Health and Wellbeing Boards (HWBs) are new local government (LG) sub-committees tasked with assessing local health and social care needs, and developing strategies for promoting integration and tackling health inequalities; yet they have no statutory authority to compel action. This research explored how they approached tackling health inequalities, focussing on the role of environmental health (EH), the LG public health occupation, in the pre-shadow and shadow stages and as they went live in April 2013. Four case study sites (based around individual HWBs) were purposively sampled to ensure that a variety of HWBs were included, including unitary and two-tier authorities and urban, suburban and rural areas. Data collection at each case study site included semi-structured interviews, observation of HWB meetings, and documentary analysis and extended for 18 months from early 2012. In addition, EH practitioners and managers were interviewed from each of the English regions to provide a wider context. The data was analysed thematically both inductively and deductively using Atlas.ti. and conclusions drawn. HWBs were varied in their structures, practices and intentions and some changed considerably during the research, as would be expected at a time of new policy development and implementation. There was evident commitment and enthusiasm from HWB members to improve the health of local populations. However it is unclear what ‘success’ will be or how it will be measured and attributed to the work of the HWB, and there were some tensions between the various parties involved. There was an espoused commitment to the principles of Marmot, in particular to children, however much of the focus during HWB meetings was on integrating health and social care. Taking action on many of the social determinants of health is outside the core sphere of HWB control, however they did not generally appear to be utilising some of the readily available tools, such as EH work to improve local living and working conditions. EH was found to be largely ‘invisible’ within its own public health community and does not have a tradition of evidence based practice needed to secure funding in the new system. This, along with the decline of the regulatory role, has led to a period of reflection and adaptation. The research findings are linked by the policy approaches of ‘doodle’ and localism, including the shrinking of the state, and in particular the retreat of statutory and regulatory roles and the introduction of overt political values in policy making; shifting the focus to relationships, partnership-building, integration and the impact of individuals. The contexts in which the research has taken place, both at local and national levels, including financial austerity, major health restructuring, and high national and local expectations are all significant factors which have shaped the findings.

L’une des principales sources de changement dans le système de santé est actuellement la numérisation et la mise en réseau technique, se traduisant par le développement de la télémédecine. Si cette « médecine à distance », utilisant les TIC, a pu se résumer en quelques expérimentations menées essentiellement dans le cadre hospitalier, le gouvernement entend lui donné une nouvelle impulsion. Elle doit constituer un facteur clé d’amélioration de la performance du système de santé. Son usage dans les territoires doit incarner une réponse organisationnelle et technique aux nombreux défis épidémiologiques, démographiques et économiques auxquels fait face le système de santé aujourd’hui. Cette recherche apour but de contribuer à établir le sens social et politique du développement de la télémédecine. Il s’agit de cerner de façon systématique et dans leur ensemble les dynamiques qui conduisent ce changement, tout en mettant en avant les conséquences dans la démarche de soin classique au niveau des usagers. Analyse des politiques publiques et étude du changement technologique se fondent dans l’approche choisie de la sociologie politique des usages. Ancrée au confluent du modèle des politiques publiques et de la sociologie de l’innovation, la recherche a permis d’identifier et d’expliquer les principales dynamiques conditionnant le processus de développement de la télémédecine, en partant des politiques publiques jusqu’à la mise en place des technologies. La télémédecine est la fois le moteur et le résultat de la réformede la modernisation du système de santé. Son référentiel est fortement imprégné par les exigences de rationalisation et de gestion du réseau socio-sanitaire et demeure principalement légitimé par des critères de rentabilité et de performance qui sont probablement incompatibles avec l’efficience clinique et thérapeutique des services de soins. La télémédecine pourrait rendre de nombreux services dans la gestion des activités humaines et professionnelles, par une gestion davantage réfléchie, concertée et planifiée du changement technologique / One the main source of change in the health service system is the digitization and Networking technique wich can be seen in the development of telemedicine. If this « medicine at distance », using ITC, could be summed up in a few experiments in the hospital field, the government wants to give it a new impulse. It must be the key to improve the health service system. Its use in the territories must embody an organizational and technical answer epidemiological, demographic and economic numerous challenges, to wich the health system has to face nowadays. This investigation is aimed at contributing to settle the social and political meaning of telemedicine development. One has to identify systematically and in the whole the forces which lead to this change, while at the same time highlighting the consequences in users the classical approach. The analysis of the public politics and the study of the technological change convey in the political sociology uses. Anchored between the public politic model and the sociological innovation, the investigation has allowed to identify and explain the main dynamics which influence the telemedicine development process, starting by the public policies to the implémentation of technologies. The telemedicine is both the impulse and the result of the health service system modernization reform. Itsrepository is strongly influenced by the rationalizing of the requirements and the management of the health and social network and remains mainly legitimized by profitability and performance criterias which are probably incompatible with clinical and therapeutic efficiency of health services. The telemedicine could make many services in the management of human and Professional activities, thank to a management more thought, concerted, planed of the technologic change

Orientador: Valeriano Mendes Ferreira Costa / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Filosofia e Ciências Humanas / Made available in DSpace on 2018-08-22T10:50:27Z (GMT). No. of bitstreams: 1 DeMario_Camila_D.pdf: 2549585 bytes, checksum: 3f7fc4b6bede9a00da6ea80dcae972aa (MD5) Previous issue date: 2013 / Resumo: Esta tese realiza uma análise do Sistema Único de Saúde (SUS) brasileiro a partir da teoria da justiça como equidade proposta por John Rawls. O ponto de partida da análise que fundamenta a definição da saúde como uma questão de justiça é a concepção ralwsiana de sociedade justa elaborada em Uma Teoria da Justiça (2008). Em diálogo com a argumentação e com o debate suscitado pela obra de Rawls, verificamos como a saúde surge como questão através da crítica à teoria rawlsiana elaborada por Amartya Sen e Martha Nussbaum. Ambos os autores, em face da "negligência" de Rawls perante o tema, afirmam que a saúde deve ser entendida como um bem de importância moral fundamental em razão das desigualdades a ela atreladas. Mas é principalmente no trabalho de Norman Daniels, que se constrói em dialogo com o de John Rawls e com o de Amartya Sen, que esta tese se baseia para fundamentar o argumento de que a saúde deve ser tratada como uma questão de justiça e que, apesar de ela não ter sido especificamente tratada pela teoria da justiça de Rawls, uma extensão de sua teoria pode se realizar a partir seus princípios da justiça, em especial do princípio da Igualdade Equitativa de Oportunidades, sem prejuízos para sua formulação. A argumentação desta tese prossegue abordando, ainda sob perspectiva normativa, duas questões fundamentais para a compreensão do SUS a partir da justiça do sistema: a primeira é a democracia e sua relação com a justiça, debate que se faz necessário dadas as características do Estado e da sociedade brasileira e, também, dado o processo de formação e implementação do sistema de saúde brasileiro; a segunda, a análise de políticas públicas baseada no método proposto por Bo Rothstein que, preocupado com a justiça das instituições, volta-se para a substância da política sem desconsiderar seu processo. É sobre esse pano de fundo de normativo, parâmetro a partir do qual é possível definir saúde e pensar uma política de saúde justa, que a análise se volta para o SUS com o intuito de identificar elementos que permitam responder sobre a justiça do sistema. Para a análise do SUS, elencamos alguns pontos/questões fundamentais: sua trajetória e sua definição de saúde, que abarca o papel da noção de Determinantes Sociais da Saúde na formulação da política e enquanto critério de justiça; os princípios definidores do SUS: universalidade, integralidade, igualdade, gratuidade, descentralização e participação popular; por fim, a relação que se estabelece entre o setor privado/suplementar e o público/complementar. Esse caminho foi percorrido com o propósito de identificar as concepções de justiça do sistema que, somadas a um parâmetro normativo de saúde justa, fornecem-nos elementos para responder sobre a justiça dos resultados alcançados pelo SUS / Abstract: This thesis studies the Brazilian health system, SUS (Sistema Único de Saúde/Unified Health System), through John Rawls? theory of justice as fairness . It?s the rawlsian conception of a just society presented in his book, Uma Teoria da Justiça ([A Theory of Justice] 2008), that supports the definition of health as a matter of justice adopted here. Establishing a dialogue with the discussion toward Rawls? works, we verified how health emerges as a central question in Amartya Sen?s and Martha Nussbaum?s criticisms to Rawls? theory. Both authors state, regarding Rawls negligence toward the theme, that health is a good with a fundamental moral importance, considering the iniquities related to it. But it?s mainly in Norman Daniels? works, done in dialogue with John Rawls? and Amartya Sen?s works, that this thesis rely on to state that health is a matter of justice and that an extension of Rawls theory can be made from his principles of justice, mostly from the principle of fair equality of opportunity. Keeping a normative stand point, this thesis? argumentation continues to deal with two main questions to the understanding of the Unified Health System justice: the first one is democracy and its relation with justice, a necessary discussion, considering the features of the Brazilian State and its society, as well as the formation and implementation process of the health system; the second is the public policies analysis based on the method proposed by Bo Rothstein, who, concerned with the institutions justice, turned to the policy?s substance without neglecting its process. It is over this normative background, parameter through which it?s possible to define and think of a just health policy, that the analysis seeks to identify in SUS elements which allows us to answer about the system justice. For its analysis, we chose some fundamental points: its history and its health definition, which embodies the Social Determinants of Health in the policy formulation and as a justice criterion; the principles of SUS: universality, integrality, egalitarianism, gratuitousness, decentralized policy management and public participation; and finally, the relationship between the private/supplementary and the public/complementary sectors. The aim here was to identify the system?s conceptions of justice that, combined with a normative parameter of just health, supplies us with arguments to answer about the justice of the results achieved by SUS / Doutorado / Ciencias Sociais / Doutora em Ciências Sociais

Simposio: Hacia un cambio del Sistema de Salud Peruano: experiencias y perspectivas. / After several months of arduous deliberations, the National Agreement, a policy coordination forum highest level in Peru, approved a document entitled “The objectives of health care reform.” In this article it review the work done and the product reached by consensus, which includes as priorities, among others, strengthening of SIS like public insurance, implementation of a policy of multi-year investment, strengthening the protection of health rights outlined, strengthening the primary health care and improving access to safe and effective medicines. The effect is an agreement that gives significance to a process that has the character of state policy and defines the framework within which they must develop health policies in the following years.

Orientadores: Marcio Ajudarte Lopes, Ana Lúcia Carrinho Ayroza Rangel / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-27T17:11:11Z (GMT). No. of bitstreams: 1 Webber_AlexandreAlmeida_D.pdf: 283505 bytes, checksum: d30a054f19998668958128133a5d989f (MD5) Previous issue date: 2015 / Resumo: O Ministério da Saúde (MS), através de sua política de incentivos financeiros, vem promovendo um processo de reorganização da atenção à saúde bucal, com a implantação das Equipes de Saúde Bucal (ESB) na Estratégia Saúde da Família (ESF), no âmbito da atenção básica, e dos Centros de Especialização Odontológica (CEO) e Laboratório Regional de Próteses Dentárias (LRPD), na atenção secundária. Entre as atividades dos CEOs, faz parte, reconhecer não apenas as lesões de câncer bucal, mas também identificar as lesões com potencial de malignização. Diante destes fatos, este trabalho avaliou os Centros de Especialidades Odontológicas como unidade de referência das neoplasias malignas de boca atendidas no Hospital do Câncer da União Oeste Paranaense de Controle e Combate ao Câncer ¿ UOPECCAN, Cascavel/PR. Analisamos a origem do encaminhamento dos pacientes atendidos pelo cirurgião de cabeça e pescoço. Também foi verificada a produção de biopsias realizadas pelos cirurgiões dentistas nos CEOs com relação ao diagnóstico do câncer bucal. A amostra foi constituída por 311 pacientes que tiveram tumor primário na cavidade bucal entre o período de jan/2003 a dez/2013. Dos prontuários analisados apenas 11,3% (35/311) foram encaminhados por serviços odontológicos e 70,6 % (220/311) de serviços médicos. Também foram analisados os dados referentes à biópsias realizadas , no mesmo período, da 10ª, 12ª e 20ª Regional de Saúde do Estado do Paraná, as quais possuem CEO e são atendidas pelo Hospital do Câncer da UOPECCAN. Foi possível observar que foram realizados os procedimentos em todas as regionais, na 10ª RS e 12ª RS encontramos esses procedimentos a partir do ano seguinte à implantação dos CEOs e na 20ª RS, apenas no ano de 2010. Apesar dos grandes avanços alcançados pela Politica Nacional de Saúde Bucal(PNSB) com a organização e divisão dos serviços de saúde bucal nos três níveis de atenção. É nítida a necessidade de divulgação dos CEOs como unidade de referência das neoplasias de cavidade oral, para atenção básica. Esta divulgação deve ser realizada não apenas para os CDs, mas para todos os profissionais de saúde deste nível de atenção / Abstract: The Ministry of Health, through its policy of financial incentives, has been promoting a process of reorganization of oral health care, with the implementation of the Oral Health Teams (OHT) in the Family Health Strategy (FHS), under primary care, and Dental Centres of Specialisation (DCS) and Regional Laboratory of Dental Prosthetics (RLDP) in secondary care. Among the activities of DCS , is part, recognize not only the oral cancer lesions, but also to identify lesions with malignant potential. Based on these findings, this study evaluated the specialized dental clinics as reference unit of neoplasms mouth of malignant treated at the UOPECCAN Cancer Hospital , Cascavel / PR. We have analyzed the origin of referral of patients seen by the head and neck surgeon. The production biopsies performed by dentists in DCS regarding the diagnosis of oral cancer was also verified. The sample consisted of 311 patients who had primary tumors in the oral cavity between the period of Jan / 2003 to Dec / 2013. From the medical records analyzed only 11,3% (35/311) were referred for dental services and 70,6% (220/311) of medical services. Also analyzed the data on biopsies performed during the same period, the 10th, 12th and 20th Regional State of Paraná Health, which have DCS and are served by the UOPECCAN Cancer Hospital. It was observed that the procedures were performed in all regional, in the 10th and 12th Regional health find these procedures from the year following the implementation of the DCS and the 20th RS, only in the year 2010. Despite the substantial progress achieved by National policy of oral health with the organization and division of oral health services in the three levels of care. There is a clear need for disclosure of DCS as reference unit of cancers of the oral cavity, for primary care. Such disclosure shall be made not only for the dentist, but for all health professionals of this level of care / Doutorado / Estomatologia / Doutor em Estomatopatologia

A regionalização emergiu dentro das diretrizes organizativas do Sistema Único de Saúde como ordenadora das ações e serviços de saúde a fim de qualificar e fortalecer a descentralização com o escopo de garantir o direito à saúde da população, reduzindo as desigualdades sociais e territoriais por meio da identificação e do reconhecimento das regiões de saúde, promovendo a integralidade de atenção e equidade das ações e serviços. Esta pesquisa tem como objetivo analisar a regionalização das ações e serviços a partir da construção de redes de saúde interfederativas da mesorregião do Bico do Papagaio, Rede TOPAMA, e da região do Vale do médio do São Francisco, Rede PEBA, fundamentadas no pacto pela saúde. Tendo a temática investigativa ancorada em uma nova estratégia de organização dos serviços de saúde, foi realizada uma pesquisa documental, com análise de conteúdo, tendo os documentos do Subprojeto QualiSUS-Rede da Rede TOPAMA e da Rede PEBA como foco de análise. Utilizaram-se, como aporte bibliográfico, os preceitos constitucionais à construção do SUS e autores brasileiros da saúde pública. Os resultados revelaram que a Região TOPAMA ainda não está dotada de elementos necessários para o pleno funcionamento com integração das ações e serviços para atender às demandas da população. O mapa de saúde da rede e elaboração do COAP ainda permanece em construção, não ocorrendo organização dos fluxos interestaduais. Verificaram-se, ainda, conflitos acerca da alocação de recursos entre os estados. No que tange à região PEBA, a rede demonstra-se articulada e hierarquizada, com fluxos interestaduais pré-definidos, contudo, com a necessidade de definir novas estratégias a fim de superar os desafios frente às barreiras geográficas para garantia da assistência e acesso às ações e serviços de saúde. Conclui-se que, para garantir assistência à saúde integralizada e equânime com gestão compartilhada, as federações devem caminhar articuladas e em sintonia para garantir o desenvolvimento regional, os entes federados devem estar despidos de interesses próprios, partidos políticos e conformar uma gestão unificada de forma participativa, solidária e cooperativa, proporcionando o bem comum em beneficio do usuário e não apenas relações entre governos. / The regionalization emerged within organizational guidelines of the Unified Health System as ordering of actions and health services in order to qualify and strengthen decentralization with the aim of ensuring the right to health of the population, reducing social and regional inequalities by identifying and recognition of health regions, promoting the full attention and fairness of procedures and services. This research aims to analyze the actions and regionalization of services from building networks of health interfederativas from the middle region of the Parrots Beak, TOPAMA Network, and Valley of the middle São Francisco, PEBA Network region, based on health pact . Having the investigative theme anchored on a new strategy for the organization of health services, documentary research was carried out, with content analysis, and documents Subproject QualiSUS TOPAMA Network-Network and Network PEBA analytical focus. We used as bibliographic contribution, the constitutional construction of SUS Brazilian authors and public health principles. The results revealed that the TOPAMA Region is not yet endowed with elements necessary for full operation with integration of programs and services to meet the demands of the population. The map of network health and development of the COAP is still under construction, not occurring organization of interstate flows. Still, there were disputes about the allocation of resources among states. Regarding the PEBA region, the network is demonstrated articulated and hierarchical, with predefined interstate flows, however, with the need to define new strategies to overcome the challenges facing the geographical barriers to care and ensuring access to actions and health services. It is concluded that, to ensure assistance to fully paid health and equitable shared with management, federations must walk articulated and in tune to ensure regional development, federal agencies must be stripped of their own interests and political parties shape a unified management so participatory, supportive and cooperative, providing the common good for the benefit of the user and not just relations between governments.

No description available.

Background: Time utilisation among primary care professionals has been affected by structural changes and reorganisation performed in Swedish primary care over several decades. The work situation is complex with a heavy administrative work load. The overall aim with this thesis was to describe time utilisation among staff in Swedish primary care and to investigate associations with perceived psychosocial work environment and legitimacy of work tasks. Methods: A multicentre, descriptive, cross-sectional study design was used including all staff categories in primary care i.e. registered nurses, primary care physicians, care administrators, nurse assistants and allied professionals (physiotherapists, occupational therapists, psychologists, counsellors, dieticians and chiropodists) at eleven primary care centres located in southeast Sweden. The data collection consisted of a questionnaire including a subjective estimate of workload, the Bern Illegitimate Tasks Scale (BITS) and the Copenhagen Psychosocial Questionnaire (COPSOQ). Also, a time study was performed, where the participants reported their work time based on three main categories; direct patient work tasks, indirect patient work tasks and other work tasks, each with a number of subcategories. The participants reported time spent on different work tasks, day by day during two separate weeks. Response rates were 75% for the questionnaire and 79% for the time study. Results: In paper I the time study revealed that health professionals at the primary care centres spent 37% of their work time with direct patient work tasks. All professions estimated a higher proportion of time spent directly with patients than they reported in the time study. Physicians scored highest on the psychosocial scales of quantitative demands, stress and role conflicts. The proportion of administrative work tasks was associated with role conflicts, the more administration the more role conflicts. Findings in paper II were that more than a quarter of physicians scored above the cut-off value for BITS regarding unnecessary work tasks, which was significantly more than the proportion observed in all other professions in the survey. Across all staff groups, a perception of having to perform illegitimate work tasks was associated with experiencing negative psychosocial work environment and with high proportion of administrative-related work tasks. Conclusions: Swedish primary care staff spend a limited proportion of their work time directly with patients and primary care physicians perceive the psychosocial work environment in negative terms to a greater extent than all other staff members. Allocation of work tasks has an influence on the perceived psychosocial work environment. The perception of having a large number of illegitimate work tasks affects the psychosocial work environment negatively, which might influence the perception the staff have of their professional roles. Perception of high proportion of unreasonable work tasks is associated with a high proportion of non-patient-related administration. This thesis illuminates the importance of decision makers thoroughly considering the distribution and allocation of non-patient related work tasks among staff in primary care, in order to achieve efficient use of personnel resources and favourable working conditions. Hopefully, the results of this study will contribute to further development of primary care so that medical competence will benefit patients as much as possible. / Bakgrund: Under de senaste decennierna har det i svensk primärvård varit omfattande omorganisationer, vilket har påverkat arbetstidens innehåll. Arbetssituationen är komplex och omfattningen av administration har ökat. Det övergripande syftet med föreliggande studie var att beskriva arbetstidens innehåll bland personal i svensk primärvård och att undersöka samband mellan upplevd psykosocial arbetsmiljö och arbetsuppgifternas legitimitet. Metod: Studien har genomförts som en deskriptiv multicenterstudie med tvärsnittsdesign och inkluderade sjuksköterskor, läkare, vårdadministratörer, undersköterskor och övriga professioner (fysioterapeuter, arbetsterapeuter, psykologer, kuratorer, dietister och fotvårdsspecialister) vid elva vårdcentraler i sydöstra Sverige. Studien inleddes med att deltagarna ombads att besvara ett frågeformulär vars första del bestod av en skattning av hur arbetsuppgifterna var fördelade. Frågeformuläret innehöll också frågor om illegitima arbetsuppgifter; Bern Illegitimate Tasks Scale (BITS) och psykosocial arbetsmiljö; Copenhagen Psychosocial Questionnaire (COPSOQ). Därefter gjordes en tidsstudie där deltagarna fick registrera tidsåtgången för olika arbetsuppgifter, varje dag under två separata veckor. Arbetsuppgifterna delades upp i tre huvudkategorier; direkt patientarbete, indirekt patientarbete och övrigt arbete. Varje huvudkategori hade flera underkategorier. Svarsfrekvensen var 75% för frågeformuläret och 79% för tidsstudien. Resultat: Resultatet från delarbete I visar att personal i primärvård ägnade 37% av arbetstiden direkt med patienter. Alla professioner skattade den direkta patienttiden till större andel än vad tidsstudien visade. Läkare upplevde sämst psykosocial arbetsmiljö avseende kvantitativa krav, stress och rollkonflikter. Det förelåg ett samband mellan andelen administrativa arbetsuppgifter och rollkonflikter, ju mer administration desto mer rollkonflikter. I delstudie II visade resultatet att mer än en fjärdedel av läkarna upplevde en hög nivå av illegitima arbetsuppgifter avseende onödiga arbetsuppgifter, vilket var signifikant mer jämfört med andra professioner. För personalgruppen som helhet framträdde ett samband mellan upplevelsen av att ha mycket illegitima arbetsuppgifter och upplevelse av negativ psykosocial arbetsmiljö samt med hög andel administrationsrelaterade arbetsuppgifter. Konklusion: Personal i primärvård ägnar en begränsad andel av arbetstiden åt direkt patientarbete och läkare upplever sämre psykosocial arbetsmiljö än övriga professioner. Arbetstidens fördelning mellan olika arbetsuppgifter påverkar den psykosociala arbetsmiljön. Upplevelsen av att utföra en stor andel illegitima arbetsuppgifter påverkar den psykosociala arbetsmiljön negativt, vilket kan ha inverkan på hur personalen uppfattar sin professionella roll. Upplevelsen av att ha mycket oskäliga arbetsuppgifter har samband med hög andel icke patientrelaterad administration. Avhandlingen belyser vikten av att beslutsfattare noga överväger fördelningen av icke patientrelaterade arbetsuppgifter bland personal i primärvård, för att möjliggöra effektiv användning av personalresurserna och för att främja goda arbetsförhållanden. Förhoppningen är också att studiens resultat ska bidra till fortsatt utveckling av primärvården så att den medicinska kompetensen kommer patienterna till nytta i så stor omfattning som möjligt.

abstract: Hepatitis C is an infectious disease that affects 71 million people worldwide and causes liver failure and death if untreated. In 2013, a direct acting antiviral drug, sofosbuvir, revolutionized treatment of the disease. Sofosbuvir showed immense promise, but the high price point at which it was launched created access barriers that prevented it from reaching its full public health potential. By 2016, fewer than 1% of Hepatitis C patients worldwide had received treatment. In the United States (US), concerns about the cost of the drug led public and private payers to implement rationing and treatment restrictions that prevented some of the most vulnerable populations from accessing Hepatitis C treatment at all. Through interviews with researchers, patients and providers, and a literature review of grants, patents, papers, court documents, and news articles, I examine the history of sofosbuvir with attention to the ways in which federal funding practices and intellectual property law encouraged the high initial pricing of the drug. I then examine the impact of this drug on healthcare systems in the United States and abroad, and discuss how the fragmented nature of the United States healthcare system has exacerbated price-based barriers to access. Finally, I discuss intellectual property laws as potential mechanisms to increase access. My study underscores how the political reluctance to use well-established federal funding and intellectual property laws has resulted in a drug development system that delivers medications that are so highly priced that the fragmented US healthcare system cannot compensate for the expense. This leads to low access and poor public health outcomes, and a continued failure to contain or control diseases for which effective therapies exist. / Dissertation/Thesis / Doctoral Dissertation Biology 2020

På varje arbetsplats uppstår det konflikter av olika slag. En del av dessa konflikter är av en mildare variant som medarbetarna på egen hand lyckas lösa, men det finns även svårlösta konflikter som på sikt kan påverka arbetsmiljön och medarbetarna negativt. I sociala verksamheter som äldreomsorg och hemtjänst handskas enhetschefer medkonflikthanteringar i sina arbetsgrupper. Det är därmed viktigt att en konflikt hanteras så fort som möjligt eftersom den annars kan bli svårlöst. En ouppklarad konflikt kan i regel leda till att personalen tappar sin arbetsglädje, motivation och energi, något som inte enbart påverkarverksamheten och övrig personal, utan även skapar en lidande situation för brukarna som tillhör verksamheten. I samhällsdebatten är konflikthantering ett omdiskuterat ämne där höga krav ställs på chefer. Chefen befinner sig oftast i en komplicerad situation där missnöje från både personalen och de överordnade finns. Ju känsligare situationen och konflikten är, desto svårare blir konflikthanteringen för chefen. Detta då varje handling från chefens sida tycks av andra ha en underliggande betydelse. Trots detta, förväntas chefen dock hantera och lösa konflikten. Denna studie har som syfte att klarlägga vad för roll en chef har vid konflikthantering. För att besvara frågeställningen har en kvalitativ metod använts, med mål att skildra informanternas känslor samt upplevelser gällande konflikter och dess hantering. Uppsatsen har sin grund i fem intervjuer med enhetschefer inom äldreomsorgen och hemtjänsten. Studien utgår utifrån semistrukturerade intervjuer, med mål att samla empiri. Slutresultatet framförde att enhetscheferna handskas med konflikter på liknande sätt, medsamma utgångspunkt att lösa konflikten omgående. Även om det inte finns någon handlingsplan i konflikthantering, ansåg informanterna att en närvarande chef kan hindra en konflikt från att bli urartad.