Public Unified Health System Research Articles

Mortality Reduction in Pediatric Intensive Care Units Using Telemedicine

Introduction: The use of telemedicine in the Intensive Care Unit (ICU) is studied worldwide, however, its impact in pediatric ICUs (PICUs) is poorly studied. Brazil is a country with continental dimensions and it faces challenges such as underserved healthcare assistance. Methods: We conducted a before-and-after study in order to evaluate the impact of telemedicine in mortality rates and length of stay in two PICUs of the Brazilian Unified Public Health System. The sample was comprised by 940 patients, in which 426 were pre-telemedicine and 514 were post-telemedicine. The intervention occurred through daily telerounds between the both healthcare team from the command center and the ICUs assisted by telemedicine. Results: Mortality in unit A was 18·86% during the pre-telemedicine period, comparing with 9·29% in the post-telemedicine (p = 0·0054). In unit B, mortality was 10·76% pre-telemedicine comparing to 9·72% post-telemedicine (p = 0·6922) and the standardized mortality ratio changed from 1·10 to 0·99 (p = 0·9002). Median Length Of Stay (LOS) in unit A was 8 days (IQR 14 – 4) pre-telemedicine and 8 days (IQR 15 – 5) post-telemedicine (p = 0·64). In unit B, median LOS was 6 days (IQR 12 – 3) pre-telemedicine and 8 days (IQR 15·5 – 4) post-telemedicine (p = 0·0013). Logistic regression showed association between telemedicine implementation and significant reduction of the mortality rate in unit A (OR 2·31; 95% CI 1·27 – 4·20). The same result was not observed in unit B (OR 1·13; 95% CI 0·63 – 2·00). However, considering both units we observed a favorable association between adhering to the recommendations made by the command center’s team and reduction of mortality (OR 4·81; 95% CI 1·06 – 3·16). Interpretation: In conclusion, we demonstrated that the implementation of telemedicine in PICUs have the ability to significantly decrease mortality by associating the team’s continuing education through telerounds. Funding: Provided by the Brazilian Ministry of Health, through the Institutional Development Program of the Brazilian National Health System (PROADI-SUS). Declaration of Interest: None to declare. Ethical Approval: The project underwent evaluation of the institution’s Ethical Review Board (CAAE: 00781218·0·0000·5330).

Being born and growing up in the Ribeirão Preto and São Luís cohorts.

This thematic issue consists of 14 articles derived from studies of the BRISA birth cohort (Ribeirão Preto, State of São Paulo and São Luís, State of Maranhão, northeastern Brazil, a socially and economically less developed region). In these more than 40 years of existence, these cohorts have been able to document the increase in women's education, the improvement of health conditions, the creation of a public Unified Health System (SUS) that provides universal and free access to health care, eradication of hunger, and transition of the nutritional status characterized by a decrease in malnutrition rates and an increase in obesity in Brazil. Particularly in reproductive health, the country experienced a significant drop in fertility, a decrease in maternal and child mortality, and an increase in breastfeeding rates. Universal access to prenatal care and hospital delivery was accompanied by an excessive number of cesareans without clinical indication and early-term births and premature births, largely due to scheduled cesareans. Articles with a longitudinal and transversal methodological approach are presented, using structural equation analysis and propensity score, together with multivariate regressions, which gave a robust analytical treatment to articles in this thematic issue.

Recent progess in phytotherapy: A Brazilian perspective

IntroductionPhytotherapy has very old origins and it is based on the use of medicinal plants to treat and prevent diseases. Brazil, because it is a country with wide biodiversity and cultural diversity, has great potential for the development of plant-based therapies ant it is considered an ideal scenario for the use of phytotherapy. Although a large part of the population uses medicinal plants, until recently, phytotherapy was not contemplated in the Brazilian health system. In this context, the objective of this study is to describe and discuss the development and challenges of phytotherapy in the Brazilian health system through a narrative review, as well as make a diagnosis of the current situation of this practice in the country. MethodsData were collected in the period from 2018 to 2019 from Portal CAPES using online databases such as PUBMED, LILACS, Scielo, among others. ResultsThe situation of phytotherapy in Brazil started to change after the Declaration of Alma-Ata (1978), in which the World Health Organization recognized and encouraged phytotherapy. Initially, there were sparse attempts to establish phytotherapy in Brazil, and it was only in 2006, with the approval of two important policies (National Policy on Medicinal Plants and Herbal Medicines and National Policy on Integrative and Complementary Practices) that this topic started to gain strength. Currently, phytotherapy services are being continuously implemented and expanded in the country, which has also led to an increase in demand for this practice. Yet, some obstacles such as the lack of knowledge and training of health professionals in medicinal plants makes it difficult to consolidate phytotherapy with the Brazilian Unified Public Health System. ConclusionThere is still much to be developed mainly in the field of research with native plants and professional training. An analysis of the evolution of phytotherapy in Brazil, though, may help in the overcome of the challenges to achieve an effective implementation of this practice in the country.

Overview of lymphoma diagnosis in Brazilian public health system patients: Open data analysis for health care planning

IntroductionKnowing the information regarding the panorama of lymphoma diagnosis in patients treated in the Brazilian Public Unified Health System from the last 10 years is a challenge for Strategic Health Planning. ObjectiveTo characterize the Brazilian population with lymphoma treated in the Brazilian Public Unified Health System between 2008 and 2017 regarding staging, sex, residence site and mortality. Material and methodsA descriptive, retrospective, and longitudinal trial with secondary data from DataSUS (SIA/SUS and SIM/SUS) obtained from patients with ICD-10 C81−85. ResultsThere were 70,850 lymphoma cases between 2008 and 2017, of which 55% were male, the median age was 51 years, and 27% had Hodgkin Lymphoma. Most patients (56%) were treated outside the residence city. São Paulo State accounted for 25% of patients. Treatment initiation took more than 60 days in 27% of cases. A total of 45,601 deaths were due to lymphoma (12% Hodgkin Lymphoma and 88% Non-Hodgkin Lymphoma), with a median age 63 years, and were mainly males (55%). Staging data were inadequate in 23% of patients, and analysis was performed only on the valid records. Advanced disease was diagnosed in 58% of patients (60% male; 57% female) and was more common in Non-Hodgkin Lymphoma (62%) versus Hodgkin Lymphoma (49%). DiscussionLate diagnosis interferes with mortality rates. Health promotion and cancer prevention campaigns, especially targeting the male public, and training for early diagnosis and early treatment are needed. ConclusionEffective measures for early diagnosis and treatment are urgently needed for lymphoma control.

An evaluation matrix for self-instructional courses of Continuing and Online Education in Health

Abstract Background In 2003, the National Policy for Continuing Education in Health (PNEPS) was created as a strategy to train and update workers of the Unified Health System. To be effectively instituted, the Open University of the Brazilian Unified Public Health System was conceived to offer free online courses. But, it was observed that the online educational modules developed were not structural and pedagogically homogeneous. Objective Propose a matrix of criteria and guidelines to support the improvement of the design of instructional modules, investigating three main areas: ergonomics, education and health. Methodology Anasynthesis was the approach to build the evaluation matrix. Results The matrix consists of 29 criteria (Accessibility, Progression Activities, Updating Practices, Self-Analysis and Self-Management, Assessment, Cognitive Load, Student-Centered, Collaboration, Compatibility and Interoperability, Consistency, Knowledge Building, Student Control, Documentation and Help, Aesthetics, Feedback, Flexibility, Error Management, Interactivity, Maintenance, Clear Instructional Goals and Objectives, Motivation, Personalization, Problem Practicing, Critical Reflection, Relevance, Renewable, Safety, Use of Different Paths, Valorization of Knowledge) with 132 guidelines that allows to check if the online self-instructional module meets minimum quality criteria. Five courses produced by the UNA-SUS system were tested and compared with the perception of users of these courses, obtained by the polls for opening and closing the courses. There was an approximation between the evaluations using the matrix and the responses of the surveys of the courses, answered by the users. Results from these surveys were transferred to a user matrix. The Interactivity and Collaboration criteria were considered non-mandatory for self-instructional courses without tutors. Conclusions The matrix is an adequate evaluation tool for self-instructional courses developed for Continuing Education. Key messages The evaluation matrix is adequate to evaluate online self-instructional courses developed for Health professionals qualification. Self-instructed courses could be a good tool for Continuing Education in health, according to students’ perceptions.

Cost-effectiveness of Drug-Eluting Stents in Percutaneous Coronary Intervention in Brazil's Unified Public Health System (SUS).

ResumoFundamento O uso do stent farmacológico (SF) comparado ao stent não farmacológico (SNF) na intervenção coronariana percutânea (ICP) reduziu o percentual de reestenose, porém sem impacto na mortalidade, com aumento no custo. A literatura carece de estudos randomizados que comparem economicamente esses dois grupos de stents na realidade do Sistema Único de Saúde (SUS).Objetivo Estimar a razão custo-efetividade incremental (RCEI) entre SF e SNF na coronariopatia uniarterial em pacientes do SUSMétodos Pacientes com coronariopatia uniarterial sintomática foram randomizados em 3 anos para uso de SF ou SNF durante a ICP, na proporção de 1:2, com seguimento clínico de 12 meses. Foram avaliados reestenose intrastent (RIS), revascularização da lesão-alvo (RLA), eventos adversos maiores e custo-efetividade (CE) de cada grupo. Os valores de p < 0,05 foram considerados significativos.Resultados No grupo SF, dos 74 pacientes (96,1%) que completaram o acompanhamento, ocorreu RIS em 1(1,4%), RLA em 1 (1,4%), óbito em 1 (1,4%), sem trombose. No grupo SNF, dos 141 pacientes (91,5%),ocorreu RIS em 14 (10,1%), RLA em 10 (7,3%), óbito em 3 (2,1%) e trombose em 1 (0,74%). Na análise econômica, o custo do procedimento foi de R$ 5.722,21 no grupo SF e de R$4.085,21 no grupo SNF. A diferença de efetividade a favor do grupo SF por RIS e RLA foi 8,7% e 5,9%, respectivamente, com RCEI de R$ 18.816,09 e R$ 27.745,76.Conclusões No SUS, o SF foi custo-efetivo, em concordância com o limiar de CE preconizado pela Organização Mundial da Saúde. (Arq Bras Cardiol. 2020; 115(1):80-89)

Costs of healthcare-associated infections to the Brazilian public Unified Health System in a tertiary-care teaching hospital: a matched case–control study

Little is known about the economic burden of healthcare-associated infections (HAIs) in Brazil. To analyse the costs of hospitalization by reimbursement from the Brazilian government, via the Brazilian Unified Health System (SUS) affiliation, and direct costs in the adult Intensive Care Unit (ICU). The matched-pairs case-control study (83 patients with HAIs and 83 without HAIs) was performed at a referral tertiary-care teaching hospital in Brazil in January 2018. In order to calculate the HAI costs from the perspective of the payer, the total cost for each hospitalization was obtained through the Hospital's Billing Sector. Direct costs were calculated annually for 949 critical patients during 2018. The reimbursement cost per hospitalization of patients with HAIs was 75% (US$2721) higher than patients without HAIs (US$1553). When a patient has an HAI, in addition to a longer length of stay (15 days), there was an extra increase (US$996) in the reimbursement cost per hospitalization. An HAI in the ICU was associated with a total direct cost eight times higher compared with patients who did not develop infections in this unit, US$11,776× US$1329, respectively. The direct cost of hospitalization in the ICU without HAI was 56.5% less than the reimbursement (US$1329× US$3052, respectively), whereas for the patient with an HAI, the direct cost was 111.5% above the reimbursement (US$11,776× US$5569, respectively). HAIs contribute to a longer stay and an eight-fold increase in direct costs. It is necessary to reinforce programmes that prevent HAIs in Brazilian hospitals.

Axillary management for patients with breast cancer after neoadjuvant chemotherapy: Results of a survey amongBrazilian breast surgeons.

Currently, there are broadly differing patterns in the management of the axilla after neoadjuvant chemotherapy (NAC) and no consensus with clinically strong evidence onthe subject. A survey was performed to assess the current axillary management after NAC amongBrazilian breast cancer surgeons. The Brazilian Society of Mastology members were invited by email to complete an anonymous online survey and a total of 426 responses were collected. The majority of responders (67%) indicated performing routine axillary staging by physical exam, ultrasound, and fine needle biopsy in case of a suspicious node before NAC. Among breast surgeons working in the Brazilian Public Unified Health System, 11.3% answered that sentinel lymph node biopsy (SLNB) is not reasonable after NAC in their services. Seventy-seven responders (18.2%) reported performing SLNB instead of axillary lymph node dissection (ALND) only in patients who are clinically node-negative before NAC. Axillary complete pathologic response is necessary to omit ALND for 42.8% of responders. The molecular profile of a breast tumor is not considered when choosing axillary management after NAC for 73.7% of responders. Our survey highlighted the trend towards de-escalation of axillary surgery and observed high heterogeneity in axillary management after chemotherapy in a group of brazilian breast surgeons.

Prevalence of Alzheimer's disease according to anticholinesterase drug usage from 2012 to 2017 in the state of Paraná, Brazil

Introduction: Alzheimer's disease (AD) is a public health problem in Brazil due to the growing number of older adults in this population. Knowing the prevalence of AD in the Paraná state is essential to improve patients’ quality of life. The objective of the study was to estimate AD prevalence in the state of Paraná, based on the prescription of anticholinesterases, from 2012 to 2017. Methods: Patients diagnosed with AD, aged 60 years or over, who used Brazil’s Unified Public Health System (SUS) and received AD medication from the Department of Pharmaceutical Assistance of the state of Paraná, from 2012 to 2017, were the target population of the present study. The medication data were collected from the Computerized system management and Monitoring of Exceptional Drugs (SISMEDEX), and the population’s data were collected from the Brazilian Institute of Geography and Statistics (IBGE). Results: The sample consisted of 52,687 patients, and the median prevalence of AD in the established period for the state was 642.6/100,000 inhabitants (0.64%). In all ages and macro-regions, women showed the highest prevalence rates. The median prevalence for women in the established period was 755.4/100,000 inhabitants (0.75%). Among men, the median prevalence was 510.2/100,000 inhabitants (0.51%). In the temporal analysis of prevalence, between 2012 and 2017, a reduction of 23% was found in the state rate. The prevalence rate of Paraná for AD is nine times lower than the Brazilian average. Conclusions: Paraná’s prevalence rate for AD is lower than the rates of Brazil and the world, suggesting that AD is underdiagnosed in most municipalities of this state.

Management of Hemodialysis Patients with Suspected or Confirmed COVID-19 Infection: Perspective of Two Nephrologists in Brazil.

Brazil is the largest Latin American country with a population of 211.75 million inhabitants as of March 2020. Sao Paulo, the capital city of Sao Paulo State, is the most economically developed and populous city (12.25 million inhabitants), and it is located in the southeastern region of the country (1). There is a unified public health system all over Brazil that has been implemented since 1993, and it provides care to about 80% of the population in a relatively well organized, although insufficient, network of basic primary health care units and public hospitals for higher-complexity cases. On the other hand, 20%–25% of the population has private health insurance and may receive care provided in other accredited hospitals. The first case of the novel coronavirus disease (coronavirus disease 2019 [COVID-19]) pandemic in Brazil was reported on February 24 in Sao Paulo. Since then, the outbreak has spread to all states in the country, and the number of cases has been increasing on a geometric scale. To date (April 23), 49,492 confirmed cases and 3313 deaths have been reported (2). Although the national and state public health authorities provided guidelines and step-by-step orientations and measures to prevent the infection from spreading in the community early in the course of the epidemic, the number of cases has still soared steeply. The outbreak initially affected people from higher social classes and afterward, those living in more vulnerable and poorer metropolitan areas, thus leading to an overburden of the public health system. Patients with mild flu-like symptoms were advised to stay at home. Physicians in the Sao Paulo Hospital, a public hospital of the Federal University of Sao Paulo, were scheduled to work shifts in a recently created ambulatory service separated from the emergency care area of the hospital to assist patients with more …

Extrapolation of indications and drug interchangeability as barriers to use trastuzumab-dkst biosimilar in Brazil.

e13010 Background: Brazil has a complex health-care system which comprises 76% of population in the public unified health system (SUS) and only 24% in private system. Even with most of the population in the public system low resources has been allocated SUS by the government compared with that in private system. Breast cancer (BC) is the more frequent malignant neoplasm in Brazilian women, including HER2 overexpression, and the most are treated in SUS. Although, the HER2 blockage benefits in overall survival have been demonstrated since 2005, the adjuvant and neoadjuvant HER2 blockage was included in SUS protocols only 2013 while the metastatic only 2018. Brazil and development countries have limited accesses to biological drugs and target therapies due to the high cost. The biosimilar technology would improve the patient access to these drugs, health-care savings with efficacy and safety. In 2017, Brazil has approved the first biosimilar in oncology, the anti-HER2 monoclonal antibody trastuzumab-dkst. Our aim is understanding the reasons that hampered the Brazilian oncologists changing practice about biosimilars. Methods: We submitted an on-line survey with 12 questions to 144 Brazilian oncologists which are registered in Brazilian Clinical Oncology Society from North, Northeast, Center east, Center west and Southeast regions in Brazil. The questions were about the anti-HER2 biosimilars knowledge, the manufacturing process, the costs, the biosimilars-based clinical trial, the drug efficacy and safety. Results: We observed that all responders have 9 years experienced oncologist with mean of care 15 patient with HER2 BC per month. In total, 95% of oncologist knows biosimilar definition and 96% assume prescribe biosimilars without doubts. However, 81% oncologists would prescribe biosimilars to all patients, 82% would interchanges and 63% would extrapolate the indication. Conclusions: This survey was conducted to understand the Brazilian oncologist knowledge about biosimilar. We demonstrated a high knowledge of biosimilar definition, however with high percentage indicated adherence barriers. The pharmacovigilance, clinical trials that support biosimilar approval and extrapolation concepts are the main aspects to be addressed. The opportunity of patient access with biosimilars is real and it is the oncologist’s duty to engage in medical education programs. This study could highlight a crucial need for greater strategies to educate physicians, to disseminate biosimilars and provide more informed decision making.

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

OBJECTIVES:The number of bariatric procedures has significantly increased in Brazil, especially in the public Unified Health System. The present study describes health outcomes and medication use in obese patients treated in a major hospital that performs publicly funded surgery in Brazil.METHODS:A retrospective, single center study was conducted to collect real-world evidence of health outcomes and medication use in 247 obese patients (female, 82.2%) who underwent open Roux-en-Y gastric bypass. Changes in weight and body mass index (BMI), presence of apnea, hypertension, and type 2 diabetes (T2D), and medication use (hypertension, diabetes, and dyslipidemia) were assessed preoperatively and up to 24 months postoperatively. The mean cost of medications was calculated for the 12-month preoperative and 24-month postoperative periods.RESULTS:During the surgery, the mean age of patients was 43.42 years (standard deviation [SD], 10.9 years), and mean BMI was 46.7 kg/m2 (SD, 6.7 kg/m2). At 24 months, significant declines were noted in weight (mean, -37.6 kg), BMI (mean, -14.3 kg/m2); presence of T2D, hypertension, and apnea (-29.6%, -50.6%, and -20.9%, respectively); and number of patients using medications (-66.67% for diabetes, -41.86% for hypertension, and -55.26% for dyslipidemia). The mean cost of medications (total costs for all medications) decreased by >50% in 12–24 postoperative months compared to that in 12 preoperative months.CONCLUSION:Roux-en-Y gastric bypass successfully reduced weight, BMI, and comorbidities and medication use and cost at 24 months in Brazilian patients treated in the public Unified Health System.

Quality indicators in type 2 diabetes patient care: analysis per care-complexity level

BackgroundThis study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population.MethodsThis was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%).ResultsIn the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered.ConclusionsOur results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

Community-based grassroot communication strategies, process and product: The drawings that saved our hospital

A case-study analysis of an urban design communication strategy employed by our university-based design team entrusted with re-envisioning the uncertain future of a local small-town community hospital in Indiana. The design process is carefully constructed from structured public input, and community participation, whereby students, faculty, physicians, nurses, as well as ordinary citizens combine their efforts to strategically develop their ‘plan for planning’. Finding a strategy to define the scope of their future needs and the definition of important priorities to organize the project scope prior to engaging professional consultants. In this scenario, the design team is only the guide and translator, working closely with stakeholders to help them visualize and clarify the aspirations of their town. This paper will present our community-based design methods and most importantly our graphic communication techniques, specifically formulated to envision and facilitate consensus for a new unified public health system in a small Midwestern American city.

Proposal of an integrated decision support system for Tuberculosis based on Semantic Web

Epidemiological surveillance of Tuberculosis (TB) requires a strong integration of different health services, programs and levels of care. The deepening and broadening of data management techniques must be constantly carried out to increase the integrality of healthcare. Otherwise, knowledge extraction and clinical and administrative decision-making processes are significantly hampered, directly affecting the management and quality of health services. Thus, this work aims to establish a computerized decision support system capable of collecting, integrating and sharing TB health data in Brazilian Unified Public Health System. Also, it will allow the monitoring of infected patients and the visualization of consolidated information of regular TB and its resistant variants for health professionals and managers. The data will be made available from heterogeneous, disconnected and unstructured sources by combining traditional web services, Semantic Web resources and security algorithms. A solid knowledge base applied to epidemiological surveillance, health information governance and clinical support will be enabled to integrate the multiple areas of TB patients care, as well as to support the creation of more accurate operational and diagnostics models.

Influence of Maternity Leave on Exclusive Breastfeeding: Analysis from Two Surveys Conducted in the Federal District of Brazil.

Since the 1980s, Brazil has implemented several initiatives to support breastfeeding. Maternity leave, paid in full for 16 weeks, has been available since 1988. However, few studies in Brazil have analyzed the impacts of maternity leave on breastfeeding using population-based indicators. The aim was to analyze the association between maternity leave and exclusive breastfeeding interruption in children younger than 4 months residing in the Federal District of Brazil, in 2008 and 2014. Data from two surveys were used: the 2008 Second National Survey on Prevalence of Breastfeeding and the 2014 Monitoring of Infant Feeding Practices. The sample included 1,742 mothers with children younger than 4 months residing in the Federal District and using the Public Unified Health System. The main independent variable was the mother being on maternity leave and the outcome was interruption of exclusive breastfeeding. Multiple analyses were performed to test the association between maternity leave and the risk of interrupting exclusive breastfeeding, adjusting for socioeconomic, demographic, and biomedical characteristics. In 2008 and 2014, the prevalence of exclusive breastfeeding was 60% and 71.4% and prevalence of maternity leave was 27% and 41%, respectively. The lack of maternity leave was strongly associated with interruption of exclusive breastfeeding in 2008 (prevalence ratio [PR] = 1.78, 95% confidence interval [CI] [1.12, 2.82]) and in 2014 (PR = 3.95, 95% CI [1.88, 8.31]) after adjusting for confounding variables. Not being on maternity leave was strongly associated with the interruption of exclusive breastfeeding among employed women residing in the Federal District.

Universal health coverage and the More Doctors physician recruitment program (Programa Mais Médicos) in BrazilCobertura universal de salud y el programa Más Médicos (Programa Máis Médicos) en Brasil

RESUMOA cobertura universal pode ser entendida como uma meta que engloba diversas medidas que permitem a ampliação do acesso pelos sistemas de saúde. A atenção primária à saúde (APS) deve ser vista como um aspecto essencial desse processo, com papel de re-organização dos serviços com base nas necessidades em saúde. O Programa Mais Médicos no Brasil traz uma série de medidas para fortalecer a APS no país. A partir de uma revisão conceitual de cobertura universal em saúde e de uma análise do Programa Mais Médicos sob a ótica dos resultados obtidos em termos de fortalecimento da APS no Sistema Único de Saúde (SUS), o objetivo do artigo foi discutir a potencial contribuição do Programa Mais Médicos para o avanço do sistema de saúde brasileiro rumo à cobertura universal. Conclui-se que o Programa Mais Médicos é um propulsor para o alcance da cobertura universal no SUS.

Experience with the introduction of Transoral Robotic Surgery (TORS) at an oncologic hospital of the Brazilian Unified Public Health System (SUS)

Experience with the introduction of Transoral Robotic Surgery (TORS) at an oncologic hospital of the Brazilian Unified Public Health System (SUS)

O direito à saúde no Brasil: da redemocratização constitucional ao neoliberalismo de exceção dos tempos atuais

Objetivo: Delinear o histórico juspolítico do Direito à Saúde no Brasil em quatro fases da Nova República, desde sua redemocratização dos anos 1980 até a conjuntura constitucional hodierna. Metodologia: Utiliza-se a revisão de literatura de tipo narrativa com a finalidade de analisar o estado da arte do Direito à Saúde no Brasil. Resultados: O histórico juspolítico do Direito à Saúde constitucionalizado no Brasil é influenciado por uma disputa ideopolítica que fornece como resultado alguns avanços e muitos retrocessos em relação ao projeto do SUS Constitucional. Conclusão: É preciso recolocar na pauta nacional a defesa da efetivação do Direito à Saúde no Brasil, afirmando os objetivos, princípios e diretrizes do Sistema Único de Saúde.

Do elections matter for private-sector healthcare management in Brazil? An analysis of municipal health policy

BackgroundThis study analyzed several political determinants of increased private-sector management in Brazilian health care. In Brazil, the poor depend almost exclusively on the public Unified Health System (the SUS), which remains severely underfunded. Given the overhead costs associated with privately contracted health services, increased private management is one driver of higher expenditures in the system. Although left parties campaign most vocally in support of greater public control of the SUS, the extent to which their stated positions translate into health care policy remains untested.MethodsDrawing on multiple publicly available data sources, we used linear regression to analyze how political party-in-power and existing private sector health care contracting affect the share of privately managed health care services and outsourcing in municipalities. Data from two election periods—2004 to 2008 and 2008 to 2012—were analyzed.ResultsOur findings showed that although private sector contracting varies greatly across municipalities, this variation is not systematically associated with political party in power. This suggests that electoral politics plays a relatively minor role in municipal-level health care administration. Existing levels of private sector management appear to have a greater effect on the public-private makeup of the Brazilian healthcare system, suggesting a strong role of path dependence in the evolution of Brazilian health care delivery.ConclusionDespite campaign rhetoric asserting distinct positions on privatization in the SUS, factors other than political party in power have a greater effect on private-sector health system management at the municipal-level in Brazil. Given the limited effect of elections on this issue, strengthening participatory bodies such as municipal health councils may better enfranchise citizens in the fundamental debate over public and private roles in the health care sector.