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This paper discusses the regulatory role that would fit the National Supplementary Health Agency (ANS ), from the results of researches and studies on the practices of micro-regulation performed by private managed care companies on hospital providers they contract. It is based on several studies, especially on the research by Ugá el al (2007), whose results allowed the questioning of issues related to the necessary regulation of some elements of the relationship between health managed care companies and hospital providers, key to ensuring access and qualification of health care received by customers of those companies, as well as the importance that hospital providers have for the public health system, SUS. The paper aims, therefore, from the studies on the subject, to reflect on the regulatory role to be played by ANS in the contractual relations between managed care companies and providers and on the role that would fit to the SUS on this matter. [ABSTRACT FROM AUTHOR]

The Health Councils, institutionalized in the early 1990s, were designed as alternatives to the traditional model of lobbying. they have the legal power to formulate strategies and monitor implementation of health policy at the federal, state and municipal levels. today, all municipalities and states in Brazil have a Health Council, with representatives of users, professionals and managers of the unified Health system. users have equal representation in the other two segments. this paper aims to assess the motivations that representatives of the users have to participate in this instance the public interest representation. Methodologically were interviewed 12 councilors, representatives of users in Rio de Janeiro, Porto alegre and Recife. the evidence found in the words of the users' counselors surveyed indicated the ratification of patrimonial practices. this paper adds to the analytical efforts of some researchers in recent years have evaluated the experience of organization and actions of the Health Councils, and innovates to assess the views of users' counselors. [ABSTRACT FROM AUTHOR]

This paper describes and analyzes, in the perspective of federal financing, the development of the so called Política Nacional de Saúde Bucal (PNSB) [Dental Care National Politics]. It considers the progress of improvement of access provided by the inclusion of Dental Care Teams (DCT) in the Family Health Strategy (FHS), and the creation of Odontological Specialties Centers (OEC) and Regional Laboratories of Dental Prostheses (RLDP). Despite the importance of such improvement, this paper aims to reflect on the following issue: how the Decree 302/2009, that disengages DCT from FHS, is able to ensure the already achieved access with continuing financial resources? So a bibliographical and documental analysis was conducted, comprising the issue of SUS Operational Norms until the 2006 Health Pact. In the final remarks, the authors point out that most part of financial resources for dental care coincides with the policies adopted by the Health Ministry in the 1990's: primary care re-organization through the Family Health Strategy, and the incentives politics, as a way of transferring federal resources. Also, they highlight the risk of retreat brought by this decree, as it jeopardizes both the primary care re-organization process in dental care, and its financing, once the incentives politics of the Health Ministry is concerned with the Family Health Strategy. [ABSTRACT FROM AUTHOR]

The satisfaction of users is one of the basic components of the quality of any health service. The incorporation of this aspect in evaluative studies of units and primary health care teams has been increasing lately. In Brazil, this process is still embrionary, few are available and have appropriate and valid instruments. This paper aimed to investigate the dimensions which are most valued by the users. Two focal groups in two primary health care units with distinct contexts were conducted in order to expand the possibilities to the responses. The researcher held the analysis of the content and the categorization of speeches into dimensions and sub-dimensions of satisfaction. A total of 17 dimensions was achieved, which the most cited were: 1) access/availability to health service; 2) organization of the work processes; 3) relationship with health professionals; 4) care longitudinality and establishment of bond between professionals and users; and 5) care coordination. The knowledge of the dimensions of satisfaction which are most valued by users is vital to the construction of instruments that will be more suitable to context of the Family Health Strategy in our country. [ABSTRACT FROM AUTHOR]

Health care in Brazil is set as a unified system, running under a legal basis and protected by the Constitution. Health is positioned as a right of every citizen, and both models are defined with a view to the operation of services organized for this purpose. The first level in Brazil is called Basic Care, and its conceptual basis comes from the Primary Health Care (PHC). This paper aimed to understand and analyze how organized is the theoretical production of Public Health in Brazil about the social construction of health demand care in PHC, in order to create a reference to analyze it. The survey was conducted using the terms related to the initial problem: health care demand, basic health care and technical health care models. [ABSTRACT FROM AUTHOR]

This paper analyzes the performance of Local Health Councils as tools for social participation in the Family Health Strategy. It is a quali-quantitative research with triangulation method. The research took place in the city of Vitoria da Conquista, state of Bahia, Brazil. Data and information were gathered through the analysis of the agenda, followup forms, minutes of meetings of the council and semistructured interviews with key informants. The results show that the local health councils have limited performance, with a low frequency of meetings, commitments directed to the council itself and meetings on difficulties to access health care services. Low levels of social mobilization and community engagement are the main draw-backs for the good performance of these forums. Some problems stand out: counselors' representativeness, lack of motivation to perform voluntary tasks and feeling unprepared due to a poor graduation and training program. We conclude that institutionalization of local councils is not enough to promote community participation. It requires actions that can promote social mobilization and inform communities of the importance of group participation and engagement. [ABSTRACT FROM AUTHOR]

In this paper we present an analysis of the issues concerning the medical-industrial complex (MIC) and medical-financial complex (MFC), inspired by the theoretical framework of the science studies. The discussion about the medical-industrial/financial complex is approached under the aegis of a dychotomic split between economic interests and social values. We intend to draw attention to the need to consider the different angles of the issue, since the mentioned notions seek to nominate a very complex type of phenomenon. In order to attain an evaluation of the problem that is at once broad and deep, we consider necessary to unearth the underlying ideas to both its epistemological and axiological aspects as well. In order to achieve this goal, we begin with a brief contextualization and reassessment of the science studies; this is followed by an equally brief review of the available literature in Portuguese pertaining to the concepts of MIF and MFC, emphasizing the recent attempts to surpass the dychotomy "economic interests versus social values"; after that we attempt to elucidate, based upon the discussion about different modes of knowledge production, the epistemological and economic background underlying the MIC; after that, we bring to the forefront some critical diagnoses of the pharmaceutical industry, drawing on the notions of social medicalization and complementary & alternative medicine (CAM); finally, we point towards an approach as broad and acute possible of a problematic that can no longer be thought of in dychotomic terms. [ABSTRACT FROM AUTHOR]

This paper discusses the data of the survey conducted in 2008 in the Manguinhos Slum Complex, Rio de Janeiro, on therapeutic itineraries of the local population. By therapeutic itineraries we mean the paths taken by the individual in search of a solution to his/ her health problems. We aim to identify to what extent these paths are ordered by symbolic schemes or by the availability of resources. A qualitative method focused on the semi-directive interview technique, following an ethnographic script, was used. Three residents of each community of Manguinhos were interviewed, in a total of 26 interviews. The results show that the offer of services is heterogeneously distributed, being itself a generating factor of inequalities in disease. The different strategies show that the knowledge and practices of these individuals are made of, and due to different experiences, given biographic situations and that there is not a single model of Therapeutic Itinerary. The urban "marathons" ran by the local population denounce the urgency of the State to put into practice more fair political policies, with a full access to health care, thus ensuring the respect for the rights. [ABSTRACT FROM AUTHOR]

This paper seeks to identify and analyze the professionals' perception about mothers who care for children between 0 and 6 years old. Professionals from the Family Health Strategy were interviewed: doctors, nurses and nursing technicians/assistants. The research took place in two districts of Florianópolis/SC. Through content analysis, we identified that, although professionals realize that mothers keep on using public health care, they claim that learning child's basic care in the family subsystem has changed, as familiy life conditions do not encourage home care. This aspect, along with the consequences of implementation of a new design of public health services particularly for basic care and available on a large scale to the population, tend to make women more dependent on health services and children's care more medicalized. [ABSTRACT FROM AUTHOR]

This paper aims to problematize the itinerancy as a way to operationalize care in the territory. With the creation of the Unified Health System, the notion of territory has become an organizing principle of work processes in primary health care and mental health policies. In the delicate field of coordination between these policies, itinerant practices now have a strategic importance in the deinstitutionalization of practices and construction of integral care. We take the deinstitutionalization and the integrality as conceptual operators that make the difference that Psychiatric and Health reforms want to print in the care practices. Warned that by joining in a posture of active search in the life territory of users, the itinerant practices fall in a field of tensions, which can both be called to work as a part of the State apparatus to population control, as in a strategic place for the construction of a contextualized care to users" way of life. We believe that it is possible to resist the social control mandate and build an ethics of care with itinerancy to explore the political power of the movement and transform the users' territory in a laboratory for the invention of life. [ABSTRACT FROM AUTHOR]

This paper focuses on the working conditions of nursing technicians of Neonatal Units, considering the relational dimension of the care activity. Having as main epistemological references Canguilhem's concept of health of and the Ergological perspective, the research was based on the clinical approaches of work, including the following methods: direct (observations) and indirect (talks and meetings about work with the technicians); analysis of documents on the previous norms concerning this work. The analysis dealt basically with the groups' language production. Some results can be highlighted: the development of this care activity implies intense mobilization of workers; the possibility of not assisting the mothers who arrive to have their babies seems to be more noxious to these technicians than to work with an overload of patients; the precarious conditions of work are producers of pathogenic suffering, once the pleasant and well-succeeded realization of this activity is hindered. [ABSTRACT FROM AUTHOR]

The Brazilian supplemental health care sector has been experiencing new health care models in the last few years. This paper aims at featuring how users perceive and how they express themselves in relation to the deployment of a program known as Family Health Strategy (FHS) by a self-management health care provider. Through focal groups, the research reveals that users present a rather clear view on the meaning of strategy, including its remarkable rationalizing elements. In addition, they percept contradictions as well as deficiencies in the formulation and deployment process, and they keep a high level of autonomy in the choice for more adequate services, which are greatly influenced by the type of insertion that they exert in the bank institution that maintains the health care service provider. Users also perceive the predicament presented by self-management regarding the maintenance of a broad authorized free access network and the advance towards turning FHS into the structuring backbone of its assistance network. .KWT-Palavras-chave: [ABSTRACT FROM AUTHOR]

Reflections on citizenship and barriers to popular participation in the Unified Health System This paper presents the contradictions of the concept of citizenship found in research conducted with users of a health unit in the East Zone of Sao Paulo and the resulting barriers to popular participation in the SUS. Data collection was organized into two meetings, discussing the concept of citizenship and popular participation with eight subjects outside the unit's management council. We used the focus group technique. As a result, there was a vagueness of meanings applied to the concept of citizenship. The subjects mentioned a number of limitations to the implementation of this concept, as State's law, the repression suffered by the people, the disbelief in representative democracy and voting as citizenship practices, and the question of equal rights in our society; and popular participation as a form of collective movement in search of solutions to community problems. Therefore, popular participation within the institutional spaces of the SUS with this concept of citizenship can lead users to leaving their demands unsolved by the State in the the management councils. Only with other forms of pressure and noninstitutional mobilization one can have a more effective popular participation and problem-solving view of the concerns of the population and health activists, who struggle for a public health and quality. [ABSTRACT FROM AUTHOR]

This paper presents and discusses data from a research about group practices developed by Family Health Teams of the nine Sanitary Districts of Belo Horizonte city. We conducted interviews with managers and health professionals from Basic Health Units, focus groups with customers and participant observation of regular groups of health units. In data analysis we aimed to highlight the process dimension and the historical construction of the investigated practices through the discussion of five aspects: (1) reasons to promote group practices; (2) changes on the structure of group practices; (3) informative and participative dimensions of the groups; (4) effects and (5) assessment of group practices. The analyses show that group practices have multiple aspects related to services organization and healthcare, the function and objectives placed by different teams, and its configuration. There is an incipient shift of approach concerning practices centered in diseases for the creation of groups by new structural axis, according to the municipal guidelines for primary health. Data show the impact of group practices in reducing the request for individual appointments and in enhancing the bond between customers, health professionals and services. The results indicate the tension between the "individual appointment" device and the "group practices" device. The former is marked by the focus in disease, while the latter produces its blurring, highlighting other dimensions of life associated with health promotion. [ABSTRACT FROM AUTHOR]

The population access to the secondary health care services is being pointed, by managers and researchers, as one of the challenges to the implementation of integrality in the Brazilian National Health System (SUS). This paper aims to evaluate the mechanisms used by SUS manager's, in the city of São Paulo, to guarantee medical assistance, from 2005 to 2008. The strategy of case study was chosen, using as data sources such as managers interviews, focus groups with SUS users, and participative observation. Thematic analysis was performed on health services organization, with theoretical references of the integrality concept. We tried to describe the path covered by the users to have access to the services, based on the view of users and managers. Secondary health care services were identified by managers as the "neck of a bottle" and one of the main obstacle to the SUS integrality. To overcome this situation, the municipal manager invested in the computerization of services, as an isolated step, and still, without considering user's needs. However, this technological incorporation had low impact on the improvement of the population access to the secondary health care services, which was confirmed by user's source. It is argued that to face such complex problem it will be necessary to articulate actions, not only in health politics but also in health services organization and also in the (re)organization of the working process in any other level of the health system. [ABSTRACT FROM AUTHOR]

In 1999, the report by the Institute of Medicine (IOM), pointed that there are significant adverse events and that more than half of these occurrences were caused by medical errors, provoking numerous actions and research on Patient Safety. Infections related to health care (IRAS), one of the problems faced in the area, are the subject of research that attempt to create procedures and strategies to prevent such events. Hand hygiene, because it is the simplest measure of control in IRAs and, paradoxically, the one with the lowest compliance rate among physicians, is the target of numerous programs and campaigns. The need to reverse this state has generated extensive literature that, among other things, indicates and identifies barriers and risk factors for poor adherence to standards and procedures for hands hygiene, but also seeks to understand the behavioral aspects concerned. This paper presents some theoretical models aimed at understanding the behavioral dynamics which involves the achievement of error and violation and carries out an analysis with the possibilities of apprehension of the process. Finally, it is considered that the explanatory models jointly presented bring contributions that can be applied in practice and that identifying and understanding the mechanisms of collective defense would lead to factors that are at stake in the low adherence to procedures, sanitation of hands among physicians, despite the existing evidence. [ABSTRACT FROM AUTHOR]

In Brazil, in spite of advances in the field of pharmaceutical care, problems in assurance, by the State, of access to medicines persist. Since the early 1990s, the judicial demand of medicines by citizens has increased. The lawsuits demand medicines that are out-of-stock in the public sector as well as medicines that have not yet been incorporated by the Brazilian Health System. This phenomenon may be analyzed under different perspectives, including the health perspective, which is basically related to health outcomes for these individuals. This paper discusses the main characteristics of judicial demands, especially regarding the rational use of medicines, the use of scientific evidence to examine and substantiate the intended therapeutic use, and the justification of litigation as a means of access to medicines, in light of the concepts of access adopted by the field of pharmaceutical services in Brazil. Health risks to individuals demanding medicines through the Judiciary must be scrutinized when the demanded medicines do not belong to essential medicines lists, when their indication may be viewed as off-label, or if they have not obtained market approval in the country. The assumption is that the Judicial System aims to warrant the health of plaintiffs and in this ultimately the dignity of the individual. But this objective will only be met if in guaranteeing health all aspects of safety for the individual are involved, including the use of medicines. [ABSTRACT FROM AUTHOR]