Health Social Organizations Research Articles

Opportunities and challenges for implementing drug checking services in British Columbia, Canada: A qualitative study

BackgroundAmidst the ongoing drug poisoning crisis across North America, drug checking services (DCS) are increasingly being implemented as an intervention intended to reduce drug-related harms. This study sought to identify key opportunities and challenges influencing the implementation of DCS in British Columbia (BC), Canada. MethodsBetween January 2020 and July 2021, semi-structured, in-depth interviews were conducted with 21 individuals involved in the implementation of DCS across BC (i.e., policymakers, health authority personnel, community organization representatives and service providers). The Consolidated Framework for Implementation Research (CFIR) was used to guide coding and analysis of the interviews. ResultsBy bringing in a wealth of knowledge about community needs and concerns, in addition to a passion and energy for social justice and health equity, community members and organizations with a dedication for harm reduction played a critical role in the successful implementation of DCS in BC. Other significant facilitators to implementation included the preventive benefits of DCS that made the intervention compelling to policy influencers and decision makers, the provincial public health emergency regarding overdose that shifted the regulatory environment of DCS, the adaptability of DCS to meet concerns and needs in various contexts, including via ongoing processes of reflection and evaluation. Barriers to implementation included criminalization and stigmatization of drug use and people who use drugs and lack of funding for community-led implementation actions. ConclusionsAlongside structural reforms that address the underlying contextual factors that influence implementation (e.g., decriminalization of drugs, increased funding for DCS), centering community expertise throughout implementation is critical to the success of DCS. Our findings provide important insights into how BC can successfully implement systems-level harm reduction interventions and offer insights for other jurisdictions in their implementation of DCS.

Social health organizations: an analysis of the specialties and exams contracted by the State of São Paulo, Brazil.

Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them.

Organizações sociais de saúde: análise sobre as especialidades e exames contratados pelo Estado de São Paulo, Brasil

Abstract Social Health Organizations (SHOs) are private entities that receive resources from governments for the management of public healthcare services. With the history of market interest in public health and the high volume of resources transferred to SHOs, one must question if the market logic continues to be inserted in this management model. The understanding of the dynamics of providing healthcare services to the population in the different contracts may help to understand how possible changes in the contracted services may have an influence. This is a descriptive-exploratory study using quantitative and qualitative approaches. Documental research was conducted through the collection of data from management contracts and amendments. The State of São Paulo was chosen because of its economic representativeness and for being the pioneer state in the implementation of SUS services managed by SHO. Medical specialties were included in 184 renegotiations (6.14%) and excluded in 187 (6.24%), whereas non-medical services were included in 26 renegotiations (2.97%) and excluded in 144 (16.44%). Regarding examinations, 101 renegotiations (18.07%) had their goals increased and 60 (10.73%) reduced, while 6 renegotiations (1.07%) included exams and 12 (2.14%) excluded them.

Assessing breast self-examination knowledge and practices among women in Iraq: A cross-sectional study.

The present study aims to shed light on the knowledge, attitude, and practice of breast self-examination with breast cancer (BC) among female patients in the oncology department of Baghdad Medical City. This cross-sectional study involved 100 female participants at the Oncology Teaching Hospital in Baghdad Medical City between June 15 and October 15, 2022. Using convenient sampling, the study targeted females aged 30-75, recently or previously diagnosed with BC, admitted for treatment and follow-ups. Regarding the assessment of knowledge, among the surveyed patients, 71 are aware of breast self-examination (BSE), primarily through social media (42 patients). The study also explores the link between BSE and education levels. While Pearson's chi-square shows no significance (0.107), the likelihood ratio suggests a significant association (0.041). Regarding the analysis of attitudes, the study assessment for the reasons for compliance showed that 19 patients cite medical reasons, and 48 patients attribute noncompliance to a lack of knowledge of how to perform BSE. Regarding the examination of practice, high statistical significance is evident in both Pearson'schi-square (0.000) and likelihood ratio (0.000) tests, emphasizing the substantial relationship between the post-diagnosis initiation timing of BSE and its correct execution. Additionally, a statistically significant association exists between performing BSE correctly and discovering BC(p = 0.000). Regarding the assessment of knowledge, our study found high awareness of BSE within the population, primarily through social media and health organizations. Regarding the analysis of attitudes, a notable proportion refrained from practicing BSE, primarily due to a perceived lack of knowledge about the methods. Regarding the examination of practice, the observed significant associations between performing BSE correctly, discovering BC, and the frequency of examinations underscore the pivotal role of consistent and accurate BSE in early detection.

How are we to interpret this then? Social cartography, transdiscipline and epistemological disorder working with three social health organizations to the south of Buenos Aires

How are we to interpret this then? Social cartography, transdiscipline and epistemological disorder working with three social health organizations to the south of Buenos Aires

Experience in managing the process of continuing medical education of medical workers in public health and health care

Introduction. The problem of continuous professional development of medical specialists with higher and secondary medical education is especially relevant at the present stage, when medical knowledge, technologies, and drugs are being improved every day. 
 Purpose. Analysis of the forms of conducting cycles of continuous medical education in the field of health care management and public health at the Pirogov Russian National Research Medical University of the Ministry of Health of the Russian Federation for the development of the most popular and perfect form of its implementation.
 Materials and methods. An analysis of the main directions of the mnagement of the process of continuous medical education of medical workers in general and in public health and health care in the Federal State Autonomous Educational Institution of Higher Education of the Russian National Research Medical University named after N.I. Pirogov of the Ministry of Health of the Russian Federation. 
 Results. Since 1977 a continuous medical education was started in the USSR. A course for advanced training of doctors in social hygiene was opened at the Department of Social Hygiene and Health Organization of the 2nd Medical Institute. Within the framework of the specialty “Organization of Health Care and Public Health”, the department conducted cycles of professional retraining (PP-504 hours), advanced training: 144 hours (PC-144), 72 hours and 36 hours. Continuing medical education is aimed at obtaining the competencies necessary to perform a new type of professional activity. The plans for further improvement of continuing medical education by the department provide for the renewal of work programs, the creation of distance and new relevant cycles.
 Limitations of the study. An analysis of professional retraining cycles of students of various durations for the acquisition of new qualifications, qualitative expansion of the field of knowledge, skills and abilities in the period 2017–2022 was carried out. 
 Conclusion. The presented data indicate the expediency of managing advanced training within the framework of the specialty “Organization of Health Care and Public Health” using short cycles of advanced training of full-time and distant forms of training of students.

Leadership to promote patient safety culture in public hospitals managed by social health organizations

PurposeThis paper aims to identify the kind of internal climate leaders should offer health-care professionals to promote a patient safety culture in public hospitals managed by social health organizations in Brazil.Design/methodology/approachTwo surveys were applied to health-care professionals working at three Brazilian public hospitals. The internal climate survey reached 1,013 respondents, and the patient safety culture survey reached 1,302 participants. Both factor and regression analyses were used to analyze the study model and determine how internal climate influences patient safety culture.FindingsResults indicate that to promote a patient safety culture among health-care professionals, leaders should generate an internal climate based on trust to foster pride in working in the hospital. Possibly, the trust dimension is the most important one and must be developed to achieve job satisfaction and provide better services to patients.Research limitations/implicationsAll the hospitals studied were managed by the same Organização Social de Saúde. Due to the limited responses concerning the respondents’ profiles, demographic variables were not analyzed.Practical implicationsThis research reveals that the trust and pride dimensions can most strongly influence a positive patient safety culture, helping hospital leaders face this huge managerial challenge of consistently delivering high standards of patient safety.Originality/valueThis research studies the promotion of a patient safety culture in public hospitals managed by social health organizations, characterized by greater flexibility and autonomy in health-care management and by a greater need for accountability.

The Effect of Social Capital and Organizational Health on Competitive Advantages of Culinary and Craft SMEs in Samarinda City

Samarinda City was appointed as a buffer for the new capital city of Indonesia through culinary and craft SMEs. Culinary and craft SMEs are believed to be the drivers in accelerating the achievement of Sustainable Development Goals (SDG), which are part of the strategy of the Provincial Government of East Kalimantan. Even so, 72% of the problems culinary and craft SMEs face in Samarinda City are related to competitive advantages. Culinary and craft SMEs in Samarinda City are still constrained by competitive disadvantage, especially in the non-substitutable resource aspect. This study aimed to analyze the effect of organizational capital and health on competitive advantage, especially in the era of post-COVID-19 economic recovery through the creative economy. This study used a survey method with a quantitative approach. The analysis techniques used were descriptive analysis and factor analysis using structural equation modeling with item parceling. The subjects of this study were SMEs in the culinary and craft sub-sector in Samarinda City (N = 365 SMEs). This study found that social capital and organizational health positively and significantly affect competitive advantage, both partially and simultaneously. Surprisingly, the dimension of work culture and climate s not suitable for modeling the impact of social capital and organizational health on the competitive advantage of culinary and craft SMEs in Samarinda City. This research is expected to contribute theoretically to developing a new model to achieve optimal competitive advantage through social capital and health organizations. This research is expected to strengthen the people’s economy to achieve SDGs through SMEs, especially for Samarinda City, a buffer for the new capital city of the Republic of Indonesia and post-COVID-19 economic recovery through the creative economy.

1792. Different Patterns of Antibiotic Use in Different Administrative Categories: An Overview of 10 years (2009/2018) of a Statewide Surveillance Program in Sao Paulo, Brazil

Abstract Background To describe intensive care unit (ICU) antibiotic use in different administrative categories based on data reported to the Nosocomial Surveillance System of the State Health Department (SHD) in the State of Sao Paulo. Methods This ecological study describes at an aggregated level the antibiotic use in adult ICU reported to São Paulo SHD, from 2009 to 2018. ICUs were categorized by hospital administrative category (private, public, and philanthropic). Public hospitals were subdivided into two administrative sub-categories as Social Health Organization (SHO), which administration is private but public funded, or direct public administration (DPA). Resistance phenotype incidence and antibiotic use correlation was calculated for meticilin-resistant Staphylococcus aureus (MRSA) and glycopeptide use, third generation cephalosporin (3GC)-resistant Enterobacterales and carbapenem use, carbapenem-resistant gram-negative bacilli (CR-GNB) and polymyxins use. Results The average number of hospitals reporting annual data on antibiotic use was 386. A total of 17.490.966 patient-days were included. Total antibiotic use in ICUs increased from 588.16 in 2009 to 943.12 DDD/1000pd in 2018 (p< 0,01). The DDD (defined daily dose) of antibiotic was higher in public hospitals (mean 889.11 DDD/1000pd), than in the private hospitals (mean 849.07 DDD/1000pd) and in the philanthropic hospitals (mean 48 785.12 DDD/1000pd) (p< 0.05). Positive correlations were detected between glycopeptide use and MRSA incidence, polymyxins use and CR-GNB incidence. A weak negative correlation between carbapenems use and 3GC-resistante Enterobacterales incidence were found. Figure I:Antimicrobial use by therapeutic class between 2009 and 2018 in DDD / 1000 patient-daysTable I:Antibiotic use by therapeutic class by administrative type in DDD/1000 patients-dayTable II:Antibiotic use in public hospital by subgroup between 2009 and 2018 in DDD/1000 patients-day Conclusion We found higher use of antibiotics in public hospitals than in private and philanthropic. Differences in antibiotic use were observed among SHO e DPA public hospitals. These data provide important information for formulating hypotheses and public health strategies to improve antimicrobial prescription. Disclosures All Authors: No reported disclosures.

Education and formation of the occupational pathology service in the Nizhny Novgorod Region

The article describes the main stages of the emergence, formation and development of the occupational pathology service in one of the largest industrial regions of Russia and the USSR - the Nizhny Novgorod region. The origin of the service was due to the high industrial potential of the region and the plans of the USSR government to significantly increase it. The materials of the article indicate that the fundamental role in the origin and subsequent development of the occupational pathology service of the Nizhny Novgorod Province belongs to the Doctor of Medical Sciences, Professor Sofia Israilevna Skundina, who in 1925 headed the newly created professional section of the sanitary department of the Gubzdrav. Thanks to her work and organizational skills, a polyclinic for the study of occupational diseases began functioning in the city of Nizhny Novgorod, in Sormov in 1926. In 1927 the Nizhny Novgorod Vocational Dispensary was organized, which in 1929 was transformed into the Regional Institute for the Study and Control of Occupational Diseases. In 1929-1932 Sofya Izrailevna actively participated in the creation and organization of a network of medical posts at industrial enterprises of the province. In 1931 The Nizhny Novgorod Medical Institute has organized the Departments of Occupational Hygiene and Occupational Diseases (headed by one of the leading occupational pathologists of the country - Professor I.N. Kavalerov) and the Department of Social Hygiene and Health Organization (founded by S.I. Skundina) and started training of occupational pathologists.

Effective hospital response to covid-19: evidence from social healthcare organizations in Brazil and Portugal

This study analyzes the impact of effective knowledge management, organizational intelligence, and organizational performance on the effective hospital response and social health to covid-19. Data were collected through a research questionnaire sent to physicians and nurses who worked in hospitals in Brazil and Portugal. We sent the survey link using a professional social network and 101 valid responses were obtained. The PLS-SEM analysis technique was used to test hypotheses. The results showed that there is a positive relationship between the constructs of effective knowledge management and organizational performance, and effective response to covid-19. This study also indicates that effective knowledge management has a positive association with organizational intelligence and organizational performance, in addition to a positive relationship between organizational intelligence and organizational performance. As practical implications, our research reinforces the importance of effective knowledge management for pandemic management and validates the relationships between effective knowledge management, organizational intelligence, organizational performance, and hospital response effectiveness. From these results, hospitals and social health organizations will be able to improve their effectiveness in responding to new disease outbreaks. As originality, this work presents a model to manage the response of these health care and hospital institutions to pandemics.

Following the money: an analysis of financial transfers from the municipality of Rio de Janeiro, Brazil to social health organizations

This article analyzed the activity of Social Health Organizations (OSS) in the Brazilian Unified National Health System (SUS) and the use of management contracts and contract addenda as instruments of privatization. The article aimed to understand the processes that legitimize privatization, based on quantification of the amounts transferred through management contracts and contract addenda to organizations that signed contracts with the Rio de Janeiro Municipal Health Department, Rio de Janeiro, Brazil, from 2009 to 2018. A descriptive, exploratory, mixed-methods study was developed to analyze the amounts transferred to the OSS. The study used secondary public data available on the Health Department's websites and other official documents. A total of 268 documents were identified, 61 of which were contracts and 207 addenda, related to 15 institutions. The funds transferred to these organizations totaled BRL 15.94 billion (USD 2.9 billion). The OSS that received the most public funds was IABAS (Institute of Primary and Advanced Health Care), with a total of BRL 4.021 billion (USD 731 million). In 2014, Rio de Janeiro's total health budget was approximately BRL 4 billion (USD 727 million), of which BRL 2.5 billion (USD 455 million) was transferred to OSS, representing 62% of the municipal health budget. The data show that management contracts and contract addenda serve as instruments for privatization of the SUS. This privatization does not employ the conventional model but a functional and fluctuating one.

Process to insulin for type 2 diabetes mellitus therapy

In type 1 diabetes mellitus and in symptomatic and critical hyperglycemic states, insulin is a lifesaving drug; however, its value in long-term type 2 diabetes therapy, which represents more than 90% of diabetes, has not been assessed. This happens despite the fact that, in randomized studies on type 2 diabetes, insulin is used in two-thirds of cases when intensive hypoglycemic treatment is needed and in half of the patients when treatment is the standard one. This is a major issue from a clinical, economic and social-health organization point of view as insulin therapy is expensive and needs a complex organization. Observational and retrospective studies from the scientific literature show that in this type of diabetes insulin treatment is associated with increased cardiovascular and all-cause mortality. It is not clear whether this is due to a greater severity of the clinical picture, to the therapeutic target of blood glucose that may induce hypoglycemia, or to the intrinsic pharmacological activity of the drug that beyond reducing hyperglycemia can cause hypoglycemia, water retention, weight gain and hyperinsulinemia with proatherogenic effects. In particular, in patients with heart failure at high cardiovascular risk or with high insulin resistance, these clues are supported by meaningful data. Although there is no definitive evidence (the so-called "smoking gun") from randomized controlled trials, the high degree of suspicion induces the preferential choice of other drugs such as sodium-glucose co-transporter 2 inhibitors, glucagon-like peptide-1 receptor agonists and metformin beyond avoiding glycemic targets that induce hypoglycemia, especially in frail, elderly patients, or patients with cardiovascular diseases. These drugs, for their proven efficacy and the easy use within an outpatient setting (that favors their prescription and improves the inertia of the doctor and the adherence of patients), could help a more effective treatment of patients, both for quality and life expectancy beyond mere glycemic control.

Exploring the use of social media sites for health professionals' engagement and productivity in public sector hospitals

PurposeCompetitive pressure and social influence for technology adoption have increased among developed, developing and emerging countries. The influence of social structure, organizational forces and political forces varies between public sector hospitals in countries where there are more social media restrictions. This study aims to explore how the use of social media can influence employee engagement and productivity in the workplaces of public sector hospitals.Design/methodology/approachThe study follows a social constructivist approach to understand employee attitudes, motivation culture, political forces and the local context. Data were collected from health professionals of five public sector hospitals using a non-directive and semi-structured interview method.FindingsThe results show that the use of social media sites has increased collaboration, coordination and cooperation among health professionals, especially in critical situations. They are more socialized, connected and engaged, thus helping them to exchange useful knowledge using instant messaging apps. Conversely, there are no organizational polices and specific laws and too little support from management and senior doctors to drive the use of social networking sites in public hospitals. The use of social media has enhanced health professionals' engagement and productivity as they are able to share their expertise, knowledge and information with their colleagues and subordinates.Research limitations/implicationsThe results can guide policy-makers, researchers, hospitals, doctors and the Ministry of Health about the positive use of social networking sites in the workplace. The positive use of social networking sites in the workplace can enhance information, knowledge and coordination which may help to enhance employee engagement and productivity.Originality/valueThe present study has provided a social media health organization workplace (SMHOW) model which explains how individual and organizational contexts can influence the actual use of social media in healthcare organizations.

Evaluation of Nursing Service Management Model applied in hospitals managed by social health organization.

Evaluate the Hospital Nursing Service Management Model from the perspective of nurses from hospitals managed by social health organization, considering the type and dimensions of the model. This is an exploratory, cross-sectional study with a quantitative approach; census population. The evaluation was conducted in 15 hospitals based on the Index of Professional Nursing Governance, including the descriptive analysis of the k-means method and multiple linear regression to score the instrument. Data collection was performed online, stored in REDCap®. Of 1,523 invited, 680 (44.6%) accepted and 518 (34.1%) completed the questionnaire. With a general average of 184.3 points, 12 hospitals indicated shared; and 3 (20%), traditional governance (average of 165.7 points). Managers presented a lower perception of shared governance with professionals without a management function. The type of function and time of activity at the institution influenced the results. The present model is hybrid, in the transition process from the traditional to corporate.

Public financing versus private billing in a public hospital under management of a Social Health Organization.

to assess the efficiency of management by a Social Health Organization (Organização Social de Saúde - OSS) compared with the private sector; to verify if there are savings for the State Health Secretariat (SES) in management contracts for financing the production of a public hospital versus its production values billed by private methods; and to establish if the amounts billed by the Unified Health System (SUS) table would finance the same procedures. we compiled and tabulated all procedures performed and the materials and drugs dispensed in the Euryclides Jesus Zerbini Transplant Hospital (HTEJZ), managed by the OSS Associação Paulista Para o Desenvolvimento da Medicina (SPDM), in September, October, and November 2018, according to the Brasíndice® table for drugs, the Simpro® table for materials, the CBHPM® table for medical fees, and tables SIGTAP SUS and SIA SUS. We then compared the average values obtained in the private billing with the costing amount reimbursed by the State Health Secretariat and the billing calculated in the SIA-SUS. the average SUS revenue was R$ 2,774,086.91; the monthly reimbursement by the SES was R$ 13,055,700.00; and the average private revenue was R$ 25,084,440.31. the management by the OSS SPDM in the Euryclides de Jesus Zerbini Transplant Hospital was more efficient in the financing / production ratio than it would be to a private hospital. The economy of public funds was significant. The current SUS table reimbursement values would not meet the need for funding for an overly complex hospital.

Implementation of the Nursing Services Management Model in 16 hospitals.

to describe the main aspects and relevant results of the implementation of the Nursing Services Management Model in hospitals managed by social health organization, from 1998 to 2018. experience report of the model implemented in 16 hospitals in the state of São Paulo, Brazil. the actions and monitoring of the implementation were based on protocols considering: management model and structure of the nursing service in hospitals; care process and main nursing care results; and people development. the implementation of methods that ensure the well-being of nursing professionals is directly related to effective care, in which the practice is driven by quality and autonomy. Promoting a culture of care excellence, at different levels of management and care, has generated better expectations and motivation. It was found that the commitment of managers, by providing resources, resulted in improvements in the quality of nursing services.

O desmonte da política de saúde sob a gestão das organizações sociais

Esta é uma reflexão realizada no período entre outubro de 2019 e abril de 2020 com o objetivo de analisar as contrarreformas na política de saúde a partir das recorrentes privatizações no âmbito da política, com enfoque às Organizações Sociais da Saúde. O estudo considerou 17 referencias e, é apresentado em duas vertentes temáticas: a privatização da saúde e a valorização do capital; e, as organizações sociais na gestão da saúde. Verificou-se a subsunção do Sistema Único de Saúde às macrodeterminações do capital financeiro. Como expressão dos ataques do capital, ressaltam-se os entraves para garantir uma saúde estatal e de qualidade, a partir das diversas formas de privatização e apropriação dos recursos públicos, especificamente da saúde. As Organizações Sociais têm sido apresentadas como uma nova estratégia de ampliar a cobertura assistencial e modernizar a gestão dos serviços de saúde, porém, na prática se configura como novo modelo de gestão privatizante sem compromisso com os princípios defendidos pelo Sistema Único de Saúde.

Social Anxiety Symptoms and Quality of Life of Secondary School Students of Abha, Saudi Arabia

Interest in social anxiety disorder has grown substantially over the past few decades. Most of the available data from United States and European countries emphasized its high prevalence, comorbidity and morbidity and its association with occupational, educational, social affairs, stress, depression and substance use disorder contributing to poor quality of life. Present study was aimed to assess the social anxiety symptoms and to explore its impact on quality of life of secondary school students. Present study included male (n = 200) and female (n = 200) students enrolled at government secondary schools, Abha, Saudi Arabia. Arabic version of Social Phobia Inventory (SPIN) and World Health Organization Quality of Life Questionnaire (WHOQOL) were implemented to assess the social anxiety symptoms and quality of life of the students. Results revealed that 45% of the students showed social anxiety symptoms. Associated factors were younger age, chronic diseases, parent’s status, parent’s occupation and income. Quality of life was found significantly lower in students with social anxiety symptoms as compared to the students without symptoms. We suggest that the school health program should include routine screening of students for social anxiety disorder. Students diagnosed with social anxiety symptoms should be promptly managed and their quality of life should be improved.

Reinventing Privatization: A Political Economic Analysis of the Social Health Organizations in Brazil.

The Brazilian state apparatus was reformed throughout the 1990s, influenced by New Public Management (NPM). NPM was embodied in the health care sector by the creation of Social Health Organizations (Organizações Sociais de Saúde or OSS), private non-profit entities to provide welfare services. We performed a systematic review of the literature outlining the origins and role of OSS in Brazil. Our selected articles (peer-reviewed) cover the origins/performance of OSS and their services provision between 1998 and 2018, in English or Portuguese. Databases used were Lilacs, Bireme, Medline, Pubmed, and SciELO. We identified 4,732 articles applying a pre-defined set of descriptors, from which we selected 49 for analysis. The main findings reveal that NPM is the central theme of most articles about OSS in Brazil (n = 26). There is evidence corroborating our hypothesis that transferring management of public health care services to private non-profit organizations is a softer version of privatization as, although financing is kept public, the rationale and ethos of OSS services institutionally and operationally mimic the private sector. The practical consequence is that attainment of health care in Brazil ends up being neither fully commodified (based on ability to pay) nor fulfilled as a citizen's right following its national constitution.