Mental illness in the United States is a major public health problem. According to the Substance Abuse and Mental Health Services Administration, in 2017, 18.9% of adults in the United States had a mental illness. The purpose of this study was to gain insight into the perceptions held by community health workers (CHWs) regarding their integration into the behavioral health care system in Maryland. Using a social constructivism paradigm and phenomenological approach, a purposive sample of 11 CHWs who supported patients with behavioral health conditions in 17 counties in the state were interviewed. Howlett, McConnell, and Perl'€™s five stream confluence policy process theory and Lipsky's street level bureaucracy theory provided the foundation to explore the perceptions of the CHWs about their integration into the behavioral health care system; the problems, policies, processes, and programs that impacted their ability to be integrated into the behavioral health team; and their function as a street level bureaucrat to facilitate their integration. A deductive iterative coding approach was used, culminating in the identification of the following 6 themes: health system utilization of CHW behavioral health integration, official policy recognition of the CHW profession, accountability for CHW integration, CHW practice support, integrated health care team management of physical and mental health and behavior, and building the CHW profession. The social change implications of this study are that CHWs'€™ integration into the broadly defined, integrated, physical and mental behavioral health team can support having a more cost-effective way toward having healthy people and communities because they link the community to health and social services and advocate for quality care.

SOCIALINIO DIALOGO IR SOCIALINĖS PARTNERYSTĖS VAIDMUO PSICHIKOS SVEIKATOS PRIEŽIŪROS SISTEMOJE. Santrauka. Informacijos visuomenėje, keičiantis visuomeniniams, technologiniams procesams, socialinio dialogo ir socialinės partnerystės vaidmuo didėja visose srityse. Tai ypač aktualu psichikos sveikatos priežiūros srityje, nes visa sistema praranda autonomiškumą ir yra veikiama įvairaus lygio sąveikų, integruojami daugialypiai socialiniai santykiai. Socialinis dialogas ir socialinė partnerystė apima bendradarbiavimą, koordinavimą, konsultavimą, tarpininkavimą, apsikeitimą informacija, teikiant psichikos sveikatos priežiūros paslaugas. Socialinio dialogo ir socialinės partnerystės svarba išryškėjo prasidėjus struktūriniams pokyčiams psichikos sveikatos srityje, nes reformos apima daugiasektorinę politiką, į kurią įtraukiamas platus partnerių ir suinteresuotųjų ratas. Prastas bendradarbiavimas ir koordinavimas tarp teikiamų paslaugų ar skirtingų sektorių finansavimas veda prie prastos ir neefektyvios priežiūros. Tyrimo tezė. Socialinis dialogas ir socialinė partnerystė tampa sudėtine šiuolainės visuomenės dalimi, keičiasi psichikos sveikatos priežiūros problemų sprendimo būdai, įtraukiami nauji metodai ir naujos pagalbos teikimo fomos, tokios kaip socialinių partnerių tinklai, tarpdisciplininis komandinis darbas, stiprinama nevyriausybinių organizacijų ir pačių paslaugų vartotojų bei jų šeimų organizacijų įtaka. Raktažodžiai: socialinis dialogas, socialinė partnerystė, socialinių... [toliau žr. visą tekstą] / THE ROLE OF SOCIAL DIALOGUE AND SOCIAL PARTNERSHIP IN MENTAL HEALTH CARE SYSTEM. Summary. With changes in societal and technical processes, the role of Social dialogue and social partnership in the Information society, have increased in all areas. This issue is crucial while talking about mental health care system. System is loosing its autonomy and is determined by interactions of different levels. Multiple social relations are integrated. Social dialogue in mental health care services include all types of negotiation, coordination, mediation and consultation, starting with the exchange of information. Social dialogue has proved particularly important in situations of structural change and reform in the health sector. Such situations are particularly complex, however, and take a long time to evolve. They involve a wide variety of social partners and stakeholders who have to deal with a long agenda of issues. Insufficient or bad cooperation and coordination between services; single-sector approaches and specific organizational objectives, budgets and activities, leads to ineffective and low quality care services. Thesis. Social dialogue and social partnership becomes a component of modern society. The problems of the mental health care system are solving by using new methods and forms, such as networks of social partners, interdisciplinary team work, capacity-building of NGO and representatives of services users and their families. Keywords. Social dialogue, social... [to full text]

Made available in DSpace on 2014-06-11T19:28:19Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-11-13Bitstream added on 2014-06-13T18:57:20Z : No. of bitstreams: 1 torralbo_fap_me_botfm.pdf: 841128 bytes, checksum: 1051049ae02ad0a1f1564b88b23d7662 (MD5) / Secretaria de Saúde do Estado de São Paulo / Enquanto Supervisora Técnica da área da saúde da Fundação CASA, o interesse pela temática surgiu em decorrência da preocupação com o direito à saúde, garantido por lei. O objetivo da pesquisa foi compreender a percepção da equipe de saúde da Fundação CASA (médicos, enfermeiros e auxiliares de enfermagem) sobre o funcionamento do sistema de referência e contra referência da rede pública de saúde, quando se faz necessário o encaminhamento do adolescente. A metodologia, de caráter qualitativo, utilizou a fenomenologia. As entrevistas áudio-gravadas foram realizadas entre maio e agosto de 2007, após assinatura do termo de consentimento livre e esclarecido. Após as etapas de transcrição, redução e compreensão fenomenológica foram evidenciadas os temas e as categorias e. As categorias são: o acesso ao atendimento à saúde pelo SUS, a condição de ser adolescente em conflito com a lei, o direito à saúde e a organização dos serviços de saúde. Os achados mostram a importância do desenvolvimento de pactuações com os municípios, exigindo maiores responsabilidades dos serviços na formulação de políticas de saúde vinculadas ao adolescente, assim como deve ocorrer para qualquer cidadão. Isto implica, na necessidade de propostas de gestão e melhoria da organização conforme diretrizes e princípios do Sistema Único de Saúde. / As a health care Technical Supervisor for CASA Foundation, the interest in this topic arose from the concern about the right to health care, which is warranted by law. This study aimed at understanding the perception of the health care team working for CASA Foundation (physicians, nurses and nursing auxiliaries) as regards the functioning of the referral and contra referral system of the public health care network when adolescents’ referral is required. The qualitative methodology was used based on phenomenology. The audio-taped interviews were conducted from May to August, 2007 after a free and informed consent document was signed by the participants. Following the transcription, reduction and phenomenological comprehension phases, the topics and categories were shown. The categories are: access to health care through the Unified Health Care System (SUS), the condition of being an adolescent in conflict with the law, the right to health care and the organization of health care services. The findings show the importance of developing agreements among municipalities, requiring greater liability from services in the formulation of health care policies for adolescents, similarly to what should occur for any other citizen. This implies the need for management proposals and organization improvement according to guidelines and principles of the Unified Health Care System.

Made available in DSpace on 2015-04-16T14:49:19Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 909719 bytes, checksum: 9f58e4b46a9be7683aee64fc095311ee (MD5) Previous issue date: 2009-09-18 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Throughout its history, Brazil has been finding many difficulties in education, economy, security, politics and health. The poor sections of the population - which is a large majority of people in relation to the ones who have more conditions - depend on governmental actions to make use of education and good health care among other services. One of the ways used to find solution to improve public health care services in the country was to create the Unique Health Care System (Sistema Único de Saúde - SUS), which aims at altering inequality in health care assistance to the population, imposing public attendance to any citizen, being prohibited the charge of money under any circumstances. With the increase in advances in technology around the world, public administration has been inserting in its practice devices that information technology (IT) disposes. In the public health care field, besides the Information systems in health, the national health card -or SUS card - represents one of the biggest projects developed by the government, using information systems that integrate all governmental spheres, providing a bigger financial control of the Ministry of health. The SUS card makes the access of registered patients to the SUS services possible, but at the same time it should not obstacle the access of the ones who do not have the card yet. According to the Health Ministry, one of the objectives of SUS card is to raise quality and efficiency in access to public health services. Ahead of the investments carried through in technology, an increase productivity is waited, that reflects in benefits to the population. This research aims at bringing to the reader the way as the users of SUS perceives the politics of SUS Card. Therefore public hospital patients in the metropolitans regions of João Pessoa and Recife were interviewed and the evaluation results proceeded from content analysis, proposed by Gläser and Laudel, with variables and dimensions established from the SERVQUAL model, scientifically validated. It was verified, to the end of the analysis, that the users of SUS do not feel themselves benefited with the implantation of SUS Card, what it makes possible the conclusion of that the high expenses of the Government with SUS Card had not been reverted in benefits to the population. / O Brasil tem encontrado grandes dificuldades, ao longo de sua história, na educação, economia, segurança, política e saúde. A população carente, que ocupa uma fatia enorme em relação àqueles que têm mais recursos depende das ações do Governo para que possa usufruir de educação e saúde de qualidade, além de outros serviços. Uma das formas adotadas na busca de soluções de otimização dos serviços de saúde pública no país foi a criação do Sistema Único de Saúde (SUS), que tem a finalidade de alterar a situação de desigualdade na assistência à saúde da população, tornando obrigatório o atendimento público a qualquer cidadão. Com os crescentes avanços tecnológicos por que vem passando o mundo, a administração pública vem inserindo em suas práticas ferramentas que a Tecnologia da Informação (TI) disponibiliza. No campo da saúde pública, além dos Sistemas de Informação em Saúde, o Cartão Nacional de Saúde, ou Cartão SUS representa um dos maiores projetos criados pelo governo, utilizando sistemas de informação que integram todas as esferas de Governo, propiciando assim maior controle financeiro do Ministério da Saúde. O Cartão SUS possibilita o acesso de pacientes cadastrados aos serviços prestados pelo SUS. De acordo com o Ministério da Saúde, um dos objetivos do Cartão SUS é aumentar a eficiência e a qualidade do acesso aos serviços públicos de saúde. Diante dos investimentos realizados em tecnologia é esperado um aumento de produtividade, que reflete em benefícios à população. Esta pesquisa objetiva trazer ao leitor, o modo como os usuários do SUS percebem a política do Cartão SUS. Para tanto, foram entrevistados pacientes de hospitais públicos das regiões metropolitanas de João Pessoa e Recife e os resultados da avaliação foram provenientes de uma análise de conteúdo, proposta por Gläser e Laudel, com dimensões e variáveis estabelecidas a partir do modelo SERVQUAL, validado cientificamente. Verificou-se, ao final da análise, que os usuários do SUS não se sentem beneficiados com a implantação do Cartão SUS, o que possibilita a conclusão de que os altos gastos do Governo com o Cartão SUS não foram revertidos em benefícios à população.

Orientador: Carmem Maria Casquel Monti Juliani / Banca: Silvia Cristina Mangini Bocchi / Banca: Moneda Oliveira Ribeiro / Resumo: Enquanto Supervisora Técnica da área da saúde da Fundação CASA, o interesse pela temática surgiu em decorrência da preocupação com o direito à saúde, garantido por lei. O objetivo da pesquisa foi compreender a percepção da equipe de saúde da Fundação CASA (médicos, enfermeiros e auxiliares de enfermagem) sobre o funcionamento do sistema de referência e contra referência da rede pública de saúde, quando se faz necessário o encaminhamento do adolescente. A metodologia, de caráter qualitativo, utilizou a fenomenologia. As entrevistas áudio-gravadas foram realizadas entre maio e agosto de 2007, após assinatura do termo de consentimento livre e esclarecido. Após as etapas de transcrição, redução e compreensão fenomenológica foram evidenciadas os temas e as categorias e. As categorias são: o acesso ao atendimento à saúde pelo SUS, a condição de ser adolescente em conflito com a lei, o direito à saúde e a organização dos serviços de saúde. Os achados mostram a importância do desenvolvimento de pactuações com os municípios, exigindo maiores responsabilidades dos serviços na formulação de políticas de saúde vinculadas ao adolescente, assim como deve ocorrer para qualquer cidadão. Isto implica, na necessidade de propostas de gestão e melhoria da organização conforme diretrizes e princípios do Sistema Único de Saúde. / Abstract: As a health care Technical Supervisor for CASA Foundation, the interest in this topic arose from the concern about the right to health care, which is warranted by law. This study aimed at understanding the perception of the health care team working for CASA Foundation (physicians, nurses and nursing auxiliaries) as regards the functioning of the referral and contra referral system of the public health care network when adolescents' referral is required. The qualitative methodology was used based on phenomenology. The audio-taped interviews were conducted from May to August, 2007 after a free and informed consent document was signed by the participants. Following the transcription, reduction and phenomenological comprehension phases, the topics and categories were shown. The categories are: access to health care through the Unified Health Care System (SUS), the condition of being an adolescent in conflict with the law, the right to health care and the organization of health care services. The findings show the importance of developing agreements among municipalities, requiring greater liability from services in the formulation of health care policies for adolescents, similarly to what should occur for any other citizen. This implies the need for management proposals and organization improvement according to guidelines and principles of the Unified Health Care System. / Mestre

O presente estudo buscou compreender a dimensão política no trabalho do enfermeiro da atenção básica em um município paulista. Consideramos como dimensão política a relação que os trabalhadores estabelecem com a gestão pública em saúde e seus desdobramentos no trabalho na Atenção Básica nas distintas modalidades de organização da Atenção Básica (AB). Relação esta que não se limita aos espaços formais, como reuniões e normativas, mas que também se refletem nos modelos de atenção e organização do trabalho presentes nos serviços de saúde. Dessa forma, ao resgatar o caráter político da Reforma Sanitária Brasileira e o papel estratégico do SUS como política de Estado, este estudo pretende colaborar com o atual debate em torno da politização da saúde. O método utilizado para o desenvolvimento deste estudo foi o Estudo de Caso, alicerçado pela abordagem qualitativa, do tipo instrumental, a partir das seguintes fontes de dados: observação participante em cinco unidades de saúde de distintas modalidades de organização da AB, entrevista semiestruturada com oito enfermeiros, considerados informantes chaves e documentos oficiais de planejamento em saúde de instancia municipal de cinco quadriênios de gestão municipal. A coleta de dados foi realizada nos meses de outubro de 2013 a março de 2014. Foi realizada análise discursiva na perspectiva de Pêcheux com o material produzido nas entrevistas. Na análise documental, o que encontramos foi que, não obstante as dificuldades vividas pelos grandes municípios, mencionadas na literatura, é uma transição incompleta do modelo de AB, mais como mistura do que de transição, com uma implantação incipiente e incompleta da estratégia Saúde da Família, apesar dos documentos de planejamento, reiteradamente, colocarem essa estratégia como a opção municipal para a AB. Fica claro que a relação entre trabalhadores e gestão, por parte dos enfermeiros, não é de confiança, nem de corresponsabilidade. Não há a perspectiva de participação nos processos de decisão. Surgem críticas, responsabilizando a gestão, pela forma como são conduzidas determinadas políticas de saúde. É interessante observar que a crítica mais veemente surja justamente numa temática que envolve o interesse direto, poderíamos dizer até corporativo, dos trabalhadores. Por fim, parece ficar reforçada a ideia de Maria Cecília Puntel de Almeida, de que há entre as enfermeiras uma aceitação das limitações de poder, de forma relativamente passiva / This study sought to understand the political dimension of the work of the primary care nurse in a city in São Paulo. We consider the political dimension as the relationship that workers have with the public health management at work and its developments in Primary Care services in different modalities of Primary Care organization. A relationship that is not confined to formal settings, such as meetings and norms, but is also reflected in models of care and work organization present in health services. Thus, by returning to the political nature of the Brasilian Heath Reform and the strategic role of the SUS as a state policy, this research intends to collaborate with the current debate on the politicization of health. An instrumental case study was the method of choice for the development of this study, with a qualitative approach, using the following data sources: participant observation involving five health units of different modalities of organization, semi-structured interviews with eight nurses we considered to be key informants and official documents in health planning from the municipal management in five four-year periods. Data collection was conducted from October 2013 to March 2014. Pêcheux\'s discourse analysis was used for the interview data. In document analysis, what we found was, despite the difficulties experienced by large municipalities mentioned in the literature, an incomplete transition of the Primary Care model, more like a mixed system than a transition, with an incipient and incomplete implementation of the Family Heath strategy despite planning documents repeatedly putting this strategy as the municipal option for Primary Care. It is clear that the relationship between workers and management is not of trust. There is no prospect of participation in decision-making. Criticism does appear, blaming the management by the way they conducted certain health policies. It is interesting to note that the most vehement criticism arises precisely in a theme that involves direct interest of the workers. Finally, it seems the idea of Maria Cecilia Puntel de Almeida is reinforced, that between nurses there is an acceptance of the limitations of power, in a relatively passive way

The diploma thesis contains a comprehensive view of the health system in the Federal Republic of Germany in 1995-2015. The main aim of this work is to establish recommendations for improvement of the Czech health system based on the evaluation of the findings on the German health system. The partial aims of the diploma thesis are the characteristics of the health system and the analysis of income and expenditure in health care in Germany. The thesis is divided into six chapters. The first chapter is focused on the information obtained from professional literature. In particular, it describes the different concepts related to healthcare and its financing. The second chapter focuses on the economic concept and the issue of the health system. The third part contains a description of the country's health system. Here are also some selected data about Germany, organization or authority at federal, state and local levels. The fourth chapter deals with the insurance market in Germany. The fifth part summarizes the fundamental reforms of the health system of the Federal Republic. The last chapter is an analysis of income and expenditure of the health system. This section analyzes the data available from statistics from the German Statistical Office or from multinational organizations such as WHO, OECD or the World Bank.

This master thesis is trying to describe the situation of private sector in public health care systems. As a private sector we understand patients, private health insurance companies and private health care providers. The focus is placed on private health care providers, especially in ambulatory treatment. At first there is a definition of health as a main determinant of a health care systems, definition of public and private sectors in health care systems and the difficulties at the market of health care, including externalities, inperfect information and elasticity of supply and demand at this market. There is also the problem of financing health care as a mix of public and private payments, which is different in every health care system. The main focus is laid on the situation in the Czech republic. As a comparison there are described situations in Denmark, Germany, Great Britain and United States. The size of private sector in every health care system is different and it depends on different circumstances in particular state, including social-economic development, regulation of health care market from the state and the attitude of patients to private health care.

Abstact The diploma thesis is focused on forms and dimensions of breast-feeding support regarding different levels of women and child care in the health care system of the Czech Republic from the perspective of a woman, a mother, who is the health care recipient in the context of the legal framework of Czech legislation and relevant international documents. The findings are based on empirical research results gained from ten semi-structured in-depth interviews. Ten individual research participants gave birth in the same medical institution with the title Baby Friendly Hospital during the last three years, which is the unifying element of the participants. The perspective of a woman, based on a thematic analysis of interviews , shows a lot of perceived dimensions of the provided health care. This work identifies the most obvious women themes: their perception of breastfeeding in pregnancy, importance of breastfeeding for woman, the mother's contact with the baby after the childbirth, medical staff attitude and quality of provided care, aspects of pediatric care and support of breast-feeding out of the health care system. These themes are part of an extensive, historically based conception of health care provided in the Czech Republic, which includes a model of the relationship between a physician (medical...

The diploma thesis focuses on impact of civic engagement on health care system. It studies to what level this participation helps health care system transformation and change of a relationship between patients and political and professional authorities. It's aim is to provide a critical sociological analysis and explain social processes accompanying patients' engagement by using examples. Patient organisations - an institutionalised form of civic society with a potential to evoke social change - get into scope here. The ambition of this thesis is to show the applicability of the reflexivity concept to the area of health care, to enrich this analytical framework by multilevel approach to the health care system and therefore add to the discourse around civic engagement phenomenon by a systemic and structured view of dynamic relationships between patient organisations and health care system. The findings of the author are based on an analysis of semi-structured interviews with patient organisations representatives and available documents. The author emphasises the ambivalent impact of civic engagement which on one side reinforces individual transformations of micro, meso, macro and meta levels of health care system and also acts as a catalyst of wider sociocultural changes. On the other hand, it is accompanied...