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This paper is intended to determine the worth of unpaid health care in Uruguay and to characterize the caregivers (either paid or unpaid) who serve ill people. These objectives are accomplished mainly through the quantitative analysis of the data gathered by the first National Survey of Unpaid Health Care (2013) in Uruguay. This survey enables to become aware and set the worth of the unpaid health care times (replacement cost method) and to characterize the unpaid caregivers. This paper shows how the unpaid health care provided by homes accounts for a third of whole health care aggregate in the Gross Domestic Product. Women are the main caregivers, thus assuming the costs of losing their autonomy and seeing reduced the opportunities to enjoy their rights. [ABSTRACT FROM AUTHOR]

This article aims to disclose the response capacity of the Health Information Systems (HIS) in Colombia to support an inspection, surveillance and control model (ISC) driven towards the monitoring of the risks undermining the access, use and quality of the health services. This paper is based on a descriptive cross-sectional study under a risk management approach including a review of the regulations framework dealing with the threats to the effective enjoyment of the right to health (EERH) and the characteristics of the information reported by the actors in the system, which is required to carry out the said monitoring. The data supporting the monitoring to the health care processes and its impact on the population health are not enough to appropriately oversee the risks involved. Advantage should be taken from the changes currently taking place in the health system in order to rethink how the system performance is taken as monitored object. [ABSTRACT FROM AUTHOR]

Objective: To explore the experiences and life events regarding the cultural competence in the public health practice. Methods: A qualitative meta-synthesis covering the databases Medline, OvidNursing, OvidJournal, Embase and BVS-LILACS, including papers in English, Spanish and Portuguese between 2009 and 2014. Ten studies were included and assessed by using the Critical Appraisal Skills Programme in Spanish (CASPe). The three stages of the meta-aggregation programme were applied to do the obtaining and synthesis of findings. Results: The findings were aggregated in six categories and two types of results: 1) paradoxes when providing public health care to people from different culture and 2) going beyond the barriers – the daring by the public health nurses. Conclusion: The nurses experienced and expressed their cultural competence from the paradoxical situation produced when encountering another culturally different people. They showed a stance open to both understand and make sense of the other's culture, even though it was hard to produce culturally competent interventions. [ABSTRACT FROM AUTHOR]

Psychological and pharmacological treatments for eating disorder involve personal and health costs. In this paper we study the various reasons that may be associated to abandonment in both types of treatments in patients diagnosed with a disorder of eating behavior and the kind of neglect: neglect after evaluation, early and late abandonment. On the other hand, we analyze whether there is any relationship between the diagnosis and the type of abandonment. Various characteristics (age, sex, diagnosis, motives and types of neglect, and satisfaction with the unit eating disorder) in 212 patients treated at a specialized service in the treatment of eating disorder were examined during a period of two years. Our data support the hypothesis that the rate of abandonment of the most common treatments is delayed type, motivated by the improvement of the disorder of eating behavior, while no verified that there is some relationship between the diagnosis and the type of abandonment. Our results indicate that the reasons for dropping out are heterogeneous. You can set two different profiles of dropouts, one linked to improvement and to temporary disability, and other related to various reasons. [ABSTRACT FROM AUTHOR]

Cuban National System faces an important challenge, which is to consolidate the improvement programs of their institutions; consequently, there are considered key objectives like: fostering creativity and innovation; promoting continuous training; and ensuring the efficiency seeking, the application of best practices and permanent processes evaluation. These objectives are commonly assumed when organizations adopted managerial approaches based on quality, efficiency, effectiveness and service to clients. Hence, this paper shows the results of experiences in business process management, being conceived as a work setting of improvement in health institutions. To seek such goal, it is conducted a bibliography study of 70 methodological procedures, resulting in a new approach that is applied to five hospitals in a Cuban province in order to prove its efficacy for performance improvement, which is illustrated by progress being obtained in service and processes functioning with consequent extension to other hospital of the province. [ABSTRACT FROM AUTHOR]

Insurers (hmos) argue that there is no incentive to invest in prevention activities because members can easily move to another insurance company. At the same time freedom to choose hmos is a key accountability mechanism of the Colombian Health System because citizens can leave low-quality insurers and enroll in high-quality insurers. This paper quantifies the size of the rate of transfers between hmos in the country to shed light on this debate. This study used publicly available information on affiliation histories to the health system for the last 14 years (2001-2014) for a random sample of adults between 40 and 50 in five different capital cities. The rate of enrollee transfers within a continuous enrollment period between HMO was estimated. Results showed that 56% of enrollees had four or more enrollment periods; within the same enrollment period at least 54% of enrollees did not transfer between HMO; in a year less than 6% decided to transfer; there was a weak correlation between transfers and HMO service quality indicators. Results showed that the transfer rate is low but that the drop-out rate is high. People do not transfer but leaves the systems frequently, which suggest that this behavior is explained by labor market fluctuations. The transfer between HMO is not frequent and this suggests that as accountability mechanism is not working and thus needs to be redesigned. [ABSTRACT FROM AUTHOR]

Traffic accidents, due to the serious consequences they have on people, and the high economic costs associated with them, are considered a worldwide social and public health problem. This paper assesses economic loss due to motorcycle accidents between 2012 and 2013 in a level 3 hospital. This is a quantitative-explanatory study, where an aggregate loss model is applied. An input of 2,518 patients is used which represents 9.08% of the Medellín's accidents reported. The 72.18% of all emergency events came from motorcycle accidents. Sunday was the day with highest accidents number with a 122 average patients. Average losses per day amount to COP 36,373 million. The operational VaR --maximum loss per day at 95% confidence-- is COP 112,400 million, and represents the probable maximum loss per day. The numbers and variables allow developing mobility policies and increased controls on days and vulnerable places with the highest traffic accidents number. [ABSTRACT FROM AUTHOR]

Objective: This paper proposed a conceptual framework to overcome the limitations the disciplinary approaches face when analysing the processes of implementation of health policies on the territory. Method and framework: With this purpose, it established links between the contributions from three fields: the studies on the performance on health care, the theoretical contributions provided by geography, and the research on public policies and implementation. Results: As a result of this approach, it is possible to capture phenomena and processes that, from each of the particular disciplinary perspectives, are opaque for the analysis: on one side, conceiving health attention as a point within a whole that compromises different notions of territory; on the other hand, recognise that at the moment of the implementation on the territory there is a process of recreation of the institutions, where they appear on scene and negotiate different regulation logics. [ABSTRACT FROM AUTHOR]

From a medical point of view, "sexual ambiguity" in new born babies has been categorized as a psychosocial emergency, which sets in motion a diagnostic and interventional protocol--both surgical and hormonal--in order to "determine" the sex and "correct" the body. From social and critical perspectives, it's preferred to speak about sexual variability, that is, about sexed bodies that don't fit into the dualistic expectations of what is considered a suitable for a man's or a woman's body, or in which the different sex components--chromosomal, hormonal, gonadal, or anatomic--are not consistent. In the last decades a strong controversy around intersexuality and the need to change not only the medical management, but also the social models, and the representation of the dualistic collective imagination, has arisen. Nevertheless there seems to be a wide gap between the medical management contexts and languages, and those typical of the political and human rights movements. Bioethical considerations, the role of support groups, and the possible social interventions may open channels of intervention and bridges for dialogue and translation among these isolated spaces. In this sense, this paper intends to analyze the meanings, uses, and practices of the psychosocial in the treatment and research of the intersexualities/DSD in order to explore up until what point there is a "psychosocial turn" taking place, or are we still in a predominantly biomedical management paradigm. [ABSTRACT FROM AUTHOR]

This paper seeks to debate the dynamics existing between users of and trainers in a home care course for illegal immigrants in Barcelona. The analysis of these dynamics reveals the ambivalence of the help and support devices used by immigrants. These devices expose distant and top-down social positions (Spanish citizen /immigrant-foreigner), as well as alliances between users and trainers based on their shared identification as "employees" vis-à-vis the "lady of the house". Our analysis also reveals the importance of care work for the reproduction of life and also the lack of social recognition, low pay and poor legal coverage this type of job gets in the labour market. [ABSTRACT FROM AUTHOR]

This paper examines psychiatric diagnosis-making within biomedicine, as studies in this field, especially empirical ones, have attracted little attention throughout the scientific world. The widely accepted assertion, that diagnosis is the result of clinical judgement, will be discussed. Through analysis of a case study conducted in a Barcelona hospital, it will be suggested that psychiatric diagnosis is not only the result of clinical assessment, but also of psychotropic drugs translation. Drawing on actor-network theory and the notion of boundary objects established by Star and Griesemer (1989), it is therefore proposed that psychotropic drugs are boundary objects which act as central mediators in knowledge management, setting up the semiotic-material assemblage of diagnosis. [ABSTRACT FROM AUTHOR]

This article approaches the issue of philosophical perspectives of social justice and its relationship with some of the implications for health systems in Latin America and the world. Three philosophical perspectives of social justice from the radical liberal approach, egalitarian and redistributive liberal, and Marxist egalitarianism or reviewed. Society, their conceptions of health and public health approach. From the theoretical support these approaches, the relationship State are identified. Based on these concepts identify some implications for health systems in each of its representative aspects. The paper concludes with some reflections about the need to discuss the fundamental right to health as a fundamental element of universal health systems and assume a perspective as input for the design and analysis of health systems from the right to health. [ABSTRACT FROM AUTHOR]

The districting problem in home health care (HHC) is part of the logistics decisions that healthcare providers face when designing service networks to deliver coordinated medical care to patients' homes. In this paper we study such problem in the context of a rapid-growing city, phenomenon that refers to the increment of the population in urban areas, and which results in problems such as the proliferation of marginal neighborhoods, increment of epidemic diseases, absence of governmental control and security, and lack of basic health services. Consequently, three factors derived from this phenomenon are integrally studied: geographical disposition of the population, security conditions to access basic units, and trends on demand for HHC services. We propose a bi-objective mathematical model and identify trade-offs, allowing finding better compromised solutions. We evaluate the model with real data instances from a HHC institution which delivers services in the largest cities in Colombia. Results show that better districting configurations can be obtained and deteriorations of less than 10% in Travel Workload can produce improvements of more than 80% in Workload Deviations. [ABSTRACT FROM AUTHOR]

The paper studies the degree of equity in access to services for Primary Health Care (PHC) among the inhabitants of the municipalities of the Province of Buenos Aires (Argentina). It is a retrospective quantitative study which used as an indicator of access to PHC services the number of persons per primary health center (PHCS) in each municipality. The results indicate the existence of strong inequalities in access among municipalities, which cannot be justified by different needs of PHC services. The needs were defined from the infant mortality rate and the percentage of households with unsatisfied basic needs. In turn, it appears that municipalities with higher levels of wealth and higher levels of health expenditure per capita for municipal health purpose have better indicators of access to PHC services. [ABSTRACT FROM AUTHOR]

The goal of this paper is to determine the profile of total demand and potential supply in health services, available for high cost illness or catastrophic illness in the Fund for Protection against Catastrophic Expenses (FPCGC by its Spanish initials) of the System of Social Protection in Health (SPSS). In the Fund's financial design's basis, health reality was considered static by deducting the effects of epidemic changes and not précising people's health needs, or "hidden demand". Thus, when this demand is revealed it becomes an effective demand for health institution and the plans used in the Fund's financial calculations change. All in all, a methodological definition from the General Health Council is needed in order to organize and make CIs temporal for the Fund's coverage. [ABSTRACT FROM AUTHOR]

This paper studies the public policies and components of the healthcare system affecting Colombian women with HIV/AIDS. Although there is national interest in controlling the HIV/ AIDS epidemic, current policies are not linked to specific lines of action and do not include a coherent gender approach that can guarantee comprehensive healthcare. HIV/AIDS policies are formulated within the frame of current economic policies and health reform implemented as part of Law 100 of 1993. These policies must be supported by economic plans that make it possible for the most vulnerable population to overcome the conditions of social inequity and by a healthcare system which guarantees complete access to appropriate healthcare. [ABSTRACT FROM AUTHOR]

The purpose of this article is to place perceived quality measurements, carried out by DANE in their Quality of Life surveys of 1997 and 2003, in relation to the concept of patient satisfaction. What is understood as health quality in general is shown briefly first and it is indicated that when quality medical attention is mentioned it is in light of a problem of satisfaction. Then, in more detail, the concept of satisfaction is considered and the shape of the relationship between the two concepts is explored, resulting from establishing the measure in which one of them can represent the other. From this perspective, quality measurements can be interpreted either as satisfaction indicators or as its direct measurement. Finally, the theories that somehow incorporate perceived quality in the determination of satisfaction are presented indicating that it doesn't constitute the totality of the explanation. These are theories that describe the paper played by expectations and their varying corroboration through the product attribute perception, which is the usual way of understanding perceived quality. It is concluded that although perceived quality of health care as an indicator, says something about the degree of satisfaction reached by the patient, it doesn't appear anyways, a good representative, as even if the expectations are an important factor in the explanation, and even if they were the principal one, there is agreement about the very relevant intervention of other factors. [ABSTRACT FROM AUTHOR]

This paper is the result of organizational culture research performed in a public hospital, aimed at making an approximation to discourses circulating in a hospital which is in process of transformation towards an "Empresa Social del Estado". The analysis illustrates how the transformation of a hospital into a productive enterprise leads to the displaying of new ways of doing things and new discourses imported from the context-client, registers and administrative control, information management, flexibilization of labor, and efficiency that contributes to the worker's construction. However, opposing voices against changes embedded in economic logic make evident that the new order is not hegemonic so far. [ABSTRACT FROM AUTHOR]

Marketing mechanisms that are introduced in health care are also present in most of the recent health care reforms where the tendency to reduce the roll of the State in delivery and financing health care, promoting free competition, giving answer to the consumers free choice and stimulating the use of "managed care" as a way to control sanitary spends, is present in their changing agendas. The aim of this paper is to debate the conception that underlay those proposals in terms of the commodification of health care, to analyze some of the difficulties derived from the application of marketing in the health systems and to discuss about the ethical consequences of the "managed care" in medical practice and in the physician-patient relationship. [ABSTRACT FROM AUTHOR]

The aim of this paper is identify the main reasons for which the providers of health services in Bogotá outsource some of their services. The framework that supports the study is based on the central concept of developing core competences in the provision of services. The empirical component of the study involved 35 providers, public and private, of various levels of complexity. The main result is that the main reason for which hospitals use outsourcing is to reduce costs, and the second reason is the advantage that specialized firms have in certain areas. [ABSTRACT FROM AUTHOR]

Objective : This paper presents an analysis of two regulatory proposals in response to the growing demand for kidney transplants in Colombia. The results can be useful in evaluating these possible policy interventions once they have been implemented. Methods: The proposed model uses System Dynamics as a tool to understand the behavior of this complex social system if two intervention projects are executed. The first is a bill of law seeking to expand the legal presumption of organ donation. The second one is to implement a Kidney Exchange Program. The analysis is made in two parts. Firstly, a causal loop diagram is proposed. Secondly, the simulation of the system using a stock and flow diagram is analyzed. Results: Results show that the projects can balance the system and encourage donations. Conclusion: The implementation of a KEP is recommended since it achieves stability of the system earlier than the amendment to the law, with a reduction in the waiting list size. [ABSTRACT FROM AUTHOR]