Ana Maria Malik

Desigualdades no uso e acesso aos serviços de saúde entre idosos do município de São Paulo

OBJETIVO: Analisar os fatores relacionados a determinacao e as desigualdades no acesso e uso dos servicos de saude por idosos. METODOS: Estudo integrante do Projeto Saude, Bem-estar e Envelhecimento (SABE), no qual foram entrevistados 2.143 individuos com 60 anos ou mais no municipio de Sao Paulo, SP, em 2000. A amostra foi obtida em dois estagios, utilizando-se setores censitarios com reposicao, probabilidade proporcional a populacao e complementacao da amostra de pessoas de 75 anos. Foi mensurado o uso de servicos hospitalares e ambulatoriais nos quatro meses anteriores a entrevista, relacionando-os com fatores de capacidade, necessidade e predisposicao (renda total, escolaridade, seguro saude, morbidade referida, auto-percepcao, sexo e idade). O metodo estatistico utilizado foi regressao logistica multivariada. RESULTADOS: Dos entrevistados, 4,7% referiram ter utilizado a internacao hospitalar e 64,4% o atendimento ambulatorial. Dos atendimentos ambulatoriais em servico publico, 24,7% ocorreram em hospital e 24,1% em servico ambulatorial; dentre os que ocorreram em servicos privados, 14,5% foram em hospital e 33,7% em clinicas. Pela analise multivariada, observou-se associacao entre a utilizacao de servicos e sexo, presenca de doencas, auto-percepcao de saude, interacao da renda e escolaridade e posse de seguro saude. A analise isolada com escolaridade apresentou efeito inverso. CONCLUSOES: Foram observadas desigualdades no uso e acesso aos servicos de saude e inadequacao do modelo de atencao, indicando necessidade de politicas publicas que levem em conta as especificidades dessa populacao, facilitem o acesso e possam reduzir essas desigualdades.

Modelos de assistência ao parto e taxa de cesárea em diferentes países

The paper reports the results of a literature review on cesarean rates and models of childbirth care in different countries according to their utilization of technology. There were reviewed 60 studies published between 1999 and 2010 retrieved from the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) and ProQuest databases. The Brazilian model of childbirth care relies on the physician-patient relationship, level of technology utilization and cesarean delivery.Revisao bibliografica que descreve as taxas de cesarea em diferentes paises e os modelos de atencao ao parto de acordo com o uso de tecnologias assistenciais. Foram analisados 60 estudos publicados entre 1999 e 2010, obtidos nas bases de dados da Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior e ProQuest. O modelo de assistencia obstetrica praticado no pais baseia-se na relacao medico-paciente, ao grau de utilizacao de tecnologias e a realizacao do parto cesareo. Revision bibliografica que describe las tasas de cesarea en diferentes paises y los modelos de atencion al parto de acuerdo con el uso de tecnologias asistenciales. Se analizaron 60 estudios publicados entre 1999 y 2010, obtenidos en las bases de datos de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior do Brasil y ProQuest. El modelo de asistencia obstetrica practicado en Brasil es embasado en la relacion medico-paciente, con el grado de utilizacion de tecnologias y con la realizacion del parto por cesarea.Revision bibliografica que describe las tasas de cesarea en diferentes paises y los modelos de atencion al parto de acuerdo con el uso de tecnologias asistenciales. Se analizaron 60 estudios publicados entre 1999 y 2010, obtenidos en las bases de datos de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior do Brasil y ProQuest. El modelo de asistencia obstetrica practicado en Brasil es embasado en la relacion medico-paciente, con el grado de utilizacion de tecnologias y con la realizacion del parto por cesarea.

Satisfação no trabalho e rotatividade dos médicos do Programa de Saúde da Família

One of the greatest problems of the Family Health Program in Brazil is the high turnover of its physicians. Given that the program is based on the relationship between health professionals and citizens, these high rates affect the models effectiveness. A survey to identify the correlation between job satisfaction and physician turnover in the city of Sao Paulo, Brazil, confirmed the hypothesis that there is a negative correlation between these indicators. The prestige of the partner institutions is the most important factor in determining the programs physician turnover in Sao Paulo. Other job satisfaction factors that showed correlation with physician turnover were: training, commuting time, and lack of adequate equipment and materials.

Hospitais e programas de qualidade no estado de São Paulo

The Health Administration field understands and deals with quality issues in a way that differs from what is seen in the industry. This article presents a survey done in a sample of 159 hospitals in Sao Paulo state during the second semester 1999 regarding the implementation of quality initiatives. The sample had public, philanthropic, non-philanthropic and university hospitals. Among 97 hospitals answering the survey, 23% said they had some quality initiatives. The other 77%, whose answer was negative, blamed high costs, delayed results and lack of need for that fact. Most of those that had the initiatives did not know much about their costs and their consequences. Almost all of those that answered positively said they monitored managerial indicators.

Gastos em saúde: os fatores que agem na demanda e na oferta dos serviços de saúde

The States current financiaI crisis makes it important to use adequately the available economic resources. To spend less and better should be one of the goals of the health sector: This paper presents a reflection about this problem and analyzes the factors that interfere on the offer and demand for health care, besides other important reasons for the rising expenditures in health in most Westem countries. The demand factors cannot be rapidly controlled, depending a lot on the consumer or on the social protection. On the other hand, the offer factors are much more easily controlIed, with the help of regulations for the installation of heavy equipment, hospital budgets, or the control on the number of health professionals that graduate. Nevertheless, the literature shows very few successful examples of such measures. In Brazil, similar attempts have been unsuccessful, mosdy due to the heaIth sectors managerial and financiaI difficulties.

Inequalities in access to health care services and utilization for the elderly in São Paulo, Brazil

OBJETIVO: Analisar os fatores relacionados a determinacao e as desigualdades no acesso e uso dos servicos de saude por idosos. METODOS: Estudo integrante do Projeto Saude, Bem-estar e Envelhecimento (SABE), no qual foram entrevistados 2.143 individuos com 60 anos ou mais no municipio de Sao Paulo, SP, em 2000. A amostra foi obtida em dois estagios, utilizando-se setores censitarios com reposicao, probabilidade proporcional a populacao e complementacao da amostra de pessoas de 75 anos. Foi mensurado o uso de servicos hospitalares e ambulatoriais nos quatro meses anteriores a entrevista, relacionando-os com fatores de capacidade, necessidade e predisposicao (renda total, escolaridade, seguro saude, morbidade referida, auto-percepcao, sexo e idade). O metodo estatistico utilizado foi regressao logistica multivariada. RESULTADOS: Dos entrevistados, 4,7% referiram ter utilizado a internacao hospitalar e 64,4% o atendimento ambulatorial. Dos atendimentos ambulatoriais em servico publico, 24,7% ocorreram em hospital e 24,1% em servico ambulatorial; dentre os que ocorreram em servicos privados, 14,5% foram em hospital e 33,7% em clinicas. Pela analise multivariada, observou-se associacao entre a utilizacao de servicos e sexo, presenca de doencas, auto-percepcao de saude, interacao da renda e escolaridade e posse de seguro saude. A analise isolada com escolaridade apresentou efeito inverso. CONCLUSOES: Foram observadas desigualdades no uso e acesso aos servicos de saude e inadequacao do modelo de atencao, indicando necessidade de politicas publicas que levem em conta as especificidades dessa populacao, facilitem o acesso e possam reduzir essas desigualdades.

Determinants of the use of health care services: multilevel analysis in the Metropolitan Region of Sao Paulo

OBJECTIVE To evaluate the individual and contextual determinants of the use of health care services in the metropolitan region of Sao Paulo. METHODS Data from the Sao Paulo Megacity study – the Brazilian version of the World Mental Health Survey multicenter study – were used. A total of 3,588 adults living in 69 neighborhoods in the metropolitan region of Sao Paulo, SP, Southeastern Brazil, including 38 municipalities and 31 neighboring districts, were selected using multistratified sampling of the non-institutionalized population. Multilevel Bayesian logistic models were adjusted to identify the individual and contextual determinants of the use of health care services in the past 12 months and presence of a regular physician for routine care. RESULTS The contextual characteristics of the place of residence (income inequality, violence, and median income) showed no significant correlation (p > 0.05) with the use of health care services or with the presence of a regular physician for routine care. The only exception was the negative correlation between living in areas with high income inequality and presence of a regular physician (OR: 0.77; 95%CI 0.60;0.99) after controlling for individual characteristics. The study revealed a strong and consistent correlation between individual characteristics (mainly education and possession of health insurance), use of health care services, and presence of a regular physician. Presence of chronic and mental illnesses was strongly correlated with the use of health care services in the past year (regardless of the individual characteristics) but not with the presence of a regular physician. CONCLUSIONS Individual characteristics including higher education and possession of health insurance were important determinants of the use of health care services in the metropolitan area of Sao Paulo. A better understanding of these determinants is essential for the development of public policies that promote equitable use of health care services.

Models of childbirth care and cesarean rates in different countries

The paper reports the results of a literature review on cesarean rates and models of childbirth care in different countries according to their utilization of technology. There were reviewed 60 studies published between 1999 and 2010 retrieved from the Brazilian Federal Agency for Support and Evaluation of Graduate Education (CAPES) and ProQuest databases. The Brazilian model of childbirth care relies on the physician-patient relationship, level of technology utilization and cesarean delivery.Revisao bibliografica que descreve as taxas de cesarea em diferentes paises e os modelos de atencao ao parto de acordo com o uso de tecnologias assistenciais. Foram analisados 60 estudos publicados entre 1999 e 2010, obtidos nas bases de dados da Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior e ProQuest. O modelo de assistencia obstetrica praticado no pais baseia-se na relacao medico-paciente, ao grau de utilizacao de tecnologias e a realizacao do parto cesareo. Revision bibliografica que describe las tasas de cesarea en diferentes paises y los modelos de atencion al parto de acuerdo con el uso de tecnologias asistenciales. Se analizaron 60 estudios publicados entre 1999 y 2010, obtenidos en las bases de datos de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior do Brasil y ProQuest. El modelo de asistencia obstetrica practicado en Brasil es embasado en la relacion medico-paciente, con el grado de utilizacion de tecnologias y con la realizacion del parto por cesarea.Revision bibliografica que describe las tasas de cesarea en diferentes paises y los modelos de atencion al parto de acuerdo con el uso de tecnologias asistenciales. Se analizaron 60 estudios publicados entre 1999 y 2010, obtenidos en las bases de datos de la Coordenacao de Aperfeicoamento de Pessoal de Nivel Superior do Brasil y ProQuest. El modelo de asistencia obstetrica practicado en Brasil es embasado en la relacion medico-paciente, con el grado de utilizacion de tecnologias y con la realizacion del parto por cesarea.

Desenvolvimento de recursos humanos, gerência de qualidade e cultura das organizações de saúde

TQM - Total Quality Management - is new to Brazilian health organizations. It is important to try to highlight its feasibility and its boundaries within the sector. It is also necessary to point out the strong relationship between TQM, organizational culture and human resources development, as well as the need for new parameters related to throughputs and outcomes. There are still more doubts than actual knowledge related to the ongoing Brazilian experiences in the field.

Análise do desempenho econômico-financeiro de empresas de saúde

The aim of this paper is to evaluate the economic a nd financial performance, and particularly the retu rn on investment, of companies operating in the health se ctor, by comparing hospitals, health plan operators and businesses in general. The data used was taken from financial sta tements for the year 2006, as compiled by Gazeta Me rcantil’s publication, ‘Annual Report 2007’. Data were compar ed using the non-parametric median and chi square t ests. When the largest companies in each category are compared, th ere are no statistically significant differences in their returns on total assets. The largest hospitals and health plan opera tors were equally profitable, but less profitable t han business in general. Hospitals had a bigger earnings before interest, ta xes, depreciation, and amortization (EBITDA) but gr ew less than operators in 2006. The conclusion reached is that t e return on investment of hospitals with large rev enues does not seem to differ significantly from that of other companies i n the economy. It was also observed that there is n o ignificant difference between for-profit or not-for-profit hospitals, wit h respect to their EBITDA margin, net margin and re tu n on total assets.