Public Health System Reform Research Articles

Паліативна допомога та еутаназія: медико-соціальні, біоетичні, правові аспекти

У статті аналізуються наукова література, міжнародні та вітчизняні нормативно-правові документи, медико-статистичні дані, що визначають актуальність проблеми, медико-соціальні, біоетичні, правові аспекти еутаназії та паліативної і хоспісної допомоги (ПХД) як альтернативи еутаназії. Мета роботи: представити аналіз ситуації в Україні і у світі щодо нормативно-правової оцінки і ставлення суспільства до еутаназії та її альтернативи – ПХД, стратегій та підходів до розвитку служби ПХД в рамках реформування системи охорони громадського здоров’я в Україні. Матеріали дослідження. Матеріалами для дослідження при виконанні представленої роботи були документи ВООЗ та міжнародних організацій, законодавча база України, вітчизняна та закордонна наукова література, міжнародні та вітчизняні нормативно-правові документи, що стосуються еутаназії та ПХД, медико-статистичні дані Держкомітету статистики та звіти МОЗ України. Методи дослідження. Авторами були використані наступні методи: інформаційно-аналітичний, бібліосемантичний, системного підходу, структурно-логічного аналізу та порівняльного контент-аналізу. Результати дослідження та обговорення. Ефективна і доступна система ПХД, застосовуючи мультидисциплінарний та міжсекторальний підхід, може адекватно реагувати та задовольняти потреби паліативних пацієнтів та їхніх рідних, що сприяє забезпеченню належної якості життя і зменшує бажання в інкурабельних хворих щодо застосування еутаназії. Це визначає велике медико-соціальне, економічне та гуманітарне значення ПХД – цього інноваційного напрямку охорони здоров’я і соціального захисту населення, яка є важливою складовою реформування системи охорони здоров’я в Україні. Найбільш важливими є міжнародні нормативно-правові акти, що стверджують невід’ємні права людини, і які, з точки зору більшості юристів, забороняють еутаназію, хоча в деяких країнах має місце легалізація та застосування еутаназії. Законодавство України однозначно забороняє еутаназію. Висновки. 1. Забезпечення максимально досяжного рівня якості життя інкурабельних хворих з обмеженим прогнозом тривалості життя стало в останні десятиліття однією з найважливіших гуманітарних проблем сучасного суспільства, що зумовлено несприятливими медико-демографічними процесами, зокрема постарінням населення і збільшенням смертності від хронічних неінфекційних захворювань. 2. Зазначене потребує оптимальної організації та розвитку сучасної ефективної та доступної системи ПХД, яка є інноваційним медико-соціальним мультидисциплінарним підходом, що найбільш адекватно забезпечує потреби та належну якість життя паліативних пацієнтів та їхніх рідних, сприяє збереженню людської гідності наприкінці біологічного життя. 3. Відповідно до сучасних міжнародних концепцій та стандартів, ПХД має забезпечити 4 обов’язкових складових: медичну, психологічну, соціальну і духовну. 4. Сьогодні найбільш важливими є міжнародні нормативно-правові акти, що стверджують невід’ємні права людини, і які, з точки зору більшості юристів, забороняють еутаназію, хоча в деяких країнах спостерігається тенденція до легалізації та застосування еутаназії. 5. Чинне законодавство України однозначно забороняє еутаназію. 6. Зазначене потребує створення та розвитку в Україні доступної та ефективної системи надання ПХД населенню як альтернативи еутаназії.

Phenomenon of social exclusion in EU countries: Definition and measurements

The article analyses the phenomenon of social exclusion and the EU policy in combating this problem. The article is based on the analysis of the works of European researchers, official EU documents and Eurostat statistical data. The concept of social exclusion began to develop actively in the second half of the 20th century, and quickly had been used by politicians of European countries to develop effective social policies and to fight poverty. The concept of social exclusion is not a synonymous to the concept of poverty, because exclusion offers a comprehensive study of the causes of poverty in developed societies and suggests theories that explain the causes of poverty. The concept of social exclusion becomes a policy tool, as it offers concrete directions for reduction of poverty and marginalized groups through system of targeted support, as well as actions to reduce the marginalization of groups and people living in poverty. The article presents methods of measuring this phenomenon that are used by the EU institutions to assess if individuals are at risk of poverty and social exclusion. In Russia, researchers and official representatives are noticeably interested in the concept of social exclusion. Methods of measuring poverty and social exclusion offered in the EU countries are being tested and discussed. Given the complexities of the transformation of social policy in modern Russia, taken pension reform, reform of public health system, family policy, and education, it is likely that the problem of social exclusion will remain being a distant target. Nevertheless, the interest of Russian specialists and officials to the problem and development of methods for measuring poverty using the experience of scientists from European countries provides some ground for optimism.

The Regulatory Complex for Health Care in the Federal District, Brazil and the challenge for integrating levels of health care.

The integration among levels of care is a continuous challenge even in consolidated and high performance health systems. The reform of public health system of Distrito Federal, based on the strengthening of primary health care associated to the reconfiguration of specialized attention (ambulatory and hospital) and of its of urgency and emergence network brought, as a challenge, the need for integration between these levels. Thus, became necessary to create an instrumentto perform the role of gatekeeper, leading to equanimous, transparent and safe access to specialized and hospital care. Thus, the Regulatory Complex in Health of Distrito Federal (CRDF) and its Regulatory Centers (CR) were created to carry out the regulatory process of access to care services, such as hospitalization, ambulatory care (procedures and specialized consultations), elective surgeries, complex procedures, sanitary transport, urgencies and transplants of patients of the Federal District and outside it. This article describes the process of the CRDF implementation and its CRs, aiming to reflect on the potential and challenges of its role as an instrument of integration among the levels of care.

The evolution of socioeconomic health inequalities in Ecuador during a public health system reform (2006\u20132014)

One of the challenges in international health care policy is the reduction of health inequalities. We study the case of a recent health care reform in Ecuador, based on a revised model of public provision and financing of comprehensive care. The policy challenged not only the health care system but also key determinants of health, seeking to grant access and reduce persistent inequalities in utilization of health care services. This study evaluates the progress made on the socioeconomic health inequalities before and after reforms, between 2006 and 2014. The Living Standards Measurement Survey 2006 and 2014 are used to examine trends in inequality of two health dimensions: health status and health care utilization in Ecuador. The analysis includes the estimation and decomposition of the concentration index of health care utilization variables to understand which the most important contributors to inequality are, and how they change during the period analyzed. Health inequality reduced after the public health system reform in Ecuador. The utilization of curative visits shows a pro-rich bias, which significantly reduced over the period of analysis. The use of a public facility for a doctor visit also shows a moderate reduction in socioeconomic inequality; although concentrated among the poor, the findings confirm an increase in the utilization of public health facilities by all socioeconomic groups. The decomposition analysis concludes that the most relevant determinants of the inequality in health care utilization variables are income, family size and education. Moreover, the contribution of income decreased dramatically in the utilization of curative visits after the reforms. This is the first study that assesses the inequality implications of recent policies targeted at guaranteeing the right to health, equity and social protection of the Ecuadorian population. We provide evidence of a significant reduction of health care inequality, following a well-rounded set of public interventions and investments to attack health and inequality determinants. Yet policies aimed at improving the distribution of education and income are necessary to further reduce health inequalities.

公众医疗风险感知的社会文化因素分析

Frequent medical risk events caused great concern in the community, medical disputes don ’ t seem to have been decreasing with the increase of medical technology and the degree of social civilization, but more intensified. Previous studies on the impact of public health risk perception are mainly from the perspective of management, law and ethics, but for the living in the society, the social development and cultural construction of people's medical risk perception is becoming more and more important. The thesis describes the values, life experience, trust and other terms of social and cultural factors that affect the public perception of health risks, explore s measures to improve public health risk perception and provide s a reference for the public health system reform and innovation and development of society.

Efficiency of medical and economic activities of a sanatorium-and-spa facility in the active phase of the public health system reform under macroeconomic instability

Results of a comprehensive study have demonstrated that the reform of the public health system currently underway in this country provides conditions for the extension of medical care based at sanatorium-and-spa facilities with simultaneous rise in relevant expenses. Bearing in mind the unstable macroeconomic situation, this requires thorough monitoring medical and economic activities of health resorts for the purpose of enhancing cost efficiency. The goal of optimization can be achieved by increasing competitive capacity based on strict control of expenditures and income redistribution for financing the most promising projects.

Sistema Único de Saúde: espaços decisórios e a arena política de saúde

This article analyzes the creation of new political arenas in the Brazilian health sector as well as shifts in power relations among state and social political actors in the context of public health system reform, focusing on the last two decades. The three main conclusions are the following: The creation of forums in which government actors can establish agreements that allow the shared national, State, and municipal coordination of management measures have strengthened the positions of these actors in the health political arena. Social actors, led by representatives of professional health societies, were both urged (and also took the initiative) to submit their demands and proposals through participatory forums that dealt mainly with secondary political issues, thus steadily losing the capacity to influence the real decision-making process in the sector. Market stakeholders took little part in the participatory forums, rather preferring to exert their influence directly on public decision-makers and to implement adaptive strategies to increase their profits.

Human resources for health challenges of public health system reform in Georgia.

BackgroundHuman resources (HR) are one of the most important components determining performance of public health system. The aim of this study was to assess adequacy of HR of local public health agencies to meet the needs emerging from health care reforms in Georgia.MethodsWe used the Human Resources for Health Action Framework, which includes six components: HR management, policy, finance, education, partnerships and leadership. The study employed: (a) quantitative methods: from September to November 2004, 30 randomly selected district Centers of Public Health (CPH) were surveyed through face-to-face interviews with the CPH director and one public health worker randomly selected from all professional staff; and (b) qualitative methods: in November 2004, Focus Group Discussions (FGD) were held among 3 groups: a) 12 district public health professionals, b) 11 directors of district public health centers, and c) 10 policy makers at central level.ResultsThere was an unequal distribution of public health workers across selected institutions, with lack of professionals in remote rural district centers and overstaffing in urban centers. Survey respondents disagreed or were uncertain that public health workers possess adequate skills and knowledge necessary for delivery of public health programs. FGDs shed additional light on the survey findings that there is no clear vision and plans on HR development. Limited budget, poor planning, and ignorance from the local government were mentioned as main reasons for inadequate staffing. FGD participants were concerned with lack of good training institutions and training programs, lack of adequate legislation for HR issues, and lack of necessary resources for HR development from the government.ConclusionAfter ten years of public health system reforms in Georgia, the public health workforce still has major problems such as irrational distribution and inadequate knowledge and skills. There is an urgent need for re-training and training programs and development of conducive policy environment with sufficient resources to address these problems and assure adequate functionality of public health programs.

Is public health ready for reform? The case for accrediting local health departments.

Reform of the governmental public health system in the United States has been stymied by changes in political, economic, and medical care landscapes since public health was called to action by the Institute of Medicine report in 1988. Despite a new national health objective calling for 90 percent of the population to be served by a local health department effectively addressing public health's three core functions by the year 2000, capacity building initiatives have not been deployed extensively, and there is little likelihood of reaching the year 2000 objective. A national program of accrediting local and state health departments could energize public health capacity building. Accreditation would build on recent initiatives in states like Washington and Illinois, promote wider use of the Assessment Protocol for Excellence in Public Health, and facilitate reform of the public health system around public health's core functions. Key questions addressing the why, how, and who of such an initiative set the stage for consideration of a national accreditation program.