Introdução: O medicamento, imprescindível no tratamento e recuperação da saúde, cresce em importância, tanto para os profissionais de saúde como para a população. Objetivo: Incluir a experiência da população de baixa renda, na pesquisa em saúde pública, sobre necessidade de tomar medicamentos; apresentar dificuldades vivenciadas, em busca destes; relatar as estratégias adotadas, diante da impossibilidade de consegui-los gratuitamente; estudar a compreensão do valor monetário deste produto; identificar a possibilidade de aquisição de medicamentos de médio e alto custo. Método: Metodologia qualitativa, usando a técnica de grupo focal, com a construção de 3 grupos, com a participação de 31 sujeitos, no período de dezembro de 2008 a março de 2009. Os sujeitos são moradores da região do Butantã, SP/SP, com 40 anos ou mais, com renda mensal até 3 salários mínimos e usuários do SUS, fazendo uso de pelo menos um medicamento. Os três grupos foram formados por usuários de medicamentos de uso contínuo; usuários de medicamentos de médio e alto custo e por moradores de uma favela. As discussões foram conduzidas por 2 profissionais e, foram baseadas em 5 perguntas referentes aos objetivos. Para a análise das discussões, optou-se pelo método do DSC (Discurso do Sujeito Coletivo), com utilização do software Qualiquantisoft®. Resultados: As discussões geraram 23 respostas categorizadas, destacando: a necessidade do medicamento, a dificuldade para consegui-lo gratuitamente; a má divulgação e a falta de informação sobre os programas de distribuição gratuita; a dependência de terceiros para aquisição; a necessidade de procura do medicamento em vários postos de saúde; a necessidade de compra. Medicamentos com preço até 50 reais foram considerados caros para a maioria. Os de alto custo são adquiridos, com algumas dificuldades, destacando-se tempo de espera, e falhas na dispensação. Conclusão: O acesso aos medicamentos mostrou-se parcial, apesar do avanço das políticas públicas na área, fazendo-se necessário um amplo conjunto de medidas, que priorize a manutenção de estoques regulares, a humanização do atendimento, a disponibilidade de profissionais competentes e que tenham compromisso social, para que a população de baixa renda alcance gratuitamente o sucesso terapêutico desejado, de forma regular e sistemática. / Introduction: Prescription drugs are indispensable to medical treatment for both health professionals and the general population. Objective: the goals of this study were to include in public health research the experience of the poor population who needs prescription drugs; to describe practical difficulties of the poor population to obtain prescription drugs from public health units; to report the main actions taken by this population when it is not possible to obtain free drugs in public health units; to evaluate the comprehension of the financial value of these drugs within this demographic segment of the population; to identify the strategies to obtain prescription drugs of medium and high cost. Method: The focal group qualitative method was selected for this research, with three groups comprising 31 subjects, studied in the period from December 2008 to March 2009. Subjects had to be residents of Butantã District, São Paulo-SP; besides being over 40 years old, in use of at least one prescription drug; to have a monthly income of up to three minimum salaries; to be a regular user of the public health system and units. All subjects lived in slums and were under treatment with medium-high cost drugs of continuous use. Two professionals conducted discussions on the five questions concerning the objectives. The collective subject method (CSM) was used for the analysis, which was performed with the Qualiquantisoft® computer program. Results: the five questions generated 23 answers, which were characterized as follows: necessity of the drug; difficulty to obtain the drug from public health units; deficiency in the advertisement programs and lack of information on free distribution programs; reliance on other people to obtain the drugs; necessity to reach many public health units to obtain the drugs; necessity to buy the drug. Drugs with prices up to R$ 50,00 were considered expensive. High cost drugs are purchased with some difficulty, such as slot time and dismissing flaws. Conclusion: Despite the advances in public health policies, the access to prescription drugs was biased, revealing a demand for a set of actions to prioritize storage and regular maintenance of these drugs, well prepared professionals to speed up and humanize the advising and assistance strategies in public health units, in order to promote a better distribution of these drugs and the effective achievement of therapeutic success for this population in a regular and systematic way.

Background: The movement of production to low cost countries has been a prominent trend during recent decades. The offshoring trend has primarily been cost motivated and has had a negative impact on domestic economic growth. Manufacturing firms operating in a high cost environment must strive to develop core capabilities to enhance competitiveness. In this study, the focus is on operations capabilities and improvement areas in a specific context (i.e. high cost environment). Purpose: The purpose of the study is to evaluate critical operations capabilities and improvement areas for competitive manufacturing in a high cost environment. Method: The research process is based on the evaluation of an existing framework of operations capabilities in a high cost environment. The study adopts a multiple case study approach in which three Swedish manufacturing firms are evaluated. The data collection was conducted through a quantitative part (i.e. questionnaire) and a qualitative part (i.e. workshop discussion). Findings: The findings revealed that 16 operations capabilities and ten improvement areas were considered critical in a high cost environment. Four critical capabilities (i.e. total cost, productivity, conformance and customization flexibility) are more prominent and appear in all three cases. Two critical improvement areas, total cost and dependability, are more prominent and have a higher occurrence. Implications: The practical implication of the study provides firms with an overview and better understanding of critical operations capabilities and potential improvement areas in a high cost environment. The theoretical implication of the study is that firm characteristics (e.g. size and position in the supply chain) influence the importance of each capability.

Background Globalization has forced textile firms to move their manufacturing to low-cost countries to reduce their prices. However, interest in local manufacturing has increased in recent years because of the trend in sustainability and changes in society’s ways of thinking, both of which can bring textile industry manufacturing back to high-cost countries. Purpose The purpose of this study is to formulate concepts and theories that can differentiate local manufacturers in high-cost countries from their competitors and identify the key competitive advantages that can lead to successful local production in high-cost countries. Methodology Two case studies were conducted of local textile manufacturers in Sweden in this study. Both companies’ value chain activities were examined to determine their competitive advantages. Empirical data were collected using semi-constructed interviews with key managers in both companies and were analysed using the thematic analysis method. Findings The textile industry in high-cost countries can create difference by considering competitive advantages, which are flexible and agile operations, development and innovation, sustainability, combining products and services, and uniqueness and differentiation. However, the competitive disadvantages of textile manufacturing in high-cost countries, which include scarcity of employees and high costs, should be considered as well.

The purpose of this thesis is to increase the understanding of supply network configuration (SNC) for small series production in high-cost contexts in relation to the textile/apparel industry. SNC encompasses strategic structural and infrastructural decisions at the supply chain level, motivated by capabilities/priorities. The key configuration decisions addressed concern textile/apparel production in Europe, with associated context-specific advantages and challenges. The thesis takes a particular focus on how practitioners consider these configurations and motivations. The thesis begins with identification of motivations for locating textile/apparel production in high-cost contexts, to capture the driving priorities. Thereafter, the thesis extends the focus beyond location motivations to identify the key SNC aspects and characteristics for small series production in high-cost contexts. These configuration-related aspects and capabilities are elaborated upon and modelled to understand how they are interrelated in textile/apparel industry contexts. The empirical work uses mixed-methods and seeks to bring together the relevant topics using a SNC and capabilities approach. The specific methods, Delphi study and interpretive structural modeling, are focused on sensitivity practitioner perspectives. Findings show multiple key motivations/capabilities for high-cost textile/apparel production, specifically small series production (customization); which is closely linked with several other priorities, including quality and flexibility/delivery. Expanding the view to the SNC aspects, the findings confirm and extend the literature regarding complexities, multi-level characteristics, synergies and trade-offs, and industry/location contingencies. Regarding this European textile/apparel context, several interrelated considerations create challenges with respect to balancing configuration, capabilities and location; in particular related to multiple priorities such as flexibility/delivery, quality, innovation/sustainability, and the level of product variety/customization. Several relational characteristics are also crucial, including focus on trust and information sharing, although, with a few significant exceptions, limited supplier integration levels are found. These findings indicate the need to build upon existing relationships to develop end-to-end digital connections. The thesis approaches issues at the intersection of theory and practice, regarding configuring supply networks for small series production in high-cost contexts. Practically, it develops an approach to evaluate and model decision aspects, demonstrating how this can be used with a variety of textile/apparel companies. Several extensions are required to support current and future state mapping, including developments related to the method and the addition of performance considerations. The thesis contributes to theory by broadening the focus on high-cost locations to include small series production and the SNC perspective. Thus, the research confirms multiple priorities including innovation and sustainability; additionally finding several challenges associated with small series textile/apparel production in high-cost contexts. Further research should extend the focus to understand (re)configuration processes, and implications on priorities like sustainable innovation.

O Sistema Único de Saúde (SUS), sistema público de saúde brasileiro, tem evoluído continuamente para se adaptar aos novos desafios da área de saúde e as novas necessidades da população. Entre os aprimoramentos para atender a esses desafios está a oferta de medicamentos de alto custo à população por meio de farmácias de medicamentos especializados como a de Ribeirão Preto, que atende aos residentes no município e também as pessoas das cidades englobadas pela DRS XIII. Com o objetivo de analisar o processo de uma farmácia de medicamentos especializados, identificando os problemas e propondo melhorias foi aplicada a metodologia lean healthcare. Inicialmente foi realizada uma pesquisa juntamente aos usuários desse serviço em busca de uma definição do valor no serviço prestado pela farmácia. Os resultados encontrados mostram que receber todos os medicamentos solicitados, a correta orientação em relação as dúvidas, pouco tempo de espera na fila e o bom atendimento são os itens mais valorizados por eles. A partir dessa definição de valor, de entrevistas com funcionários da farmácia e de observações no local, foram criados mapas do fluxo de valor do processo de trabalho da farmácia, identificando os desperdícios praticados e apontando sugestões de melhorias através da aplicação da metodologia lean healthcare. Após a finalização dessa etapa foram criadas propostas para a melhoria do fluxo contínuo, para o estabelecimento da demanda puxada e para a melhoria contínua. Além disso, realizou-se uma análise crítica dos resultados obtidos em que se pôde perceber que as soluções aos problemas vivenciados pela farmácia possuem diferentes graus de dificuldade de implantação, porém, apresentam grande potencial para a melhoria do valor entregue ao público da farmácia. Verificou-se também que a má distribuição do seu espaço físico, a divisão dos estoques em diferentes unidades e a falta de medicamentos são origens de grandes desperdícios. Assim, foi sugerida a inclusão de outras etapas ao modelo de implantação do lean utilizado para que seja alcançada a maior participação da equipe de trabalho da farmácia e para que o lean healthcare seja implantado de maneira completa, com foco na busca da perfeição e não se limitando a solução de problemas pontuais. / The Unified Health System (SUS), the Brazilian public health system, has continuously evolved to adapt to the new challenges of the healthcare and the new requirements of the population. The offering of the high-cost medicines is between the enhancements to meet these challenges and it`s dispensation is conducted to the population through specialized medicine pharmacies like the Ribeirão Preto pharmacy, which serves the people of this city and also the people of the cities encompassed by the DRS XIII. In order to analyze the process of specialized medicines pharmacy identifying problems and proposing improvements was applied the lean methodology healthcare. Initially a survey was conducted among the users of that service aiming the definition of what was most important to them in the services provided by the pharmacy. The results show that receive all required medicines, be well oriented about the doubts, stay a short time in the queue and be well attended are the most valued items by them. From this definition, interviews with pharmacy staff and on-site observations, the value stream maps were created enabling to understand the pharmacy work process, identify the waste and aiming suggestions for improvements through the application of lean healthcare tools. After this stage, proposals were designed to improve the continuous stream, for the establishment of the pull demand and the continuous improvement. In addition, was conducted a critical analysis of the results and is possible to realize that the solutions to the problems experienced by the pharmacy features different degrees of difficulty implementation, however, offers a great potential to improve the value delivered to the pharmacy public. It was also found that the poor distribution of its physical space, the division of stocks in different units and lack of medicines are the major sources of the waste observed. Thus, was suggested the inclusion of other steps to the lean implementation model, in order to reach greater involvement of the pharmacy work team and to implement the lean healthcare completely, focusing on the pursuit of perfection and not limiting the solution of specific problems.

La recherche se propose d’introduire en sciences de gestion le concept de cherté de la vie du point de vue des consommateurs. Pour ce faire, la recherche propose, dans un premier temps, de définir le concept de cherté de la vie tel qu’évalué par les consommateurs et d’en identifier son contenu. Dans un second temps, la recherche pose la question des antécédents de cette évaluation et de ses conséquences sur le comportement d’achat des consommateurs.La démarche empirique s’appuie sur une Mixed Methods Research. Il s’agit là d’une méthode de recherche qui implique de combiner à la fois les éléments d’une approche quantitative et d’une approche qualitative à des fins de compréhension et de corroboration. Dans cette optique, deux principales études empiriques ont été réalisées : (1) une étude exploratoire qualitative composée de plusieurs méthodes de collecte de données (entretiens semi directifs, netnographie, sondage en sortie de supermarché) et (2) une étude quantitative confirmatoire menée auprès de 700 résidents de l’île de La Réunion.L’étude qualitative permet (1) de déterminer les causes de cette cherté de la vie du point de vue des consommateurs, (2) de définir l’évaluation de la cherté de la vie et de structurer son contenu et (3) d’analyser les conséquences de cette évaluation sur le comportement d’achat des consommateurs. A la lumière de ces premiers résultats et de la revue de la littérature, une série d’hypothèses ainsi que le modèle de la recherche qui en découle sont alors formulés. Hypothèses et modèle testés lors de la phase quantitative.L’étude quantitative permet quant à elle (1) de valider un instrument de mesure de l’évaluation de la cherté de la vie, (2) de mettre en évidence l’influence de l’évaluation de la cherté de la vie sur les comportements d’achat des consommateurs, et (3) de souligner le rôle modérateur de la préoccupation du maintien du pouvoir d’achat (PPA). La recherche a comme principaux apports la conceptualisation de la cherté de la vie du point de vue des consommateurs et la mise en exergue des conséquences de cette évaluation sur les habitudes de consommation des individus. Les résultats permettent ainsi d’alimenter la réflexion sur la nécessité, pour les managers, de tenir compte de / The research proposes to introduce the concept of high cost-of-living from customers’ point of view into managementscience. In order to do this, the research first proposes to define the concept of high cost of from customers’ point of viewand to identify its content. Secondly, the research focuses on the antecedents of the concept and its consequences onconsumers' purchasing behavior.The empirical approach is based on a Mixed Methods Research. This is a research method that involves combining boththe elements of a quantitative and qualitative approach in order to understand the high cost-of-living from customers’point of view. Two main empirical studies have been carried out: (1) a qualitative exploratory study composed of severalmethods of data collection (semi-directive interviews, netnography, survey at the exit of a supermarket) and (2) aquantitative confirmatory study with a sample of 700 residents of Réunion Island.The qualitative study allows (1) to determine the causes of this high cost-of-living from customers’ point of view, (2) todefine the concept and to structure its content and (3) to analyze the consequences of this evaluation on consumerpurchasing behavior. From the results of the qualitative study and the literature review, a series of assumptions and themodel of research are formulated. The assumptions and the model are tested during the quantitative study.The quantitative study allows (1) to validate a measuring instrument of evaluation of the high cost-of-living, (2) todetermine the influence of this evaluation on consumer buying behavior, and (3) to emphasize the moderating role ofPPA.The main contributions of this research are the conceptualization of the high cost of living from customers’ point of viewand the description of the consequences of this evaluation on consumer.

O Sistema Único de Saúde (SUS), sistema público de saúde brasileiro, tem evoluído continuamente para se adaptar aos novos desafios da área de saúde e as novas necessidades da população. Entre os aprimoramentos para atender a esses desafios está a oferta de medicamentos de alto custo à população por meio de farmácias de medicamentos especializados como a de Ribeirão Preto, que atende aos residentes no município e também as pessoas das cidades englobadas pela DRS XIII. Com o objetivo de analisar o processo de uma farmácia de medicamentos especializados, identificando os problemas e propondo melhorias foi aplicada a metodologia lean healthcare. Inicialmente foi realizada uma pesquisa juntamente aos usuários desse serviço em busca de uma definição do valor no serviço prestado pela farmácia. Os resultados encontrados mostram que receber todos os medicamentos solicitados, a correta orientação em relação as dúvidas, pouco tempo de espera na fila e o bom atendimento são os itens mais valorizados por eles. A partir dessa definição de valor, de entrevistas com funcionários da farmácia e de observações no local, foram criados mapas do fluxo de valor do processo de trabalho da farmácia, identificando os desperdícios praticados e apontando sugestões de melhorias através da aplicação da metodologia lean healthcare. Após a finalização dessa etapa foram criadas propostas para a melhoria do fluxo contínuo, para o estabelecimento da demanda puxada e para a melhoria contínua. Além disso, realizou-se uma análise crítica dos resultados obtidos em que se pôde perceber que as soluções aos problemas vivenciados pela farmácia possuem diferentes graus de dificuldade de implantação, porém, apresentam grande potencial para a melhoria do valor entregue ao público da farmácia. Verificou-se também que a má distribuição do seu espaço físico, a divisão dos estoques em diferentes unidades e a falta de medicamentos são origens de grandes desperdícios. Assim, foi sugerida a inclusão de outras etapas ao modelo de implantação do lean utilizado para que seja alcançada a maior participação da equipe de trabalho da farmácia e para que o lean healthcare seja implantado de maneira completa, com foco na busca da perfeição e não se limitando a solução de problemas pontuais. / The Unified Health System (SUS), the Brazilian public health system, has continuously evolved to adapt to the new challenges of the healthcare and the new requirements of the population. The offering of the high-cost medicines is between the enhancements to meet these challenges and it`s dispensation is conducted to the population through specialized medicine pharmacies like the Ribeirão Preto pharmacy, which serves the people of this city and also the people of the cities encompassed by the DRS XIII. In order to analyze the process of specialized medicines pharmacy identifying problems and proposing improvements was applied the lean methodology healthcare. Initially a survey was conducted among the users of that service aiming the definition of what was most important to them in the services provided by the pharmacy. The results show that receive all required medicines, be well oriented about the doubts, stay a short time in the queue and be well attended are the most valued items by them. From this definition, interviews with pharmacy staff and on-site observations, the value stream maps were created enabling to understand the pharmacy work process, identify the waste and aiming suggestions for improvements through the application of lean healthcare tools. After this stage, proposals were designed to improve the continuous stream, for the establishment of the pull demand and the continuous improvement. In addition, was conducted a critical analysis of the results and is possible to realize that the solutions to the problems experienced by the pharmacy features different degrees of difficulty implementation, however, offers a great potential to improve the value delivered to the pharmacy public. It was also found that the poor distribution of its physical space, the division of stocks in different units and lack of medicines are the major sources of the waste observed. Thus, was suggested the inclusion of other steps to the lean implementation model, in order to reach greater involvement of the pharmacy work team and to implement the lean healthcare completely, focusing on the pursuit of perfection and not limiting the solution of specific problems.

The thesis is dealing with financial aspects of the U.S. health care system. The main reasons are excessively high costs and less beneficial outputs of the system compared to other developed countries. The topic is more than up to date especially with regard to the latest changes in American health care and the neverending discussion about the necessity of further reforms aiming especially at fiscal sustainability of the system.The introduction is devoted to a brief description of basic models of health care system. It also introduces the approach of the United States to health care and provides an overview of the structure and participants of American health care. Moreover, the thesis provides details about the latest reform of the system. The main objective of the thesis is analysis of main factors that contributes to high growth of health care costs. Technological development, consolidation of markets and ineffective setting of health care reimbursement are identified as some of the main contributors to high cost in the U.S. health care system.

This thesis analyses how elite athletes travel to/from sport events and which barriers prevent them from engaging in a more sustainable travel behaviour. For this purpose, unstructured interviews with elite athletes were conducted to gain an in-depth understanding about travel experiences and decision-making from elite athletes’ perspective. The sport of biathlon, which combines cross-country skiing with rifle shooting, was used as a case study. The analysis revealed that biathletes engage in frequent and extensive travelling, and that their most-used modes of transportation are road and air transportation. Travel arrangements were found to be usually taken care of by national federations and not by biathletes themselves. Moreover, the analysis demonstrated that while biathletes generally seem to be concerned about the environment, their environmental concern does not seem to translate into pro-environmental travel behaviour, which can be explained by the fact that sustainable transportation represents a high-cost situation. Furthermore, some barriers were found to prevent elite athletes from travelling more sustainably. The barriers are related to individuality (other priorities – performance), responsibility (not athletes’ responsibility) and practicality (national regulations regarding rifle transport in public transportation (PT)). However, many barriers were found to lie on a continuum between individuality and practicality. The most important of these barriers include travel time, equipment, exposure to other people or inconvenient PT system. Based on the findings, it was recommended to optimize schedules, which was found to be to be overall highly appreciated by biathletes. Some other recommendations include, for example, reservation of train compartments and/or special buses for biathletes and teams, communal equipment transportation between competition venues, vehicle provision at venues, or clear and updated information about regulations regarding rifle transport. These and other recommendations are believed to help biathletes to overcome some of their barriers and, thereby, encourage a more sustainable travel behaviour. Thereby, it is hoped that the knowledge gained in this thesis can help sport organizations and athletes to reduce the emissions from travelling to/from sport events. / <p>2024-01-19</p>

The aim of this study is to get a better understanding of the transition out of an aberrantclosed group. This thematic literature study is based on 16 articles of people leaving criminalgangs, closed religious groups, and white supremacy groups. The different articles focus onprocesses that lead people to leaving their groups or the different changes and experiencespeople went through as they left. Three themes highlight the common experiences oftransitioning out of these groups are: disillusion, the experience of loss, and the struggle withcreating a new identity. Some people experienced disillusionment with their groups whilethey were still inside the group while others' experience of disillusionment with their formergroup came after they had left it. People who left their groups often began to shift their pointof reference, whereby they started to compare themself with norms and values that existed intheir new setting, although this could take time. Their previous group's narratives sometimesweighed heavily on their minds. Some people felt as if they had gone astray after they hadleft their former groups. The disillusionment and the different losses people went throughlead some of the people into what can be described as an identity crisis. A place where somefelt not only alienated from their former group or the society that they entered but sometimesalso felt alienated from themself, a mental state of disorientation. Some people struggled withwhat can be referred to as a hangover identity. Although they tried to get rid of their previousideas and thought patterns they were still haunted by them. For some people their newidentities both helped them distance themselves from thoughts and feelings connected to theirformer identity but also helped them see themself as something else then a former member oftheir group. Others struggled to access desired roles and identity. They instead experiencedthe pains of goal failure where they were held back because of societal views of their formerroles.