Introdução: A redefinição das políticas de atenção a Saúde Mental no Brasil redirecionou também a atenção aos usuários de álcool e outras drogas, como dispositivo central a política do Ministério da Saúde instituiu em 2002, em todo o território nacional, os Centros de Atenção Psicossocial em Álcool e Outras Drogas. Considerando que se trata de serviços de saúde pública, com pouco mais de uma década de existência, os processos avaliativos desses equipamentos tornam-se relevantes. Objetivo: Avaliar a estrutura, o processo e os resultados do tratamento recebido de uma amostra de CAPS ad do munícipio de São Paulo-SP. Metodologia: Estudo avaliativo quantitativo, transversal, descritivo e exploratório, realizado em 12 CAPSad do município de São Paulo-SP, com abordagem Donabediana. A amostra do estudo constituiu-se de 760 participantes divididos entre profissionais, usuários e familiares de usuários dos CAPSad. Para a coleta dos dados foram aplicados: um questionário sócio demográfico, a SATIS-BR para profissionais, usuários e familiares, a EMP para usuários e familiares e a EAFAAA para os profissionais. Resultados: Na dimensão de estrutura foi evidenciada percepção favorável dos usuários e familiares, contraditoriamente aos profissionais que apresentaram uma percepção mediana. Em relação ao processo as atividades terapêuticas desenvolvidas foram heterogêneas, com ênfase nos atendimentos individuais e nas atividades grupais desenvolvidas com os usuários dentro dos CAPS e pouca integração aos outros equipamentos de saúde ou dos recursos do território. Quanto aos resultados obtivemos níveis elevados de satisfação com o serviço (SATIS_BR), por parte dos usuários (escore médio 4,71) e familiares (4,23); enquanto que por parte dos profissionais o grau de satisfação apresentou-se entre a indiferença e a satisfação (3,77). Com relação à mudança que os usuários e seus familiares perceberam após o inicio do tratamento no CAPSad, medida pela EMP, observou-se que ambos perceberam melhoras, sendo a média do usuário 2,62 e do familiar 2,50. Os resultados obtidos com a EAFAAA sugerem que os profissionais do CAPS ad apresentam atitudes positivas frente ao usuário de AOD, com um escore médio de 3,5. Conclusões: Esses resultados sugerem que os CAPSad, apesar de algumas fragilidades, cumprem com o seu papel por meio do estabelecimento de vínculos, da construção da co-responsabilidade e de uma perspectiva ampliada da clínica, transformando esses serviços em locais de acolhimento e enfrentamento coletivo das situações ligadas ao uso de AOD. Alertamos que algumas semelhanças encontradas entre o CAPS de Saúde Mental e o CAPS ad podem contribuir para a perpetuação da vigência do modelo jurídico moral que vê o usuário de AOD como marginal ou doente, não abarcando todas as possibilidades de trabalho existentes nessa área / Introduction: The Mental Health policies redefinition in Brazil also redirected attention to the users of alcohol and other drugs. And, as a central device in the 2002 policy, it was established the Psychosocial Care Centers in alcohol and Other Drugs (CAPSad) as a public health services to treat the addicts. Thus, after more than a decade of CAPSads establishment, it is relevant an evaluation processes of these services. Objective: The aim was evaluate the CAPS ads structure, its therapeutic process, and its treatment outcomes for addiction in the municipality of São Paulo-SP. Methodology: It was a quantitative, cross-sectional, descriptive and exploratory evaluation study, conducted in 12 CAPSad of São Paulo, and based in the Donabediana approach. The sample consisted of 760 participants, as CAPSads professionals, patients and patients families. For data collection it was used: a demographic questionnaire, the Scale of Satisfaction with Mental Health Services (SATIS-BR) for professionals, patients and patients families, the Scale Perceived Change (EMP) for patients and patients families, and Scale of Attitudes Towards Alcohol, Alcoholism and Alcoholics (EAFAAA) for professionals. Results: Regarding the structures dimension, it was found a favorable structures perception of patients and their families, and a median professionals structures perception. Respecting the therapeutic process, the results showed that the activities were heterogeneous, with emphasis on individual sessions, and group activities with the CAPSads patients, it was observed also a little integration with other health services, and health territorial resources. The SATIS_BR results showed high satisfactions levels for patients (mean score 4,71) and their families (mean score 4,23) ; while the professionals\' satisfaction presented between indifference and satisfaction (mean score 3,77). Regarding the change that patients and their families noticed after the start of treatment in CAPSad, measured by the EMP, it was observed that both improved, the average patients was 2,62 and the average their families was 2,50. Finally, the EAFAAAs results showed that CAPSads professionals have positive attitudes towards the addicts, with a mean score of 3,5. Conclusions: These results suggest that CAPSad, despite some weaknesses, fulfill their role, through the establishing of linkages, construction of co-responsibility and because of the broader clinical perspective, what make these services as a place of refuge and a place of collective coping situations involving the addiction. We caution that some similarities found between the CAPS Mental Health and the ad CAPS may contribute to the perpetuation of the legal validity of the moral model that sees the users of alcohol and other drugs as marginal or sick, not covering all the possibilities of existing work in this area

Orientador: Antonieta Keiko Kakuda Shimo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T03:53:00Z (GMT). No. of bitstreams: 1 Vigano_SabrinaMomesso_M.pdf: 5635836 bytes, checksum: 99824b10e6b0d821fbed6859a3516a9f (MD5) Previous issue date: 2013 / Resumo: Objetivo: Avaliar os registros acerca da vacinação antitetânica na gestação e verificar a conformidade deles com o relato das pacientes. Metodologia: Trata-se de um estudo transversal com abordagem quantitativa e caráter avaliativo. Foi realizado estudo piloto e Validação de Conteúdo do Instrumento de Coleta de Dados. Os dados foram coletados por entrevista semi-estruturada com puérperas, fotografia de Cartões de Gestante e de Fichas Obstétricas. Para análise dos dados foi utilizado o programa estatístico SAS 9.2 e calculado o coeficiente Kappa. O estudo está em conformidade com a Resolução 196/96. Resultados: 38 (12,30%) puérperas relataram não ter recebido vacina na gestação. 39,11% (106 de 309) das mulheres referiram ter recebido a vacina antitetânica na gestação, 50,16% (155) dos Cartões de Gestante e 20,06% (62) de Fichas Obstétricas continham registro desta vacina. Quanto a vacina antitetânica na gestação, o relato da mulher comparado ao registro do Cartão de Gestante é pouco coincidente (Kappa 0,55, moderado), o registro do Cartão de Gestante com o registro da Ficha Obstétrica é menos coincidente (Kappa 0,27, suave) e o relato com o registro da Ficha Obstétrica é menos coincidente ainda (0,11, desprezível). Status vacinal adequado foi identificado em 62,14% (192). Conclusão: O relato da mulher e o registro do Cartão de Gestante são mais coincidentes do que os registros entre si. Os profissionais registram vacinas mais no Cartão de Gestante do que na Ficha Obstétrica. A média de 8,91 consultas por mulher e a idade gestacional de início do pré-natal com 12 semanas ou menos de 72,49% (224) evidenciam vínculo satisfatório da paciente com os serviços. As consultas à gestante de baixo risco podem ser intercaladas entre os profissionais médicos e enfermeiros / Abstract: Objective: Evaluate records about tetanus vaccination in pregnancy and to check their compliance with the reporting of patients. Methodology: This is a cross-sectional study with a quantitative approach and evaluate character. Pilot study was performed and Content Validation Instrument for Data Collection. Data were collected through semi structured interview with puerperal, photography maternity card and obstetric records. For data analysis we used the statistical program SAS 9.2 and calculated the Kappa coefficient. For data analysis we used the statistical program SAS 9.2, calculated the degree of agreement between the data sources and calculated the Kappa coefficient. The research is in accordance with Resolution 196/96. Results: 38 (12,30%) reported not having received vaccine during pregnancy. 39,11% (106) of women reported having received tetanus toxic vaccination during pregnancy, 50,16% (155) of maternity card and 20,06% (62) document obstetrical record contained this vaccine. About tetanus vaccination during pregnancy, the reported of the woman compared to the record of maternity card is almost coincidental (Kappa 0,55, moderate), the record of maternity card with the record of the obstetric records is less coincident (Kappa 0,27, suave) and the reported with the record of the obstetric records is still less coincident (0,11, insignificant). Status suitable vaccine was identified in 62,14% (192). Adequate vaccination status are 62,14% (192). Conclusion: The reported of the woman and record of the maternity card are more coincident than the records together. Professionals register about vaccine more in maternity card than the obstetric records. The average of 8,91 consultations per woman and gestational age at first prenatal care at 12 weeks or less (72,49% = 224) show satisfactory bond of women with the services. The antenatal care at low risk women can be interspersed among medical and nurses professionals / Mestrado / Enfermagem e Trabalho / Mestra em Enfermagem

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-02T18:21:58Z No. of bitstreams: 1 Carolina Siqueira Dantas Guedes Batista.pdf: 3429320 bytes, checksum: 1933475675fdb6c7b48b0774e61da019 (MD5) / Made available in DSpace on 2015-12-02T18:21:58Z (GMT). No. of bitstreams: 1 Carolina Siqueira Dantas Guedes Batista.pdf: 3429320 bytes, checksum: 1933475675fdb6c7b48b0774e61da019 (MD5) Previous issue date: 2013 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / Trata-se de um estudo de caso típico, retrospectivo e descritivo com abordagem metodológica quantitativa a partir dos relatórios dos atendimentos realizados no serviço de orientação de alta do Hospital Estadual do Rio de Janeiro no período de junho a dezembro de 2011. Os dados foram coletados em fontes primárias de informação do serviço de orientação de alta e também no banco de dados secundário de informatizado do hospital. Com objetivo de analisar o perfil das readmissões hospitalares após implantação do serviço de orientação de alta do hospital estadual do Rio de Janeiro, relacionando com as com as ações desenvolvidas no serviço. Para tanto primeiro caracterizou-se a demanda de pacientes atendidos no serviço, sendo a maternidade a clínica com maior prevalência. Com relação aos dados demográficos dos pacientes readmitidos, observa-se que há um predomínio de mulheres e a com média de idade dos pacientes readmitidos de 66,4 anos e DP± 14,0065. Com relação ao bairro onde residem constatou-se que 58,67% eram moradores pertencentes a área programática 5.1 do Programa Saúde da Família referencia na região. Os dados de diagnóstico principal na readmissão não foram significativos, não se pode afirmar a relação dessas doenças apresentadas com a readmissão e as ações desenvolvidas no serviço. No que se refere ao tempo entre a alta e readmissão evidenciou-se que a média de dias igual a 63,4138 e o DP± 52,6074, com tempo mínimo de 0 dias e tempo máximo de 153 dias. Quanto as ações do serviço de orientação de alta, demonstro-se que 65,52% dos pacientes readmitidos aguardavam a marcação da consulta pelo SISREG, no entanto, com a demora foram readmitidos a unidade. Apontando uma grande lacuna entre a alta e a continuidade do tratamento na atenção primária de saúde, sendo as especialidades de cardiologia e neurologia as que representam o maior número de encaminhamentos.As intervenções de enfermagem evidenciaram que todos os pacientes readmitidos receberam no mínimo 3 orientações no entanto, essas são a nível geral não sendo especificados os cuidados orientados. Os resultados dessa investigação fornecem subsídios para prática dos enfermeiros no planejamento da alta, visto que o perfil de readmissão da unidade é o mesmo apontado na literatura, idade avançada e doenças crônico-degenerativas, no entanto a falta de registro impossibilitou maiores aprofundamentos, demonstrando também a necessidade de capacitação dos funcionários no preenchimento do impresso do serviço. / This is a typical study of an especific, retrospective and descritive case, with a quantitative approach from reports of care accomplished for the service orientation of dischard of the State Hospital in Rio de Janeiro from June to December 2011. The data was collected from primary researches from the service discharge orientation and also from the secondary hospitals’s computerized database. Aiming to analyze the profile of hospital readmissions after the implementation of orientation service of discharge hospital in Rio de Janeiro, relating to the developed in the service. For that, first it characterized the demand of patients care through the service, with maternity as prevalence clinic type. As far as the demographics data of readmitted patients are concerned, it realized the majority of them is made by women and the avage age of readmitted patient is 66.4 years and PD ± 14.0065. Related to the district where the live, it was verified that 58.67%, were living in the programatic area 5.1 of the Health Family Program of that area. The main diagnostic datas were not significant, we can not state the relationship between the presented diseases and readmission and developed actions in the service. Regarding to the time gap between the discharge and readmission, it was showed that the average number of days equal to 63.4138 and PD ±52,6074, with a minimum of 0 days and maximum of 153 days. Regarding to the actions of the service and discharge orientation, it was showed that 65.52% of the readmitted patients would wait for the arangement of the appointment through SISREG, however, it tooke a long time for them to be readmitted to te unit. Pointing a hupe gap between discharge and the continuation of the treatment in the primary attention health, with the especialities of cardiology and neurology as the ones which represent the biggest number of routings. The nursing intervention showed that all the readmitted patients received at last 3 orientations, however, these were about general issues not specific to the routed cares.The results of these investigation give subsidy to the nurses in the planning of the discharge, since the profile of readmission of the unit is the same appointed in the literature, advanced ages and chronic-degenerative diseases, however, the absence of records forbid a closer deepening study about the subjective, also demonstrating the need for training of employees in filling in the form of service.

Submitted by Haroudo Xavier Filho (haroudo.xavierfo@ufpe.br) on 2016-04-20T14:14:11Z No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTACAO MESTRADO RAFAELA NIELS DA SILVA versão 8 Revisada biblioteca.pdf: 1577048 bytes, checksum: 796952415a5c9699f66cf1eaa644d4ea (MD5) / Made available in DSpace on 2016-04-20T14:14:11Z (GMT). No. of bitstreams: 2 license_rdf: 1232 bytes, checksum: 66e71c371cc565284e70f40736c94386 (MD5) DISSERTACAO MESTRADO RAFAELA NIELS DA SILVA versão 8 Revisada biblioteca.pdf: 1577048 bytes, checksum: 796952415a5c9699f66cf1eaa644d4ea (MD5) Previous issue date: 2015-07-22 / O Programa Academia da Saúde (PAS) foi implantado na cidade do Recife a partir de 2011 e tem o objetivo contribuir para a promoção da saúde e produção do cuidado através de ações articuladas no âmbito da Atenção Básica. Entretanto, o programa ainda não foi submetido a avaliações. Esta dissertação foi desenvolvida em formato de artigo e tem como objetivo aferir a avaliabilidade do programa Academia da Saúde em Recife. Para tanto, desenvolveu-se um estudo de caso com ênfase na análise descritiva e exploratória dos aspectos operacionais das ações e do contexto do programa, utilizando-se o sistema de sete elementos, o qual permitiu a descrição, elaboração dos modelos lógico e teórico de avaliação, além de identificar perguntas avaliativas para estudo posterior. Verificou-se que os gestores têm pouco conhecimento sobre as diretrizes do programa e que os documentos oficiais apresentem uma extensa gama de objetivos, princípios e diretrizes, sem, contudo, identificarem as metas para que o programa cumpra sua finalidade. A partir da análise dos documentos, entrevistas e com base na modelagem do programa e pactuação das estratégias de avaliação com os interessados conclui-se que há viabilidade metodológica para execução de pesquisa avaliativa no Programa Academia da Saúde de Recife, no entanto, verificou-se a necessidade de aperfeiçoar a normativa do PAS no intuito de qualificar as atividades de planejamento, operacionalização e avaliação. Além disso, a partir dos produtos desse estudo será possível apreciar o grau de implantação em estudos posteriores. / The Health Academy Program (SBP) was deployed in the city of Recife in 2011 and aims to contribute to the promotion of health and care production through joint actions within the framework of primary care. However, the program has not yet been subjected to evaluation. This work was developed in article format and aims to assess the evaluability of the Health Academy Program in Recife. To this end, it was developed a case study with emphasis on descriptive and exploratory analysis of the operational aspects of the actions and program context, using the seven elements of the system, which allowed the description, preparation of logical and theoretical models evaluation, and identify evaluative questions for future studies. It was verified that managers have a little knowledge about the program guidelines and that official documents have several goals, principles and guidelines, without, however, identify the goals for the program to satisfy its purposes. From the analysis of documents, interviews and based on program modeling and agreement of the assessment strategies with stakeholders it is concluded that there are methodological feasibility for evaluative research program running on the Academy of Health of Recife, however, it was found the need to improve the rules of the PAS in order to qualify the planning, implementation and evaluation. Moreover, the products from this study will be possible to assess the degree of implantation in subsequent studies.

The purpose of the study is to develop a foundation of knowledge that could improve the current policies and procedures with regards to their implementation within the mental health services provided by the Children's Bureau.

The purpose of this study is to test the utility of Talcott Parsons' AGIL Model, i.e., Adaptation, Goal Attainment, Integration, and Latency (Pattern Maintenance) in evaluating the program effectiveness of a community mental health center (CMHC). The model provided a conceptual framework for the selection of appropriate variables. The dependent variable in this study is the overall evaluation of the CMHC as measured through the perception of community leaders. Fourteen hypotheses were constructed to identify and test the relationship among the AGIL criteria and the use of a selected set of independent variables. Data for this study were collected from primary and secondary sources. Secondary data were obtained from the Texas Department of Mental Health and Mental Retardation in Austin and the CMHC center in Eton. Primary data were collected through personal interviews of general community leaders and influential persons in health-related activities in the community. The selected independent variables included the scope of leadership, the attitude towards this community, socio-economic status, knowledge of the CMHC, and the commitment and involvement in the CMHC. Data indicated that Parsons' criteria for evaluating the CMHC's program were comprehensive and related to each other both positively and negatively. Among the selected independent variables, the type of leader was found to be the best predictor of program evaluation of this CMHC. Overall, generalized community leaders were more defensive and favorable to the CMHC's program compared with the specialinterest leaders. The leaders also differed in their emphasis of the AGIL criteria. The generalized community leaders were conservative in emphasizeing the evaluative criteria of adaptation, integration, and pattern maintenance; the special-interest leaders gave more emphasis to the goal attainment function of CMHC. It was concluded that Parsons' AGIL model was useful for evaluating a CMHC. The variant direction of relationship among AGIL criteria indicated differences in the perception of community leaders in the evaluation of the CMHC.

Research objectives: This study examined research, media, and public opinion related to maternal health in order to understand some of the social and structural factors that influence the passage of comprehensive maternal health policies in the United States. This study also examined the messaging of race and racism in media and health communication. Research objectives were: 1.) To summarize the perinatal care experiences of Black birthing people through a scoping review of the literature, 2.) To explore media depictions of maternal mortality in terms of the groups, causes, and solutions discussed in coverage, and 3.) To test the effects of two different approaches to communicating maternal health on public beliefs about the causes of racial health disparities and public support for structural policies. Methods: The review of the literature followed a scoping review protocol and developed tailored search strings to retrieve relevant articles in three databases. The review protocol included developing selection criteria, screening articles retrieved from three databases, charting the data, and identifying themes across articles using an ecological health model as a conceptual guide. For the second paper – a content analysis of news media coverage of maternal mortality – relevant news articles were retrieved using NexisUni, an online database of newspaper articles. A codebook was developed deductively using previous research and grey literature on maternal health, and articles were subsequently coded for the presence or absence of codes that assessed how articles framed causes, solutions, and social groups in their coverage of maternal mortality in the United States. The third paper tested the effects of articles that communicated the maternal health issues faced by Black birthing people using a web-based survey experiment. Participants in this study were recruited using Qualtrics’ panel services, and were randomly assigned to read either a narrative or nonnarrative article communicating the relationship between race and adverse maternal health outcomes. Participants were then asked to respond to the questions that assessed their agreement with structural causes for racial health disparities and their support for policies to improve maternal health. Findings: The scoping review found that Black birthing people described factors at the interpersonal, organizational, community, and policy level in their accounts of their perinatal care experiences. This included their interactions with their providers, the dominant models of care in healthcare settings, institutional representation, and the limitations of care covered through existing Medicaid policies. The content analysis of media found that newspaper coverage of maternal health reflected the factors described in research. Media predominantly focused on structural causes and solutions for maternal health (e.g., access to services and care, social determinants of health, structural racism) and described racial disparities in maternal mortality. The final study built on the findings of the media analysis by testing the effects of news articles that described the role of social and structural factors on the maternal health outcomes of Black birthing people. Data from the experiment showed that participants who read a narrative article about the issue had greater support for structural policies than participants who read a nonnarrative article. The difference in agreement with structural causes for racial health disparities between participants in the narrative and nonnarrative groups was not statistically significant. Additionally, data showed significant differences in treatment effects and policy support across groups distinguished by race and gender.

This thesis comprises three chapters on topics in development economics. The first chapter studies access to maternal healthcare in markets with vertically differentiated public and private providers. The second chapter studies the efficacy of induction stoves in reducing indoor air pollution in rural households when faced with erratic power supply. Finally, the third chapter studies the role of financial incentives in correcting disparities in sex ratios. All three chapters study the context of India but are representative of important development issues in low-income countries. The first chapter titled "Equilibrium Effects of Subsidizing Public Services" studies one of India's largest welfare schemes Janani Suraksha Yojana (JSY) that incentivized pregnant women in India to access institutional maternal care at public hospitals. We argue that governments can make complementary investments to improve welfare gains from large scale policies. JSY did not improve health outcomes despite a substantial increase in the take-up of institutional care. We document three equilibrium responses that explain this policy failure. First, JSY led to a mismatch of risk across health facilities -- high-risk mothers sorted out of highest quality care at private facilities. Second, in line with the literature, public sector quality deteriorated as a result of congestion. This resulted in lower quality care for both marginal as well as infra-marginal patients at public hospitals. We show that only mothers with high socio-economic status adapted to the worsening quality of care at public hospitals by sorting into more expensive private hospitals. Third, despite increased competition, private hospitals maintained high prices, crowding out riskier and poorer mothers. We do not find evidence that private hospitals improved healthcare quality to justify higher prices. The second chapter titled "Electric Stoves as a Solution for Household Air Pollution" is an interdisciplinary field-based research study that studies the role of reliable electricity in inducing rural Indian households to switch away from dirty cooking fuels towards a clean cooking technology, induction cookstoves, thereby reducing the exposure to high levels of indoor air pollution. We collected minute-by-minute data on electricity availability, electric induction stove use, and kitchen and outdoor particulate pollution in a sample of rural Indian households for one year. Using within household-month variation generated by unpredictable outages, we estimate the effects of electricity availability and electric induction stove use on kitchen PM2.5 concentration at each hour of the day. Electricity availability reduces kitchen PM2.5 by up to 50 ??/?3, which is between 10 and 20 percent of peak concentrations during cooking hours. Induction stove use instrumented by electricity availability reduces PM2.5 in kitchens by 200-450 ??/?3 during cooking hours. The final chapter titled "Can Large-Scale Conditional Cash Transfers Resolve the Fertility-Sex Ratio Trade-off? Evidence from India" studies a large-scale conditional cash transfer (CCT) scheme Ladli Laxmi Yojana that offered cash incentives to households upon the birth of girl children. The policy also offered substantial incentive for investing in girls' education. In my evaluation of the Ladli Laxmi Yojana in Madhya Pradesh, India. I find that financial incentives aimed at the girl child increased average fertility by about 0.15 children per household (on baseline average of 0.93 children) children per household and improved sex-ratio by 3%. This points to the well known fertility-sex ratio trade-off. Moreover, these effects are quite opposite to a similar CCT scheme in Haryana (Anukriti, 2018) suggesting context dependence of such policies.

This dissertation is motivated by the study of economic development and inequality within and across nations. Spanning topics in labor and public economics, this collection of papers speaks to two overarching themes: (i) how the distribution of power affects economic outcomes, and (ii) how governments can mobilize resources and spend them effectively. In Chapter 1, I study how the allocation of ownership and control rights within firms affect responses to economic shocks. To shed light on this issue, I study the heterogeneous effects of a pro-competitive reform on cooperative manufacturing firms and their non-cooperative counterparts in India. The reform removed firm-size restrictions on the production of “reserved” items, increasing competition for incumbents in “de-reserved” product markets. Using a difference-in-differences approach, I find that supplier cooperatives (SCs), owned and controlled by producer-members who supply material inputs, are resilient to the shock in terms of total revenue and move away from the production of de-reserved items. SCs increase their share of income spent on materials relative to similarly sized non-cooperatives in the same industry and location, with some evidence of downward adjustments in labor spending. These cooperatives are able to withstand competitive pressure from entrants while broadly catering to the interests of their membership. On the other hand, worker cooperatives (WCs), owned and controlled by worker-members employed at the firm, face a sharp decline in revenue due to de-reservation, unlike their non-cooperative counterparts. A potential channel behind these results is that WCs are less likely to respond by picking up items that are not directly affected by the reform. Spending on labor does not fall as much as revenue for WCs, which is in line with the immediate interests of membership, but adjustments to labor inputs vary sigificantly across employment categories. In the following chapter, my co-author, Utkarsh Kumar, and I study the equilibrium effects of subsidizing public services in the presence of vertically differentiated public and private suppliers. We evaluate one of India’s largest welfare schemes, Janani Suraksha Yojana (JSY), which subsidized childbirth at public health institutions. JSY did not improve health outcomes despite a substantial increase in take-up of institutional care. We document three equilibrium responses that explain this policy failure. First, JSY led to a mismatch in patient risk across health facilities. High-risk mothers sorted out of the highest-quality care at private facilities and into lower-quality public facilities. Second, in response to congestion and deterioration of care at public hospitals, only mothers with high socio-economic status sorted out of congested public facilities into more expensive private facilities. Third, private hospitals increased prices without improvements in healthcare quality in a specific subset of states, further crowding out high-risk and poor mothers. These findings point to the need for complementary public policies in addition to JSY. In Chapter 3, I, along with my co-authors, Alexander Klemm and Li Liu, explore the increasingly prominent position of services in international trade and their potential to facilitate tax-driven reporting and reallocation of economic activity. Given their potential in countering this form of base erosion, withholding taxes (WHTs) on payments for services have featured extensively in ongoing reforms of the international tax architecture. The rationale behind WHTs is to preserve some taxation rights in the source country given their straightforward application, which is particularly important for low-income countries in the absence of more effective rules. We build a simple model of reporting decisions when firms have economic activities in one country and affiliates in others. We then test the predictions of this model using newly compiled data on treaty and non-treaty rates for 120+ countries over 2009-2021. Our findings indicate that while there is no significant relationship between WHTs and services trade in general, these taxes do have a strong negative impact on services imports from known low-tax jurisdictions, when base erosion is a particular concern.

INTRODUÇÃO: Serviços de saúde desenvolvidos para a atenção à demanda espontânea de baixa complexidade como as Walk-in Clinics canadenses e britânicas estão sendo oferecidos no Brasil como alternativa à Estratégia de Saúde da Família (ESF). Em São Paulo, recebem o nome de Assistências Médicas Ambulatoriais (AMA). Entretanto, não há estudos comparativos entre eles. OBJETIVO: Comparar aspectos estruturais e processuais de uma Unidade Básica de Saúde (UBS), vinculada à ESF, e de uma AMA utilizando a ferramenta de avaliação PCATool. METODOLOGIA: Trata-se de um estudo transversal utilizando o instrumento para avaliação de qualidade de serviços de APS, Primary Care Assessment Tool, - versão validada para o Português (PCATool Brasil), em uma área da Zona Sul da cidade de São Paulo coberta por dois modelos de serviços voltados para a APS: uma Unidade Básica de Saúde (UBS), parte integrante da ESF, e uma AMA. Participaram da pesquisa 616 adultos maiores de 18 anos, residentes na área adstrita à UBS, cadastrados ou não à UBS. Foi considerado como fator de exclusão não estar afiliado a nenhum dos dois serviços de interesse do estudo, o que, na prática, se traduziu por não ter passado nenhuma vez em consulta na UBS ou na AMA durante último ano. Além do questionário do PCATool Brasil, composto por 87 perguntas focadas na mensuração dos atributos essenciais e derivados da APS, um questionário sociodemográfico foi aplicado para incluir dados como idade, sexo, profissão, escolaridade e classe social. A coleta dos dados aconteceu na casa dos usuários, em horários variados, entre novembro de 2013 e julho de 2014, por meio de entrevistadores capacitados previamente. Cada visita demorou entre 20 a 40 minutos. Não houve contato telefônico anterior. Os escores individuais do PCATool Brasil dos serviços AMA e UBS foram calculados conforme manual do instrumento. RESULTADOS: Dos 616 questionários, 76,3% eram afiliados à UBS e 12,3% a AMA. Os frequentadores da UBS pertenciam a uma classe social mais baixa comparados aos da AMA. A UBS apresentou escores essencial e geral maiores: 5,64 (IC95% 5,53-5,74) e 5,58 (IC95% 3,44-3,95), respectivamente, contra 3,70 (IC95% 3,44-3,95) e 3,38 (IC95% 3,08-3,59) da AMA. Teve médias superiores em quase todos os atributos, alcançando alta orientação à APS em dois: \"utilização\" (7,22 - IC95% 6,97-7,47) e \"sistemas de informação\" (7,31 - IC95% 7,15-7,47). A AMA apenas foi superior em relação à \"acessibilidade\" que apresentou escore de 3,68 (IC95% 3,38-3,98) contra 2,46 (IC95% 2,34-2,58) da UBS, mas não apresentou nenhum atributo com alta orientação à APS (nenhum atributo teve escore > 6,6). DISCUSSÃO: De maneira geral, os usuários avaliam mal os atributos de APS propostos por Starfield nos dois serviços, em um nível aquém do considerado satisfatório, embora os escores da UBS sejam mais elevados do que os da AMA em 8 dos 10 atributos. CONCLUSÃO: A UBS Luar do Sertão e a AMA Pq. Fernanda não estão cumprindo suas potencialidades de maneira satisfatória. Seus usuários percebem pouco os atributos de APS propostos por Starfield nos dois serviços avaliado pelo PCATool Brasil. Embora a UBS apresente uma performance melhor do que a AMA, ela ainda está muito abaixo do esperado, sendo necessária implementação de mudanças que melhorem seu desempenho, assim como o da AMA / INTRODUCTION: In Brazil, Health Care Services focused on low-complexity demand as the Canadian and British walk-in clinics are available in Brazil as an alternative option to the Family Health Strategy (FHS - Estratégia Saúde da Família). In the city of São Paulo, they are called Outpatient Medical Care units (Assistências Médicas Ambulatoriais - AMA). However, there are no studies comparing the performance of these two strategies. OBJECTIVE: To compare structural and procedural aspects of two services in the city of São Paulo: a Basic Health Unit (BHU) of the FHS, and an AMA using the Primary Care Assessment Tool - Portuguese validated version (PCATool Brazil). METHODS: A cross-sectional study to assess the presence and extent of primary health care (PHC) attributes in an area covered by two Primary Care units of São Paulo: a Basic Health Unit (Unidade Básica de Saúde - BHU), part of the FHS, and an AMA. PCATool Brazil questionnaire were applied to 616 adults older than 18 years, living in the area linked to the BHU, registered or not in the BHU. Individuals with affiliation to none of the two services, i.e., that did not used the units in the last year, were excluded from the analysis. Besides the PCATool Brazil questionnaire, composed by 87 questions focused on the measurement of the essential and derived PHC attributes, the researchers applied a sociodemographic questionnaire to evaluate sociodemographic characteristics such as age, sex, occupation, education and social class. Data collection occurred between November 2013 to July 2014 in the participant household at different schedules during the day by previously trained interviewers. Each visit demanded 20 to 40 minutes. There was no previous phone contact. PCATool Brazil scores for AMA and BHU units were calculated as instructed by PCATool\'s manual. RESULTS: Of the 616 questionnaires, 76.3% reported an affiliation with the BHU and 12.3% with the AMA. BHU users were from lower social level compared to the AMA. BHU presented higher essential and general scores: 5.64 (95%CI, 5.53 to 5.74) and 5.58 (95%CI, 3.44 to 3.95), respectively, compared to 3.70 (95%CI 3, 44 to 3.95) and 3.38 (95%CI 3.08 to 3.59) of the AMA. BHU showed higher average scores in almost all attributes, reaching high PHC orientation in two of them: \"First Contact - Utilization\" (7.22 - 95%CI, 6.97 to 7.47) and \"Coordination - information systems\" (7.31 - 95%CI, 7,15 to 7.47). In the AMA, the only attribute that scored higher than in BHU was \"accessibility\" with a score of 3.68 (95%CI, 3.38 to 3.98) compared to 2.46 (95% CI 2.34 to 2.58) in the BHU. Therefore, AMA did not present any attributes with high PHC orientation (no attributes had scores > 6.6). DISCUSSION: In general, the users identified a very low level of satisfactory development of PHC attributes in the two services evaluated, although BHU scores are higher than AMA\'s in 8 of the 10 attributes. CONCLUSION: UBS Luar do Sertão and AMA Pq. Fernanda did not fulfill all their possible potentials. Users realize few of the attributes proposed by Starfield for each one of the services. Although the UBS present a better performance compared to the AMA, it is lower than expected. It is necessary to make some changes to improve the performance of these units