oeuvre et des frais généraux. Résultats : (1) Le modèle de téléRT proposé se limiterait aux traitements palliatifs à 250 patients par année. (2) Les coûts sont de 5918$/patient (95% I.C. 4985 à 7095$) pour téléRT comparativement à 4541$/patient (95%I.C. 4351 à 4739$) pour itineRT. Les coûts annuels de téléRT sont de 1,48 M$ (d.s. 0,6 M$), avec une augmentation des coûts nets de seulement 0,54 M$ (d.s. 0,26 M$) comparativement à itineRT. Si on modifiait certaines conditions, le service de téléRT pourrait s’étendre au traitement curatif du cancer de prostate et du sein, à coûts similaires à itineRT. Conclusion : Ce modèle de téléRT pourrait améliorer l’accessibilité et l’équité aux soins, à des coûts modestes. / Purpose: Radiotherapy (RT) is centralized in urban areas in Quebec. Patients with cancer living in remote areas must travel to receive RT, and the proportion of RT patients is inferior to that of urban patients. Telemedicine could allow a minimally staffed RT unit to operate at reasonable costs in a rural setting. This study aims (1) to outline a feasible structure and target population for a tele-radiotherapy unit (teleRT); and (2) to estimate the costs of teleRT, compared to the current situation based on travel to urban centres (travelRT). Methods and Materials: (1) We developed an evidence-based teleRT model meeting the criteria of: feasibility & safety, elimination of patient travel, and minimisation of staff migration. (2) Costs were estimated from the public payor perspective using a previously published activity-based costing model for RT. The model included annualized capital costs, labour, and overhead. Results: (1) In our model, teleRT was restricted to 250 palliative care patients per year. (2) The public payor cost of teleRT was 5918$/patient (95% C.I. 4985 to 7095$) as compared to 4541$/patient (95%C.I. 4351 to 4739$) for travelRT. Yearly costs of the teleRT unit was 1,48 M$ (s.d. 0,6 M$), with a net cost increase to the payor of 0,54 M$ (s.d. 0,26 M$) compared to travelRT. Under less stringent conditions, breast and prostate cancer patients could also benefit from teleRT at similar costs to travelRT. Conclusion: Establishing a teleRT unit to treat a small rural population of palliative care patients results in a modest net increase in cost to the public payor and could lead to increased accessibility and equity.

Thesis (MMed) -- Stellenbosch University, 2010. / Bibliography / Objectives: To describe the establishment of a colposcopy service in a district hospital in a rural sub-district and to assess its impact on the uptake of colposcopy. Design: A retrospective double group cohort study using a laboratory database of cervical cytology results, clinical records and colposcopy clinic registers. Setting: The Overstrand sub-district in the Western Cape: 80 000 people served by 7 clinics and a district hospital in Hermanus, 120 km from its referral hospitals in Cape Town and Worcester. A colposcopy service was established at Hermanus Hospital in 2008. Subjects: All women in the Overstrand sub-district who required colposcopy on the basis of cervical smears done in 2007 and 2009. Outcome measures: The number of women booked for colposcopy at distant referral hospitals in 2007 and at the district hospital is 2009, the proportion of those women who attended colposcopy, the time from cervical smear to colposcopy, comparison between the two years. Results: The uptake of colposcopy booked for distant referral hospitals was 67% in 2007. The uptake improved by 18% to 79% for the local district hospital colposcopy service in 2009 (p=0.06). When analysed excluding patients from an area with no transport to the district hospital, the improvement was more marked at 22% (p=0.02). The delay from cervical smear to colposcopy improved significantly from 170 to 141 days (p=0.02). Conclusion: The establishment of a colposcopy service in a rural sub-district increased the uptake of colposcopy and decreased the delay from cervical smear to colposcopy. This district hospital colposcopy service removed 202 booked patients in one year from the colposcopy load of its referral hospitals.